Treatment Of Otitis Media Research Articles

Circ_KATNAL1 promotes the inflammation and apoptosis in human middle ear epithelial cells induced by lipopolysaccharide by regulating the miR-153-3p / TLR4 axis.

The purpose of this experiment was to explore the effects and mechanism of circ_KATNAL1 on inflammatory injury and apoptosis of human middle ear epithelial cells (HMEECs) induced by lipopolysaccharide (LPS). For this aim, the cell inflammatory injury model was established by HMEECs cells induced by LPS. It was divided into a blank control, model, circ_KATNAL1 and circ_KATNAL1 + LPS groups. The cell viability was detected by the MTT method. The apoptosis rate of each group was detected by flow cytometry. The cell migration ability of each group was detected by cell scratch assay. The mRNA expression levels of miR-153-3p and TLR4 in the cells of each group were detected by RT -PCR method. The protein expressions of BCL-2 and TLR4 in the cells of each group were detected by WB method. The levels of IL-6 and TNF-α were detected by ELISA method. Results showed that compared with the control group, the cell viability in the model group was decreased, the cell apoptosis rate was increased, the cell migration ability was weakened, the mRNA expression level of miR-153-3p and protein expression level of BCL-2 in the cells were decreased, and the mRNA and protein expression levels of TLR4 were increased and the levels of IL-6 and TNF-α in the cell supernatant were increased. Compared with the model group, the cell viability in the circ_KATNAL1 group was increased, the cell apoptosis rate was decreased, and the cell migration ability was increased, the mRNA expression level of miR-153-3p and BCL-2 protein expression level in the cells were increased, the mRNA and protein expression levels of TLR4 were decreased, and the contents of IL-6 and TNF-α in the cell supernatant were decreased. Compared with the model group, the cell viability in the circ_KATNAL1 + LPS group was decreased, cell apoptosis rate was increased, cell migration ability was weakened, the mRNA expression level of miR-153-3p and protein expression level of BCL-2 in cells were decreased, mRNA and protein expression levels of TLR4 were increased, and the content of IL-6 and TNF-α in the cell supernatant were increased. The differences were all statistically significant (P ﹤0.05). It showed that LPS could promote cell injury by increasing inflammatory cell pyroptosis, and the abnormal expression of circ_KATNAL1 played an important role in cell inflammation induced by LPS. Up-regulation of circ_KATNAL1 could promote inflammatory pyroptosis in HMEECs induced by LPS. miR-153-5p and TLR4 were downstream targets of circ_KATNAL1. The inhibition of miR- 153-5p or up-regulation of TLR4 could reverse the protective effects of silencing circ_KATNAL1. In conclusion, circ_KATNAL1 can promote an inflammatory role in human middle ear epithelial cells through the miR- 31-5p / TLR4 axis, which may become an important target for the diagnosis and treatment of otitis media.

Bacteriostatic effect of Ag@TiO2-Poly(p-dioxanone)-coated gauzes in vitro and in vivo on otitis media pathogens

The application of packing agents affects the final surgical outcomes in treating otitis media (OM) and introduces the risk of infection. To decrease the infectious risks of packing agents and even introduce positive bacteriostatic functions, a kind of PPDO-grafted Ag-incorporated TiO2 nanoparticles (Ag@TiO2-PPDO NP)-coated gauzes were prepared by a solution immersion method. Morphologies and in vitro Ag+ releasing of Ag@TiO2-PPDO NP coated gauzes were determined by scanning electron microscope (SEM) and inductively coupled plasma-mass spectrum (ICP-Ms). Ag@TiO2-PPDO NP could respond to visible light, which might make Ag@TiO2-PPDO NP inhibit the proliferation of bacteria continually and positively with irradiation of visible light. Then the bacteriostatic effects of these gauzes on OM pathogens were investigated in vitro and in vivo. These gauzes could inhibit the proliferation of pathogenic Staphylococcus aureus (S. aureus) and Streptococcus pneumoniae (S. pneumoniae) in vitro and rat subcutaneous infection models. Specifically, the bacteriostatic effect of these gauzes on S. aureus and S. pneumoniae could be enhanced with irradiation by visible light in vitro. Further, the rat external auditory canal infection model verified the enhanced bacteriostatic effect of Ag@TiO2-PPDO-coated gauzes on S. aureus with irradiation by visible light. The Ag@TiO2-PPDO-coated gauzes are promising for packing materials after OM surgery and could reduce postoperative antibiotic requirements.

The 2022 to 2023 Amoxicillin Shortage and Acute Otitis Media Treatment.

The 2022 to 2023 Amoxicillin Shortage and Acute Otitis Media Treatment.

Prevalence and Antibiotic-Resistance Indices of Bacterial Pathogens of Otitis Media among Patients Attending a Tertiary Hospital in Calabar, Nigeria

Background: Otitis media is linked to middle ear inflammation and sequelae, frequently occurring in infants and early childhood dealing with the accumulation of fluid behind the eardrum. It is often associated with the absence of timely and appropriate antibacterial interventions.
 Aim: To investigate the identity and antibiogram of bacterial agents of otitis media among patients attending a tertiary health facility in Calabar, Nigeria.
 Methods: Ear specimens collected from a total of 70 subjects were processed by conventional bacteriological methods for isolation and identification of pathogens. Antibiotic susceptibility testing was carried out on all the isolates using the Kirby-Bauer disk diffusion method. Multiple antibiotic resistance (MAR) indices of the isolates were evaluated.
 Results: The prevalence of bacterial otitis media was 72.9% in the study population. A total of 51 bacterial isolates including Pseudomonas aeruginaosa (26), Staphylococcus aureus (17), Proteus mirabilis (6), and Klebsiella pneumoniae (2) were found. Isolates of P. aeruginosa and S. aureus showed high susceptibility to amoxicillin-clavulanate (92.3%) and ciprofloxacin (88.3%), respectively. The prevalence of multidrug resistant (MDR) isolates was 25.4%. MDR percentages such as 100%, 33.3%, 30.7% and 29.4% were reported for isolates of K. pneumoniae, P. mirabilis, P. aeruginosa and S. aureus respectively. MAR indexing revealed high values ranging from 0.4 to 0.87 for all the isolates.
 Conclusion: High susceptibility of the predominant isolates to amoxicillin-clavulanate and ciprofloxacin may underscore the drugs’ potential as antibiotics of choice for prompt treatment of otitis media in the population. However, the overall high drug-resistance indices of the isolates would suggest dire implications for empiric antibacterial therapy in the population. Choice of antibiotics for treatment of bacterial infections in this population should be driven by results of microbiological drug-susceptibility tests.

Dynamic Microscopic Optical Coherence Tomography as a New Diagnostic Tool for Otitis Media

Hypothesis: Otitis media (OM) can be successfully visualized and diagnosed by dynamic microscopic optical coherence tomography (dmOCT). Background: OM is one of the most common infectious diseases and, according to the WHO, one of the leading health problems with high mortality in developing countries. Despite intensive research, the only definitive treatment of therapy-refractory OM for decades has been the surgical removal of inflamed tissue. Thereby, the intra-operative diagnosis is limited to the surgeon’s visual impression. Supportive imaging modalities have been little explored and have not found their way into clinical application. Finding imaging techniques capable of identifying inflamed tissue intraoperatively, therefore, is of significant clinical relevance. Methods: This work investigated a modified version of optical coherence tomography with a microscopic resolution (mOCT) regarding its ability to differentiate between healthy and inflamed tissue. Despite its high resolution, the differentiation of single cells with mOCT is often impossible. A new form of mOCT termed dynamic mOCT (dmOCT) achieves cellular contrast using micro-movements within cells based on their metabolism. It was used in this study to establish correlative measurements with histology. Results: Using dmOCT, images with microscopic resolution were acquired on ex vivo tissue samples of chronic otitis media and cholesteatoma. Imaging with dmOCT allowed the visualization of specific and characteristic cellular and subcellular structures in the cross-sectional images, which can be identified only to a limited extent in native mOCT. Conclusion: We demonstrated for the first time a new marker-free visualization in otitis media based on intracellular motion using dmOCT.

Malignant Melanoma of the Middle Ear: Case Report.

We present a case of malignant melanoma in the middle ear in a 63-year-old woman who presented with severe pain on the right side of her face and head, tinnitus, photophobia, and hemorrhagic discharge from the right ear, as well as right facial nerve paralysis. After more than two years of conservative treatment for otitis media and sclerotic mastoiditis, a pathologically enlarged lymph node on the right side of the neck appears. It is removed, and the histopathological examination reveals that it is metastatic malignant melanoma. Imaging examinations reveal a tumoral lesion in the middle ear with bone infiltration. The right middle ear is operated on, and the tissue sent for testing reveals melanoma. The patient was treated with Nivolumab after the operation and is now in sustainably good condition.

Standing surgical procedure for treatment of otitis media in a horse

SummaryA 13‐year‐old Appaloosa gelding was referred for evaluation of a left‐sided facial nerve paralysis. On clinical examination, the gelding exhibited muzzle deviation to the right, dropped left ear and blepharospasm of the left eye. A Schirmer tear test revealed 66% reduction in tear production in the left eye and a focal corneal ulcer (0.7 cm by 0.7 cm) was present ventrally in the left eye. Endoscopic examination of the upper airways and guttural pouches showed no abnormalities. Computed tomographic examination revealed an accumulation of soft‐tissue attenuating material within the tympanic bulla, consistent with otitis media. Medical management with 30 mg/kg trimethoprim sulfadiazine and 2.2 mg/kg phenylbutazone orally twice a day for 6 weeks was unsuccessful. The non‐perforated tympanic bulla was fenestrated from the left guttural pouch using diode LASER transendoscopically, under standing sedation, to allow drainage of the inner ear. Mucopurulent fluid drained from the tympanic bulla cavity. Endoscopic examination 6 months post‐surgery showed that the fenestrated site had healed over, with no evidence of inflammation at the site. A very mild muzzle deviation to the right was still present 6 months' post surgery but the horse was able to prehend and masticate without difficulty. The procedure was successful, and the clinical signs improved significantly post‐surgery.

Surgery for Otitis Media with Effusion: A Survey of Otolaryngologists Who Treat Children in Brazil.

Introduction Myringotomy and ear tube placement (MTP) is the surgical treatment for otitis media with effusion (OME), and it is the most common surgery performed in children. Several guidelines have been developed to assist in the care of patients who become candidates for MTP. Objectives To evaluate the practice of Brazilian otorhinolarynogologists when performing MTP according to the years of clinical experience. Secondarily, we also want to assess if their practice regarding MTP varied according to the percentage of children treated and the location of their practice. Methods A 30-question survey was sent to otolaryngologists affiliated with the Brazilian Academy of Pediatric Otorhinolaryngology (Academia Brasileira de Otorrinolaringologia Pediátrica, ABOPe, in Portuguese) and/or the Scientific Department of Otorhinolaryngology of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP, in Portuguese). The questions included were carefully chosen to provide a profile about the practices adopted in the pre-, peri- and postoperative periods of MTP. Results The questionnaire was sent to 208 otolaryngologists, and there were 124 (59.6%) respondents. Of those, 59.7% use antiseptics before surgery. Only 54 otolaryngologists, less than half of the subjects in this study (43.5%), always place a tube during the procedure. More physicians who practice in small cities recommend water precautions after MTP when compared to other physicians ( p < 0.001). Conclusion The present study reveals that many respondents do not follow some of the recommendations of the current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) on OME, either perioperatively and postoperatively, or regarding the option of placing a ventilation tube. This part of the care also varied depending on the respondents' work location and experience in the medical practice.

Can non-typeable Haemophilus influenzae carriage surveillance data infer antimicrobial resistance associated with otitis media?

In remote communities of the Northern Territory, Australia, children experience high rates of otitis media (OM), commonly caused by non-typeable Haemophilus influenzae (NTHi). Few data exist on antibiotic susceptibility of NTHi from OM. To determine whether population-level nasopharyngeal NTHi antibiotic susceptibility data could inform antibiotic treatment for OM. NTHi isolates (n=92) collected from ear discharge between 2003 and 2013 were selected to time- and age-match NTHi isolates from the nasopharyngeal carriage (n=95). Antimicrobial susceptibility were tested. Phylogenomic trees and a genome-wide association study (GWAS) were performed to determine the similarity of nasopharyngeal and ear isolates at a population level. Among 174 NTHi isolates available for antimicrobial susceptibility testing, 10.3% (18/174) were resistant to ampicillin and 9.2% (16/174) were resistant to trimethoprim-sulfamethoxazole. Small numbers of isolates (≤3) were resistant to tetracycline, chloramphenicol, or amoxicillin-clavulanic acid. There was no statistical difference in the proportion of ampicillin-resistant (P=0.11) or trimethoprim-sulfamethoxazole-resistant isolates (P=0.70) between ear discharge and nasopharynx-derived NTHi isolates. Three multi-drug resistant NTHi isolates were identified. Phylogenomic trees showed no clustering of 187 Haemophilus influenzae isolates based on anatomical niche (nasopharynx or ear discharge), and no genetic variations that distinguished NTHi derived from ear discharge and nasopharyngeal carriage were evident in the GWAS. In this population-level study, nasopharyngeal and ear discharge isolates did not represent distinct microbial populations. These results support tracking of population-level nasopharyngeal NTHi antibiotic resistance patterns to inform clinical management of OM in this population.

Evaluation of Temporal Bone Infections - Comparing Sensitivity of Multiplex Assay to Standard Bacterial Culture

Background: The multiplex assay is a nucleus acid/base assay that can detect a wide array of distinct nucleic acid sequences from different pathogens. This study hopes to show the necessity and utility of this technology in detecting pathogens that cause middle ear infections. Methods: This observational study was conducted from May 2021-July 2022 to assess the sensitivity of a multiplex assay in a microfluidics pouch in the detection of bacterial and viral pathogens in middle ear fluids. Standard bacterial culture was used as a control. Middle ear fluid was obtained from 98 pediatric patients undergoing tympanostomy to treat otitis media. The BioFire PNA panel was used, which detects bacterial, viral, drug resistance, and atypical bacterial nucleic acid targets. Patient demographics, past medical history, and otitis media risk factors were also recorded.&#x0D; Results: A total of 107 ear samples were assessed from 98 patients. The average age of study subjects was 3.53 ± 2.99 years. The population of this study was 61.22% male, 75.51% Caucasian, 22.44% African American, and 2.04% Other, 88.78% Non-Hispanic, 10.2% Hispanic, and 1.02% Unknown. We found that Haemophilus influenzae was she most common pathogen detected (multiplex; culture) - (34.58%; 14.02%), followed by Moraxella catarrhalis (10.28%; 4.67%), Streptococcus pneumoniae (6.54%; 2.80%), Staphylococcus aureus (1.5%; 5.61%), and Proteus spp. (.94%; 0%). All bacteria, except Staphylococcus aureus were identified in more ear specimens by multiplex testing than bacterial culture.&#x0D; Conclusion: Our study demonstrates that multiplex testing is more sensitive than culture in identification of pathogens in middle ear fluid from patients undergoing tympanostomy for treatment of otitis media. The increased sensitivity for bacterial identification and simultaneous detection of viral targets in a very limited patient specimen make the multiplex assay a novel diagnostic tool which may be useful in the management of patients with otitis media in the future.

Is Mometasone Effective in Treating Otitis Media with Effusion?

Otitis media with effusion (OME) is the long-term deposition of mucus in the middle ear cleft. It is the leading cause of childhood hearing loss and a common childhood infection. It can impair communication and life quality. OME's direct and indirect costs are also crucial. Improving OME care is crucial. This study examines intranasal mometasone's efficacy in treating otitis media with effusion. A clinical trial study was conducted during a period from January 2021 to June 2022. It included 80 patients suffering from otitis media with effusion bilaterally (160 ears) who had an intact tympanic membrane and tympanometry type B. These patients were included only if they had a hearing change or loss noted by the parents or by the patient if he or she could complain for three months or more. These patients were split into two groups. Group A had 80 ears (40 patients) who got one puff of mometasone furoate nasal spray in each nostril every day for three months, and Group B had 80 ears (40 patients) who got one puff of seawater nasal spray in each nostril every day for the same period. On the first visit, otoscopic findings were recorded, and all patients had pure-tone audiometry and tympanometry performed. All of the above-mentioned measures were repeated and compared to the records from the first visit at the end of the three months of treatment. After treatment, 75% of ears in Group A changed from type B to type A tympanometry. This was significantly higher than in Group B, where only 15% of ears changed from type B to type A tympanometry. Regarding retraction, 75% of ears in Group A showed no retraction after treatment with mometasone furoate, while in Group B, it was 40%. The average pure-tone audiometry score in Group A improved after therapy. Corticosteroids are effective in the treatment of otitis media with effusion and safer when used as topical intranasal steroids than systemic preparations.

Efficacy and safety of 1.5% levofloxacin otic solution for the treatment of otitis media in a multicenter, randomized, double-blind, parallel-group, placebo-controlled, phase III study

ObjectiveThe present study aimed to evaluate the efficacy and safety of 1.5% levofloxacin (LVFX) otic solution for the treatment of patients with otitis media. MethodsThis multicenter, randomized, double-blind, parallel-group, placebo-controlled phase 3 trial was conducted at 34 institutions in Japan. A total of 202 patients with chronic suppurative otitis media (CSOM) or acute otitis media (AOM) were randomized into either the LVFX group or placebo group. A total of 6–10 drops of 1.5% otic solution of LVFX or its matching placebo were administered in the diseased ear twice daily, in the morning and evening for up to 10 days. Images corresponding to three clinical findings—purulent otorrhea, hyperemia (redness), and granulation tissue formation in the middle ear and tympanic membrane—for each diseased ear were evaluated using digital endoscopy by a blinded central independent review committee (BICRC) at each visit after treatment administration. ResultsIn total, the data of 201 participants (LVFX group, 99; placebo group, 102) were analyzed. The proportion of patients with disappearance (improvement rate) of all three clinical findings at the end of treatment or discontinuation by the BICRC was 46.5% (46/99) in the LVFX group and 23.5% (24/102) in the placebo group, and the difference (95% confidence interval) between the groups was 22.0% (8.7, 34.2), with a significantly higher improvement rate in the LVFX group than in the placebo group (p = 0.001; Cochran–Mantel–Haenszel test), demonstrating the efficacy of LVFX. The bacterial eradication rates were 93.9% (77/82) and 12.5% (11/88) in the LVFX and placebo groups, respectively, and the rate was significantly higher in the LVFX group than in the placebo group (p < 0.001). Treatment-related adverse events (AEs) occurred in 5.1% (5/99) and 7.8% (8/102) of the patients in the LVFX and placebo groups, respectively, and no significant difference was noted in incidence rate between the groups. ConclusionThe clinical efficacy of 1.5% LVFX otic solution for CSOM and AOM was demonstrated by the resolution of inflammation in the middle ear and tympanic membrane as well as through the high bacterial eradication rate observed. No deaths or serious treatment-related AEs were observed. The study provided confirmation that 1.5% LVFX otic solution is a safe, well-tolerated, and effective treatment for CSOM and AOM.

Efficacy of bioregulative drugs in the treatment of otitis media with effusion associated with rhinosinusitis and adenoiditis

Improving of otitis media with effusion (OME) with rhinosinusitis (RS) and adenoiditis treatment effectiveness. The study included 112 patients 12-18 y.o. with otitis media with effusion, who were divided into 2 groups depending on the treatment scheme. The Group I (the main group) patients treatment included Traumeel S and Euphorbium compositum Nasentropfen S in addition to the standard treatment, and the Group II (comparison), children were prescribed standard therapy. Patients of both groups were divided into 3 subgroups depending on the upper respiratory tract inflammation symptoms: A - patients with adenoiditis; B - with rhinosinusitis and C - combination of adenoiditis and rhinosinusitis. The comparison group (groups IIB and IIC) treatment scheme (children with rhinosinusitis) included topical corticosteroids and the main group patients didn't receive corticosteroids. All patients went through complaints and anamnesis collection, routine otorhinolaryngological and instrumental examination before and after treatment. Analysis of treatment results demonstrated high efficacy of multicomponent drugs with low doses of active ingredients in the therapy of patients with OME, regardless of comorbid pathology. Significantly better results were obtained in the patients treated with bioregulatory drugs when comparing the outcomes of OME therapy in combination with adenoiditis (groups IA and IIA). Comparable efficacy results were obtained in the treatment group of patients with OME associated with RS (in groups IB and IIB as well as in groups IC and IIC), where GCS was received in the comparison group. The high efficacy and safety of bioregulatory drugs makes the use of these agents a promising treatment for patients with OME, RS and adenoiditis.

Assessment of Grommet Tube Insertion versus Myringotomy with Intratympanic Steroid Injection in Treatment of Otitis Media with Effusion

Assessment of Grommet Tube Insertion versus Myringotomy with Intratympanic Steroid Injection in Treatment of Otitis Media with Effusion

Audiologic Measures in an Indigenous Community with A2ML1- and FUT2-Related Otitis Media.

Background: Many indigenous peoples are at elevated risk for otitis media, however there is limited information on hearing loss due to OM in these communities. An Indigenous Filipino community that has previously been described with an elevated prevalence of OM that is due to rare A2ML1 variants and a common FUT2 variant underwent additional phenological testing. In this study, we describe the audiologic profiles in A2ML1- and FUT2-related otitis media and the validity of otoscopy and genotyping for A2ML1 and FUT2 variants in screening for otitis media and hearing loss. Method: We analyzed A2ML1 and FUT2 genotypes together with demographic, otologic and audiologic data from tympanometry and hearing level assessments of 109 indigenous individuals. Results: We confirmed previous findings of a spectrum of nonsyndromic otitis media as associated with A2ML1 variants. A2ML1 and FUT2 variants were associated with high-frequency hearing loss at 4000 Hz. As expected, young age was associated with flat tympanograms, and eardrum perforations due to chronic otitis media were associated with severe-to-profound hearing loss across frequencies. Adding A2ML1 or FUT2 genotypes improved the validity of otoscopy as a screening test to rule out moderate-to-profound hearing loss. Conclusion: Continued multi-disciplinary management and audiologic follow-up using tympanometry and screening audiometry are needed to document and treat otitis media and prevent permanent hearing loss in the indigenous community.

Medical treatment of otitis media with effusion using fluticasone propionate nasal spray

Objective: To determine how well fluticasone propionate aqueous nasal spray worked to reduce fluid buildup in the middle ear, a condition known as middle ear effusion. Methodology: This comparative interventional clinical study involving 70 patients with otitis media with effusion (OME) was conducted in Al-Sader Medical City in Najaf from December 2020 and January 2022. Participants had their parents' medical history and ENT exam. OME signs. These included child hearing loss and school failure. OME Otoscopy verified. Pure-tone audiometry and tympanometry followed. Group A received 100 micrograms/day (50 per nostril) fluticasone propionate aqueous nasal spray (NSS-nasal steroid spray) for 12 weeks. NS drops for B. All patients received four-week follow-up calls. Each appointment included otoscopy and audiology. Normal otoscope, type A tympanogram, and better hearing resolved OME. Results: Nasal steroids helped 40 (NSS). 35 nasal saline drop (NS) patients were 4–13 years old, averaging 8.2. After 12 weeks, group A patient who used the intranasal steroid spray exhibited a definite subjective hearing improvement, but group B patients who used nasal saline drops did not. 75% of intranasal steroid patients had type A tympanometry curves after three months (p&lt; 0.00001). Group A intra nasal steroid spray decreased PTA from 35 dB to 15 dB. Nasal saline drop patients had 25 dB PTA. Conclusion: One effective therapy for OME is the use of a steroid nasal spray. It's much safer to use now. Research on its long-term and repeated applications is necessary.

Prevalence of Otitis Media in Children and Pattern of Antibiotic Prescription at a Tertiary Hospital in Makkah

Background: Otitis media (OM) is a common inflammatory disease of the middle ear and mostly affects children less than 5 years. It is divided into several disease subcategories: acute otitis media (AOM), recurrent AOM, OM with effusion (OME), and chronic otitis media (COM). This study aims to determine the otitis media and identify the manner of prescribing antibiotics used for the treatment of OM cases in children from 3 months to 5 years old in Hera General hospital in Makkah city. Methods: The samples were retrospectively conducted at a tertiary General Hospital in the western region of Saudi Arabia. 113 records met the inclusion criteria for the study. Data were analyzed using descriptive statistics (percent and frequency). For quantitative data, the chi-square test and mean were used. Results: The number of OM cases was higher in patients aged 3 years old and less among age categories. The percentage of males (54.6%) was higher than females (45.4%). Amoxicillin-clavulanate was the most used treatment of OM in the inpatient ward, outpatient, emergency, and after discharge. The protocol of treatment was mostly by prescribing both antibiotics and analgesics without requesting any further samples to investigate the type of pathogen related to this infection. Cases presented to the emergency department were discharged with an antibiotic prescription without further investigation of the records for previous infection or recurrence. Conclusions: Due to increasing the antibiotics resistance alert around the globe, we believe that OM recurrence could be one of the community-acquired infections that affect the pediatric population and lower the quality of life and need specific attention from a physician who prescribes antibiotics for OM without further investigation.

558. Increasing Safety Net Antibiotic Prescriptions (SNAP) for Acute Otitis Media Treatment in Pediatric Urgent Care Clinics

Abstract Background Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in pediatrics. National guidelines recommend offering a safety net antibiotic prescription (SNAP) to select patients, to be filled if symptoms worsen or do not improve within 48-72 hours. However, clinicians continue to prescribe immediate antibiotics for most cases of AOM. Our goal was to increase the percentage of eligible patients diagnosed with AOM in our pediatric urgent care (PUC) clinics who are offered a SNAP from our baseline of 7.7% to 40% within nine months. Methods A multidisciplinary team of PUC clinicians, an Infectious Diseases physician, and a data analyst, used quality improvement (QI) methodology to identify barriers to offering SNAP (Figure 1). Patients without chronic ear conditions were considered eligible for SNAP if they had no or mild otalgia for &amp;lt; 48 hours, fever &amp;lt; 39oC, no otorrhea, and for patients ≤ 24 months old, if they had only unilateral AOM. We analyzed all encounters of patients ≥ 6 months old with a discharge diagnosis of AOM from three PUC clinics during baseline (October 2020 – September 2021) and study (October 2021 – March 2022) periods. Interventions included clinician education, standardized discharge instructions, electronic health record updates to improve documentation, and educational flyers for clinicians and families. Our outcome measure was the percentage of eligible encounters during which SNAP was offered. Our process measure was the percentage of AOM encounters in which SNAP eligibility was documented. Our balancing measure was the percentage of patients returning with AOM symptoms within 14 days. Results We reviewed 12,502 encounters from October 2020 through March 2022. At baseline, clinicians documented SNAP eligibility in 5.5% of AOM encounters and offered SNAP to 7.7% of eligible patients. By March 2022, clinicians documented SNAP eligibility in 58.9% of AOM encounters and offered SNAP to 40.7% of eligible patients (Figure 2). There was no change in our balancing measure. UCL: Upper control limit. LCL: Lower control limit. Conclusion Using QI methodology, we increased the percentage of eligible patients with AOM who were offered SNAP, reducing antibiotic exposure in PUC clinics. Efforts are ongoing to further improve this process. Disclosures Brian R. Lee, PhD, MPH, CDC: Grant/Research Support|Merck: Grant/Research Support.

Nano-silver composite antibacterial gel in the treatment of otitis media

Nano-silver composite antibacterial gel in the treatment of otitis media

Association Between Social Disadvantage and Otitis Media Treatment in US Children With Commercial Insurance

It is well established that social disadvantage is associated with earlier, more frequent, and more severe otitis media in children. Appropriate medical and surgical treatment of otitis media can prevent hearing loss and other complications, which may affect future academic and employment opportunities in socially disadvantaged populations. Clinical treatment patterns for otitis media in the US are unclear. To describe and quantify social disparities in the treatment patterns of otitis media in children in the US. This cross-sectional study included claims data from the Optum Clinformatics Data Mart Database between January 1, 2003, and March 31, 2021, with linked inpatient, outpatient, and pharmaceutical claims for 4 831 408 children with otitis media. Age at first otitis media diagnosis, sex, environmental allergies, gastroesophageal reflux, adenotonsillar hyperplasia, zip code, social deprivation index score, social vulnerability index score. Treatment of recurrent and suppurative otitis media in children, insertion of tympanostomy tubes, and treatment for severe complications of undertreated otitis media. The principal measure of social disadvantage was the social deprivation index. The social vulnerability index was used for sensitivity analyses to ensure external validity. Multiple logistic regression analyses were used to quantify the association of all projected variables with the study outcomes. Among 4 831 408 US children with otitis media (median [IQR] age, 4 [1-8] years; 2 491 557 boys [51.57%]), 994 921 (20.59%) were treated for recurrent otitis media, 717 978 (14.86%) were treated for suppurative otitis media, 335 949 (6.95%) received tympanostomy tubes, and 10 975 (0.23%) had severe complications of otitis media. In multivariable regression models including patient factors and social indices, earlier age at diagnosis, male sex, environmental allergies, gastroesophageal reflux, and adenotonsillar hyperplasia were associated with increased treatment for otitis media, whereas social deprivation index was associated with lower odds of medical treatment for recurrent otitis media (odds ratio [OR], 0.86; 95% CI, 0.85-0.87), suppurative otitis media (OR, 0.61; 95% CI, 0.60-0.62), and insertion of tympanostomy tubes (OR, 0.76; 95% CI, 0.75-0.78) but higher odds of having severe complications (OR, 1.28; 95% CI, 1.19-1.37). The findings of this cross-sectional study suggest that children with otitis media who were socially disadvantaged were less likely to receive treatment and more likely to experience complications for undertreated otitis media. As otitis media is a modifiable risk factor for hearing loss, efforts need to be made to ensure equitable access to treatment for all children.