Risk Factors For Acute Otitis Media Research Articles

Middle ear disease in CF? It's not just about the sinuses anymore!

IntroductionHistorically cystic fibrosis (CF), in contrast to primary ciliary dyskinesia (PCD), has been considered protective of the middle ear from otitis media and rarely were such patients “severely affected” to require tympanostomy tube placement (BMT). Previously the Pittsburgh Otitis Media Research group reported a 10% prevalence of otitis media in the pediatric CF population which is significantly lower than age matched non-CF children. We studied the prevalence of OM in pediatric CF patients to assess if the otologic phenotype has changed in parallel with changes in the diagnosis itself. MethodsThe medical records of 133 CF patients seen either inpatient or outpatient from one of the largest tertiary pediatric CF centers in the world from 2010 to 2019 were reviewed for demographics, acute otitis media (AOM) episodes, risk factors for AOM, placement of myringotomy tubes, genotype, BMI, pancreatic status, respiratory culture results, and pulmonary exacerbations. ResultsJust over half (52.6%) the patients were male. A median age for CF diagnosis was 11 days old (range 0 days–16 years). The most common genotype (49.6%) was homozygous for ΔF508 mutation. Fifty-five (41.4%) patients had 1-2 episodes of AOM, and 15 (11.3%) were severely affected (i.e. ≥3 episodes/6 months or ≥4 episodes/year). COME was diagnosed in 4 (3.0%) of the patients. Twelve (9.0%) patients had tympanostomy tubes at least once, including 3 patients with multiple sets of tubes. Having at least one AOM episode was not predicted by genetic mutation groups, BMI, age at diagnosis, or comorbidities, p > .05. ConclusionsThe time-honored adage of CF protecting against otitis media is no longer true and pediatric otolaryngologists must now prioritize the management of middle ear disease as highly as sino-nasal and pulmonary disease. Future study into mechanisms explaining the change is needed.

Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era.

To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era. Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006-June 2016). All clinical diagnoses of AOM were confirmed by tympanocentesis and bacterial culture of middle ear fluid. By 1 year of age, 23% of the children experienced ≥1 episode of AOM; by 3 years of age, 60% had ≥1 episodes of AOM, and 24% had ≥3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis causing AOM had dynamic changes during the past decade. We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.

Individual-level effects of antibiotics on colonizing otitis pathogens in the nasopharynx

BackgroundAlthough there is evidence of an association between antibiotic consumption and resistant bacteria on a population level, the relationship on an individual level has been less well studied, particularly in terms of nasopharyngeal colonization. We have therefore analysed this association, using data from a closely followed cohort of children taking part in a vaccination trial. Methods109 children with early onset of acute otitis media (AOM) were randomised to heptavalent pneumococcal conjugate vaccine (PCV7) or no vaccination. They were followed for three years with scheduled appointments as well as sick visits. Nasopharyngeal cultures were obtained at all visits. Antibiotic treatments were recorded, as were risk factors for AOM, including siblings, short breast-feeding and parental smoking. Data were entered into a Cox regression model, and the findings of Streptococcus pneumoniae and Haemophilus influenzae with reduced susceptibility to the penicillin group were related to the number of previous courses of antibiotics. ResultsThere was evidence of an association between the amount of previously consumed betalactams and colonization with beta-lactamasenegative ampicillin-resistant (BLNAR) H. influenzae (RR 1.21; 95% CI 1.03–1.43; p = 0.03), and also with the most commonly prescribed drug; amoxicillin (RR 1.39; 95% CI 1.09–1.76; p = 0.01). There was no evidence for an association between antibiotic consumption and betalactamase producing H. influenzae or S. pneumoniae with reduced susceptibility to penicillin. Furthermore, there was no evidence of an association between resistant bacteria and AOM risk factors or PCV7. ConclusionIn this subgroup of children, most of whom were given several courses of antibiotics in early childhood, there was evidence of an association between betalactam/amoxicillin consumption and nasopharyngeal colonization with BLNAR strains, bacteria that have increased in prevalence during the last 10–15 years, and that are notoriously difficult to treat with oral antibiotics.

Risk Factors for Acute Otitis Media in Children Aged 0 to 5 Years in Parakou

Introduction: Acute otitis media (AOM) is one of the most common ENT childhood diseases. Objective: To identify risk factors for AOM in children aged 0 to 5 years. Methods: This research work was a cross-sectional, descriptive and analytical study. It focused on 2040 children aged 0 to 5 years from both sexes, who were healthy or sick, and living in the Local government of Parakou for at least one year. Those children were randomly selected in all three districts of Parakou. Results: Frequency of AOM was 2.8% and their prevalence was estimated at 16.3%. The identified risk factors were persistent or chronic cases of rhinitis, exposure to charcoal and wood smoke, low socioeconomic status, personal history of AOM, AOM history among the siblings, and children’s poor nutritional status. No relationship could be established between AOM occurrence and factors like sex, passive smoking, attendance of a day-care centre or stay in nursery, prematurity, exclusive breastfeeding and large number of siblings. Conclusion: The identification of those risk factors will help put in place appropriate measures to reduce AOM prevalence in Parakou.

Study of Effect of Household Parental Smoking on Development of Acute Otitis Media in Children Under 12 Years.

Background and Aim:High prevalence of acute otitis media (AOM) in children represents a combination of the factors developing eustachian tube dysfunction and higher susceptibility to upper respiratory tract infections in children. This disease is relatively prevalent in Iran and much cost is spent annually to treat it. This study investigated the effect of household parental smoking on development of AOM in children under 12 years.Methods:In this case-control study all patients under the age of 12 years with AOM referring an ENT clinic in Shahrekord, southwest Iran between April 2014 and August 2014 were enrolled by convenience sampling. This study included two groups. Group 1 (G1) was exposed to parental smoking at home and group 2 (G2) was not. For the patients, a questionnaire of demographic data such as age and gender, the disease symptoms, parents’ education level, history of respiratory diseases, allergy, surgery (adenoidectomy, tonsillectomy, and tympanostomy), and household smoking was filled out by a specialist through interview.Results:In this study, 250 children 1-12 years with AOM, 145 in G1 and 105 in G2, were investigated. Clinical symptoms including fever (p=0.001) and hearing loss (p=0.014) were significantly more frequent in the children of G1 than G2, and otalgia, discharge, and tinnitus were similarly frequent in the two groups (p>0.05). Also, eardrum inflammation was more frequent in G1 than G2, with no significant difference (p>0.05). AOM was reported 70.3% in G1, which was higher than 26.7% reported in G2 (p=0.001). Also, asthma, recurrent ear pain, enlargement of the tonsils, and respiratory problems were more frequent in G1 than G2 (p<0.05).Conclusions:Parental smoking was a risk factor for AOM and respiratory problems and therefore the parents are recommended to avoid smoking near children to reduce the likelihood of AOM development and exacerbation in children.

Suture restriction of the temporal bone as a risk factor for acute otitis media in children: cohort study.

BackgroundEustachian tube (ET) dysfunction plays an important role in the pathogenesis of acute otitis media (AOM). Unfortunately, there is a lack of knowledge about the exact role of the ET’s bony support, the temporal bone, on occurrence of AOM. This study investigates whether severe suture restriction of the temporal bone is a risk factor for development of AOM in young children.MethodsUsing a prospective cohort design, 64 children aged 6 to 18 months without prior history of AOM were followed during the cold season (September 2009 to April 2010). Temporal bone status (categorized as with or without severe suture restriction) was evaluated using palpation and a cranial bone mobility test. Information about potential baseline confounders and risk factors for AOM (gender, age, birth weight, gestational age, use of pacifier, daycare attendance, presence of siblings, low socioeconomic status, breastfeeding ≥ 6 months, parental smoking and history of upper respiratory tract infection) were also collected. Occurrence of AOM diagnosed by physicians blinded to temporal bone status was the main outcome. Data were analyzed using hierarchical linear and nonlinear (multilevel) models.ResultsSevere suture restriction of the temporal bone was identified in 23 children (35.9%). At least one AOM episode was diagnosed in 14 (48.3%) of the ears associated with temporal bones previously identified as having severe suture restriction and in 28 (28.3%) of those without severe suture restriction. Higher risk for AOM was explained by severe suture restriction of the temporal bone (adjusted relative risk (RR), 2.26, 95% CI 1.43 to 2.91, p<.01), pacifier use (RR, 2.59, 95% CI 1.51 to 3.22, p<.01) and younger age (RR, 0.22, 95% CI 0.10 to 0.52, p=.001).ConclusionsThe study results indicate that severe suture restriction of the temporal bone is a risk factor for AOM in young children. Subsequent intervention studies are needed to determine if this mechanical risk factor can be modified in young children.

Viral-Bacterial Interactions and Risk of Acute Otitis Media Complicating Upper Respiratory Tract Infection

Acute otitis media (AOM) is a common complication of upper respiratory tract infection whose pathogenesis involves both viruses and bacteria. We examined risks of acute otitis media associated with specific combinations of respiratory viruses and acute otitis media bacterial pathogens. Data were from a prospective study of children ages 6 to 36 months and included viral and bacterial culture and quantitative PCR for respiratory syncytial virus (RSV), human bocavirus, and human metapneumovirus. Repeated-measure logistic regression was used to assess the relationship between specific viruses, bacteria, and the risk of acute otitis media complicating upper respiratory tract infection. In unadjusted analyses of data from 194 children, adenovirus, bocavirus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were significantly associated with AOM (P < 0.05 by χ(2) test). Children with high respiratory syncytial virus loads (≥3.16 × 10(7) copies/ml) experienced increased acute otitis media risk. Higher viral loads of bocavirus and metapneumovirus were not significantly associated with acute otitis media. In adjusted models controlling for the presence of key viruses, bacteria, and acute otitis media risk factors, acute otitis media risk was independently associated with high RSV viral load with Streptococcus pneumoniae (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.90 and 10.19) and Haemophilus influenzae (OR, 2.04; 95% CI, 1.38 and 3.02). The risk was higher for the presence of bocavirus and H. influenzae together (OR, 3.61; 95% CI, 1.90 and 6.86). Acute otitis media risk differs by the specific viruses and bacteria involved. Acute otitis media prevention efforts should consider methods for reducing infections caused by respiratory syncytial virus, bocavirus, and adenovirus in addition to acute otitis media bacterial pathogens.

Random amplified polymorphic DNA analysis applied to acute otitis media caused by penicillin non-susceptible Streptococcus pneumoniae.

The spread of penicillin non-susceptible Streptococcus pneumoniae (PNSSP) is an emerging problem for the treatment of acute otitis media (AOM). Attendance of children at day care centers, as well as the spread of PNSSP, is a risk factor for AOM. The status of the spread of PNSSP during the acute infection phase of AOM has not been evaluated. We examined the clonality of samples from seven children in a day care center who simultaneously developed AOM caused by PNSSP. The seven isolates from the children, and six control samples were grouped by serotyping, by determining resistance to antimicrobial agents, and by genotyping, carried out by sequencer-based random amplified polymorphic DNA (RAPD), and validated by bootstrap analysis. There was no evidence to indicate the direct dissemination of PNSSP among these patients in the day care center, although the simultaneous occurrence of PNSSP AOM had initially suggested a clonal outbreak. The possible presence of a common ancestral strain suggested the importance of surveillance during the carrier state. The result of RAPD genotyping was highly reproducible, as validated by the high bootstrap score. The use of an automated sequencer, in combination with a careful choice of primers, and commercially established kits, played a significant role in the reproducibility of the studies.