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Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children. Curr Allergy Asthma Rep 2017; 16:72. [PMID: 27613655 DOI: 10.1007/s11882-016-0654-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.
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The Effect of Ventilating Tubes in Young Children with Recurrent Acute Otitis Media: an Update of the Literature. CURRENT OTORHINOLARYNGOLOGY REPORTS 2017. [DOI: 10.1007/s40136-017-0150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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103
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Shaffer AD, Ford MD, Choi SS, Jabbour N. The Impact of Tympanostomy Tubes on Speech and Language Development in Children with Cleft Palate. Otolaryngol Head Neck Surg 2017; 157:504-514. [PMID: 28462671 DOI: 10.1177/0194599817703926] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Describe the impact of hearing loss, tympanostomy tube placement before palatoplasty, and number of tubes received on speech outcomes in children with cleft palate. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Records from 737 children born between April 2005 and April 2015 who underwent palatoplasty at a tertiary children's hospital were reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, sensorineural or mixed hearing loss, no tubes, first tubes after palatoplasty, or first clinic after 12 months of age. Data from 152 patients with isolated cleft palate and 166 patients with cleft lip and palate were analyzed using Wilcoxon rank-sum, χ2, and Fisher exact test and logistic regression. Results Most patients (242, 76.1%) received tubes before palatoplasty. Hearing loss after tubes, but not before, was associated with speech/language delays at 24 months ( P = .005) and language delays ( P = .048) and speech sound production disorders (SSPDs, P = .040) at 5 years. Receiving tubes before palatoplasty was associated with failed newborn hearing screen ( P = .001) and younger age at first posttubes type B tympanogram with normal canal volume ( P = .015). Hearing loss after tubes ( P = .021), language delays ( P = .025), SSPDs ( P = .003), and velopharyngeal insufficiency ( P = .032) at 5 years and speech surgery ( P = .022) were associated with more tubes. Conclusion Continued middle ear disease, reflected by hearing loss and multiple tubes, may impair speech and language development. Inserting tubes before palatoplasty did not mitigate these impairments better than later tube placement.
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Affiliation(s)
- Amber D Shaffer
- 1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Matthew D Ford
- 2 Division of Cleft Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Sukgi S Choi
- 1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Noel Jabbour
- 1 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Ito M, Takahashi H, Iino Y, Kojima H, Hashimoto S, Kamide Y, Kudo F, Kobayashi H, Kuroki H, Nakano A, Hidaka H, Takahashi G, Yoshida H, Nakayama T. Clinical practice guidelines for the diagnosis and management of otitis media with effusion (OME) in children in Japan, 2015. Auris Nasus Larynx 2017; 44:501-508. [PMID: 28473270 DOI: 10.1016/j.anl.2017.03.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/23/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To (1) indicate the definition, the disease state, methods of diagnosis, and testing for otitis media with effusion (OME) in childhood (<12 years); and (2) recommend methods of treatment in accordance with the evidence-based consensus reached by the Subcommittee of Clinical Practice Guideline for Diagnosis and Management of OME in Children. METHODS We produced Clinical Questions (CQs) concerning the treatment of OME and searched the literature published until April 2014 according to each theme including CQ, the definition, the disease state, the method of diagnosis, and examination. The recommendations are based on the results of the literature review and the expert opinion of the Subcommittee. RESULTS Because children with Down's syndrome and cleft palate are susceptible to OME, we categorized OME into low-risk and high-risk groups (e.g., Down's syndrome and cleft palate), and recommended the appropriate treatment for each group. CONCLUSION In the clinical management of OME in children, Japanese Clinical Practice Guidelines recommend management not only of OME itself, such as effusion in the middle ear and pathological changes in the tympanic membrane, but also pathological abnormality in surrounding organs, such as infectious or inflammatory diseases.
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Affiliation(s)
- Makoto Ito
- Department of Pediatric Otolaryngology, Jichi Children's Medical Center Tochigi, Jichi Medical University, Tochigi, 329-0498, Japan.
| | - Haruo Takahashi
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Japan
| | - Sho Hashimoto
- Department of Otorhinolaryngology, National Sendai Medical Center, Japan
| | | | - Fumiyo Kudo
- Department of Nutrition, Faculty of Health Care Science, Chiba Prefectural University of Health Sciences, Japan
| | - Hitome Kobayashi
- Department of Otorhinolaryngology, Showa University School of Medicine, Japan
| | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Japan
| | - Hiroshi Hidaka
- Department of Otorhinolaryngology, Head and Neck Surgery, Tohoku University School of Medicine, Japan
| | - Goro Takahashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Hamamatsu University School of Medicine, Japan
| | - Haruo Yoshida
- Department of Otolaryngology Head and Neck Surgery, Nagasaki University School of Medicine, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Japan
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The use of practice guidelines in the management of pediatric cases of Acute Otitis Media in Amman, Jordan. Int J Pediatr Otorhinolaryngol 2017; 96:39-46. [PMID: 28390611 DOI: 10.1016/j.ijporl.2017.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The widespread emergence of antimicrobial resistance has led many healthcare institutions to adopt more conservative antibiotic prescription practice guidelines for the treatment of acute otitis media (AOM). Little is known about the awareness and use of such guidelines by physicians in Jordan. Our aim was to pilot an anonymous survey instrument that would assess AOM treatment trends as well as awareness of and adherence to practice guidelines in Amman. By qualitatively assessing the management of AOM we could illuminate possible disparities in treatment trends, evaluate variability in practice guideline adherence, and help focus efforts of future educational programs that pertain to pediatric AOM management. METHODS A total of 71 practicing physicians were anonymously surveyed in Amman, Jordan. The survey assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted. RESULTS In total, participants answered 61.2% of the questions correctly. It was found that trainees would prescribe more appropriate antibiotics relative to attending physicians (p = 0.008). It was found that medical physicians followed guidelines more appropriately relative to ENT surgeons (64.2% of questions answered correctly vs. 58.1% of questions answered correctly; p = 0.015) and that physicians who report adhering to guidelines all/most of the time followed guidelines more appropriately relative to those who report adhering only sometimes or never (64.0% of questions answered correctly vs. 58.0% of questions answered correctly; p = 0.011). Also, cases that dealt with children were the most difficult for participants to diagnose as compared with cases that dealt with adults. CONCLUSION We conducted the first known qualitative analysis of otitis media practices in Amman and found numerous shortcomings in AOM guideline familiarity. Awareness of practice guidelines can lead to more appropriate AOM management, but there is variability between groups in guideline familiarity and utilization. Interventions that promote more conservative antibiotic prescriptions could be targeted towards groups that prescribe antibiotics less appropriately relative to their colleagues e.g. attending physicians and ENT surgeons. Interventions could also target physicians who manage pediatric AOM cases as participants had the most difficulty in properly diagnosing cases that involved children and infants.
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Varricchio A, De Lucia A, Varricchio AM, Della Volpe A, Mansi N, Pastore V, Ciprandi G. Sinuclean Nebules treatment in children suffering from otitis media with effusion. Int J Pediatr Otorhinolaryngol 2017; 94:30-35. [PMID: 28167007 DOI: 10.1016/j.ijporl.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/29/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Otitis media with effusion (OME) is an ear disorder defined by the presence of fluid in the middle ear without signs or symptoms of acute infection. The current randomized, double-blind, controlled study aimed to evaluate whether Sinuclean Nebules treatment, administered by nasal douche (Rinowash), could induce ear healing better than isotonic saline in children with OME. METHODS The study was randomized, double-blind, and controlled. Group A (30 children) was treated with Sinuclean Nebules 45 and Group B (31 children) was treated with isotonic saline; both compounds were administered by nasal nebulization with Rinowash nasal douche twice/day in the morning and in the evening for 10 days, followed by a one-week suspension, and after by a second course as the first. Tympanogram and audiometry were performed at baseline and after treatment. RESULTS Considering the global evaluation of the treatment: in Group A, 28 (93.3%) patients had complete resolution and 2 (6.7%) had partial resolution; in Group B, all patients had failure of treatment. There was a significant difference between groups (p < 0.0001). CONCLUSION The current randomized-controlled study demonstrated that Sinuclean Nebules was effective and in the treatment of children with OME.
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Affiliation(s)
- A Varricchio
- UOSD Videondoscopia delle vas ASL-Napoli1-Centro, P.O. S.Gennaro, Naples, Italy
| | - A De Lucia
- UOC ORL, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | | | - A Della Volpe
- UOSD Chirurgia Protesica della Sorditá Infantile, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - N Mansi
- UOC ORL, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - V Pastore
- UOSD Chirurgia Protesica della Sorditá Infantile, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - G Ciprandi
- Department of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S.) - Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy.
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Buzatto GP, Tamashiro E, Proenca-Modena JL, Saturno TH, Prates MC, Gagliardi TB, Carenzi LR, Massuda ET, Hyppolito MA, Valera FCP, Arruda E, Anselmo-Lima WT. The pathogens profile in children with otitis media with effusion and adenoid hypertrophy. PLoS One 2017; 12:e0171049. [PMID: 28231295 PMCID: PMC5322954 DOI: 10.1371/journal.pone.0171049] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/13/2017] [Indexed: 01/28/2023] Open
Abstract
Objectives To evaluate the presence of viruses and bacteria in middle ear and adenoids of patients with and without otitis media with effusion (OME). Methods Adenoid samples and middle ear washes (MEW) were obtained from children with OME associated with adenoid hypertrophy undergoing adenoidectomy and tympanostomy, and compared to those obtained from patients undergoing cochlear implant surgery, as a control group. Specific DNA or RNA of 9 respiratory viruses (rhinovirus, influenza virus, picornavirus, syncytial respiratory virus, metapneumovirus, coronavirus, enterovirus, adenovirus and bocavirus) and 5 bacteria (S. pneumoniae, H. influenzae, M. catarrhalis, P. aeruginosa and S. aureus) were extracted and quantified by real-time PCR. Results 37 OME and 14 cochlear implant children were included in the study. At the adenoid, virus and bacteria were similarly detected in both OME and control patients. At the middle ear washes, however, a higher prevalence of bacteria was observed in patients with OME (p = 0.01). S. pneumoniae (p = 0.01) and M. catarrhalis (p = 0.022) were the bacteria responsible for this difference. Although total virus detection was not statistically different from controls at the middle ear washes (p = 0.065), adenovirus was detected in higher proportions in adenoid samples of OME patients than controls (p = 0.019). Conclusions Despite both OME and control patients presented similar rates of viruses and bacteria at the adenoid, children with OME presented higher prevalence of S. pneumonia, M. catarrhalis in middle ear and adenovirus in adenoids when compared to controls. These findings could suggest that these pathogens could contribute to the fluid persistence in the middle ear.
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Affiliation(s)
- G. P. Buzatto
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - E. Tamashiro
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - J. L. Proenca-Modena
- Department of Genetics, Evolution, and Bioagents, Institute of Biology, University of Campinas (UNICAMP), Biology Institute, Campinas, São Paulo, Brazil
| | - T. H. Saturno
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - M. C. Prates
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - T. B. Gagliardi
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - L. R. Carenzi
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - E. T. Massuda
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - M. A. Hyppolito
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - F. C. P. Valera
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - E. Arruda
- Department of Molecular and Cell Biology, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - W. T. Anselmo-Lima
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
- * E-mail:
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108
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Torretta S, Marchisio P. Otitis media in children: A proposal for a new nosological classification. Int J Pediatr Otorhinolaryngol 2017; 93:174-175. [PMID: 28011068 DOI: 10.1016/j.ijporl.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sara Torretta
- Otolaryngology Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
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Garcia C, Salgueiro AB, Luís C, Correia P, Brito MJ. Acute mastoiditis in children: Middle ear cultures may help in reducing use of broad spectrum antibiotics. Int J Pediatr Otorhinolaryngol 2017; 92:32-37. [PMID: 28012530 DOI: 10.1016/j.ijporl.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute mastoiditis (AM) is a suppurative infection of the mastoid air cells, representing the most frequent complication of acute otitis media. AM remains an important entity in children due to its potential complications and sequelae. We aim to describe the cases of AM admitted at our department, identify risk factors potentially associated with complications and analyse the changes in clinical approach of AM over time. METHODS Case review of clinical files of children admitted with acute mastoiditis from June 1996 to May 2013 at a Lisbon metropolitan area hospital. Data was divided into two groups (prior and after May 2005) in order to evaluate changes in AM approach over the years. RESULTS 135 AM episodes were included. The median age was 3.8 years and 42% children were less than 24 months of age. Symptoms at presentation included fever (69%), ear pain (56%) and otorrhea (40%). Complications occurred in 22% patients and were more common in children under 24 months (33% vs 15%, p ≤ 0.01). Leukocyte count was significantly higher in children with complications (16.7 vs 14.5 × 109/μL, p ≤ 0.05) as was C-Reactive Protein value (13 vs 6.3 mg/dL, p ≤ 0.001). There was a significant association between the development of complications and C-Reactive Protein value at admission (OR 1.892; IC95%: 1.018-2.493, p ≤ 0.01). The optimal cut-off value was 7.21 mg/dL. Over time there was a significant increase in middle ear cultures obtained by tympanocentesis during surgery (2% vs 16%, p ≤ 0,01) and also a decrease in the use of broad spectrum antibiotherapy as initial treatment (52% vs 25%,p ≤ 0,001). CONCLUSIONS Children under 24 months, with high leukocyte count or with high C-Reactive Protein value should be monitored closely since complications tend to be more frequent. A CRP value of 7.21 mg/dL at admission seems to be a good cut-off to monitor children for potential complications. Throughout the period analysed more cultures were performed allowing identification of the pathogens and implementation of appropriate antibiotic therapy.
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Affiliation(s)
- Catarina Garcia
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Ana Bárbara Salgueiro
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Catarina Luís
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Paula Correia
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
| | - Maria João Brito
- Department of Pediatrics, Hospital Prof. Doutor Fernando Fonseca, EPE, Estrada IC-19, 2720-276, Amadora, Portugal.
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110
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Otitis Media and Externa. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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111
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Otitis, Sinusitis and Related Conditions. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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112
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Knopke S, Böttcher A, Chadha P, Olze H, Bast F. Seasonal differences of tympanogram and middle ear findings in children. HNO 2016; 65:68-72. [PMID: 27995276 DOI: 10.1007/s00106-016-0288-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND It is a known fact that bacterial or viral acute otitis media occurs more frequently in the winter months. Only a few older studies on seasonal differences in middle ear findings are available. These studies are based solely on tympanography, without correlation to intraoperative middle ear findings. This study addresses the question of whether seasonal differences can be found in the preoperative tympanogram and in the corresponding intraoperative findings in children with chronic middle ear problems. PATIENTS AND METHODS This retrospective study included patients who had undergone myringotomy with or without tympanostomy tube insertion at the Charité-Universitätsmedizin Berlin between January and December 2011. Corresponding to the catarrhal phases, winter months were defined as those from November to April; summer months from May to October. The preoperative tympanogram and the documented intraoperative middle ear finding were statistically analyzed for seasonal differences. RESULTS A total of 654 ears from 206 male and 127 female patients with mean age 3.7 ± 2.5 years were analyzed. In the majority of cases, a type B tympanogram was found (n = 376; 57.5%), whereas the middle ear was filled with air in 19.1% of cases. No significant seasonal differences were found for either the intraoperative middle ear findings or the preoperative tympanograms (p > 0.05). CONCLUSION For children with a typical history of chronic otitis media without effusion and chronic tube ventilation dysfunction, myringotomy with or without tympanostomy tube insertion is indicated independently of the season. The results indicate that a wait-and-see approach with hope of improvement during the summer months is not rational.
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Affiliation(s)
- S Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - A Böttcher
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Chadha
- Craniofacial Unit, Chelsea and Westminster Hospital, London, UK
| | - H Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Bast
- Department of Otorhinolaryngology, AMEOS Klinikum Haldensleben, Haldensleben, Germany
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Rosenfeld RM, Bluestone CD, Casselbrant ML, Chonmaitree T, Grote JJ, Haggard MP, Lous J, Marchisio P, Paradise JL, Prellner K, Schilder AGM, Stangerup SE. 8. Treatment. Ann Otol Rhinol Laryngol 2016. [DOI: 10.1177/00034894051140s112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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114
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Son MJ, Choi S, Kim YE, Kim YH. Herbal medicines for the treatment of otitis media with effusion: a systematic review of randomised controlled trials. BMJ Open 2016; 6:e011250. [PMID: 27884841 PMCID: PMC5168523 DOI: 10.1136/bmjopen-2016-011250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 09/06/2016] [Accepted: 11/03/2016] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This systematic review aimed to assess the clinical evidence supporting the use of herbal medicines (HMs) for the treatment of otitis media with effusion (OME). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, AMED, CINAHL and three trial registries were searched up to January 2015. We also searched five Korean medical databases (KoreaMed, RISS, OASIS, DBPIA and KISS) and three Chinese databases (CNKI, Wanfang and VIP). STUDY ELIGIBILITY CRITERIA This study included randomised clinical trials that reported the effects of HM for OME. The primary outcome was the complete resolution of OME at 2 or 3 months post randomisation. Secondary outcomes included the partial or complete resolution at all possible time points and hearing test. Three authors independently screened the titles and abstracts, selected studies and extracted the data relating to trial quality, characteristics and results. RESULTS A total of 2141 potentially relevant studies were identified, of which 17 randomised clinical trials met our inclusion criteria. Most were evaluated as having a high or unclear risk of bias. Tongqiao tablets, Tongqiao huoxue decoctions and Tsumura-Saireito were associated with a lower complete or partial resolution rate when compared with conventional medicines (CMs) (p=0.02, p=0.0001, and p=0.04, respectively), and similar outcomes were observed with Huanglong tonger pills, Erzhang decoctions and Shenling baizhu powder when combined with CM versus CM alone (p<0.00001, p=0.02, and p=0.05, respectively). Tongqiao huoxue decoction plus CM appeared to be more effective than CM in terms of improving the pure tone threshold levels (p=0.0007). Tsumura-Saireito was found to affect the proportion of patients with normalised tympanometry (p=0.03). CONCLUSIONS Despite some indications of potential symptom improvement, the evidence regarding the effectiveness and efficacy of HMs for OME is of poor quality and therefore inconclusive. PROTOCOL REGISTRATION NUMBER CRD42013005430.
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Affiliation(s)
- Mi Ju Son
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Songie Choi
- K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Young-Eun Kim
- Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Yun Hee Kim
- KM Convergence Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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Tocornal F, Labatut T. OTITIS MEDIA CON EFUSIÓN: DIAGNÓSTICO Y MANEJO PRÁCTICO. REVISTA MÉDICA CLÍNICA LAS CONDES 2016. [DOI: 10.1016/j.rmclc.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Jafari Z, Malayeri S, Bahramian E. The Effect of Age and History of Recurrent Otitis Media on Dichotic Listening and Verbal Memory in Children. Ann Otol Rhinol Laryngol 2016; 125:1015-1024. [PMID: 27738265 DOI: 10.1177/0003489416671333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the possible effects of recurrent otitis media (ROM) in early childhood on binaural processing and verbal memory in school-aged children. METHODS Two hundred eleven children, including 31 children with and 180 children without a history of ROM, were examined. A dichotic digit test (DDT) and a forward and backward digit memory span test (DMST) were administered. RESULTS A significant difference was observed between age groups among ROM-free children. The ROM-positive group earned significantly poorer results than the ROM-free group in all measurements, except for the right DDT (rDDT) score. Furthermore, a significant correlation was found between the DDT and EA scores with both DMST scores in the ROM-free group. The correlation between the rDDT and forward DMST scores was not significant in the ROM-positive group, and no significant correlation was observed between the EA score and either DMST score. CONCLUSIONS Our findings support that a history of OM in early childhood based on a parental survey of children is associated with differences in DDT and DMST outcomes.
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Affiliation(s)
- Zahra Jafari
- Rehabilitation Research Center (RRC), Iran University of Medical Sciences (IUMS), Tehran, Iran .,Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Canadian Center for Behavioral Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
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Duncan I, Clark K, Wang S. Cost and Utilization of Retail Clinics vs. Other Providers for Treatment of Pediatric Acute Otitis Media. Popul Health Manag 2016; 19:341-8. [DOI: 10.1089/pop.2015.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ian Duncan
- Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, California
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te Molder M, de Hoog MLA, Uiterwaal CSPM, van der Ent CK, Smit HA, Schilder AGM, Damoiseaux RAMJ, Venekamp RP. Antibiotic Treatment for First Episode of Acute Otitis Media Is Not Associated with Future Recurrences. PLoS One 2016; 11:e0160560. [PMID: 27632355 PMCID: PMC5025241 DOI: 10.1371/journal.pone.0160560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Antibiotic treatment of acute otitis media (AOM) has been suggested to increase the risk of future AOM episodes by causing unfavorable shifts in microbial flora. Because current evidence on this topic is inconclusive and long-term follow-up data are scarce, we wanted to estimate the effect of antibiotic treatment for a first AOM episode occurring during infancy on AOM recurrences and AOM-related health care utilization later in life. METHODS We obtained demographic information and risk factors from data of the Wheezing Illnesses Study Leidsche Rijn, a prospective birth cohort study in which all healthy newborns born in Leidsche Rijn (between 2001 and 2012), The Netherlands, were enrolled. These data were linked to children's primary care electronic health records up to the age of four. Children with at least one family physician-diagnosed AOM episode before the age of two were included in analyses. The exposure of interest was the prescription of oral antibiotics (yes vs no) for a child's first AOM episode before the age of two years. RESULTS 848 children were included in analyses and 512 (60%) children were prescribed antibiotics for their first AOM episode. Antibiotic treatment was not associated with an increased risk of total AOM recurrences (adjusted rate ratio: 0.94, 95% CI: 0.78-1.13), recurrent AOM (≥3 episodes in 6 months or ≥4 in one year; adjusted risk ratio: 0.79, 95% CI: 0.57-1.11), or with increased AOM-related health care utilization during children's first four years of life. CONCLUSIONS Oral antibiotic treatment of a first AOM episode occurring during infancy does not affect the number of AOM recurrences and AOM-related health care utilization later in life. This information can be used when weighing the pros and cons of various AOM treatment options.
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Affiliation(s)
- Marthe te Molder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke L. A. de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ear Institute, University College London, London, United Kingdom
| | - Roger A. M. J. Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.
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Affiliation(s)
- Anne G. M. Schilder
- evidENT, Ear Institute, University College London, Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tasnee Chonmaitree
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas USA
| | - Allan W. Cripps
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Queensland Australia
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York USA
| | | | - Mark P. Haggard
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Hospital clinical trial: Homeopathy (Agraphis nutans 5CH, Thuya occidentalis 5CH, Kalium muriaticum 9CH and Arsenicum iodatum 9CH) as adjuvant, in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol 2016; 88:217-23. [PMID: 27497418 DOI: 10.1016/j.ijporl.2016.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/15/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) is the most common cause of paediatric hearing loss. No single treatment has proved its effectiveness. There is a lack of evidence-based medicine studies in the area of homeopathy. METHOD A prospective randomized, double blinded interventional placebo control study was conducted. Patients, from 2 months to 12 years, with OME diagnosed by pneumatic otoscopy (PNO) and tympanometry, were randomized into two groups. Both groups received aerosol therapy (mucolytics and corticosteroids). In addition, the experimental group (EG) received homeopathy (Agraphis nutans 5CH, Thuya Occidentalis 5CH, Kalium muriaticum 9CH and Arsenicum iodatum), and the placebo group (PG) placebo, both of them for 3 months. Patients were evaluated by PNO examination and tympanometry at baseline, at 45 and 90 days. RESULTS 97 patients were enrolled. In the EG, 61.9% of individuals were cured (PNO went from negative in the 1st visit to positive in the 3rd visit) compared with 56.8% of patients treated with placebo. 4.8% of patients in the EG suffered a recurrence (positive PNO in the 2nd visit changed to negative in the 3rd visit) while 11.4% did in the PG. No significant difference was found. Adverse events were distributed similarly, except in the case of upper respiratory tract infections, which were less frequent in EG (3 vs. 13, p: 0.009). CONCLUSION The homeopathic scheme used as adjuvant treatment cannot be claimed to be an effective treatment in children with OME. TRIAL REGISTRATION EUDRACT number: 2011-006086-17, PROTOCOL code: 55005646.
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Szőke H, Maródi M, Sallay Z, Székely B, Sterner MG, Hegyi G. Integrative versus Conventional Therapy of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children: A Prospective Observational Study. ACTA ACUST UNITED AC 2016; 23:231-9. [PMID: 27607438 DOI: 10.1159/000448440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment. METHODS We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education. RESULTS The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period. CONCLUSION Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.
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Affiliation(s)
- Henrik Szőke
- Faculty of Health Sciences, Doctoral School, University of Pécs, Pécs, Hungary
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Heidemann CH, Lous J, Berg J, Christensen JJ, Håkonsen SJ, Jakobsen M, Johansen CJ, Nielsen LH, Hansen MP, Poulsen A, Schousboe LP, Skrubbeltrang C, Vind AB, Homøe P. Danish guidelines on management of otitis media in preschool children. Int J Pediatr Otorhinolaryngol 2016; 87:154-63. [PMID: 27368465 DOI: 10.1016/j.ijporl.2016.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Otitis media is one of the most common diseases in small children. This underlines the importance of optimizing diagnostics and treatment of the condition. Recent literature points toward a stricter approach to diagnosing acute otitis media (AOM). Moreover, ventilating tube treatment for recurrent AOM (RAOM) and chronic otitis media with effusion (COME) has become the most frequently performed surgical procedure in pre-school children. Therefore, the Danish Health and Medicines Authority and the Danish Society of Otorhinolaryngology, Head and Neck Surgery deemed it necessary to update the Danish guidelines regarding the diagnostic criteria for acute otitis media and surgical treatment of RAOM and COME. METHODS The GRADE system (The Grading of Recommendations Assessment, Development and Evaluation) was used in order to comply with current standards of evidence assessment in formulation of recommendations. An extensive literature search was conducted between July and December 2014. The quality of the existing literature was assessed using AGREE II (Appraisal of Guidelines for Research & Evaluation), AMSTAR (assessing the Methodological Quality of Systematic Reviews), QUADAS-2 (Quality of Diagnostic Accuracy Studies), Cochrane Risk of Bias Tool for randomized trials and ACROBAT-NRSI (A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies). The working group consisted of otolaryngologists, general practitioners, pediatricians, microbiologists and epidemiologists. CONCLUSION Recommendations for AOM diagnosis, surgical management for RAOM and COME, including the role of adenoidectomy and treatment of ventilating tube otorrhea, are proposed in the guideline.
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Affiliation(s)
- C H Heidemann
- Danish Health and Medicines Authority, Denmark; Department of ENT - Head & Neck Surgery, Odense University Hospital, Denmark; Department of Otorhinolaryngology, Vejle Hospital, Denmark.
| | - J Lous
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark
| | - J Berg
- ENT Private Clinic, Århus, Denmark
| | - J J Christensen
- Department of Clinical Microbiology, Slagelse Hospital, Denmark
| | - S J Håkonsen
- Danish Health and Medicines Authority, Denmark; Centre for Clinical Guidelines, Department of Health Science and Technology, University of Aalborg, Denmark
| | - M Jakobsen
- Danish Health and Medicines Authority, Denmark
| | | | - L H Nielsen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Denmark
| | - M P Hansen
- Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Denmark; Centre for Research in Evidence-Based Practice, Bond University, Australia
| | - A Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Denmark
| | - L P Schousboe
- Department of Otorhinolaryngology, Vejle Hospital, Denmark
| | - C Skrubbeltrang
- Danish Health and Medicines Authority, Denmark; Medical Library, Aalborg University Hospital, Denmark
| | - A B Vind
- Danish Health and Medicines Authority, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Køge University Hospital, Denmark
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Chessman R, Kamani T, Birchall JP, Barry JG, Daniel M. Which outcome measures are reported by clinical trials investigating OME treatment? A case for standardised reporting. Int J Pediatr Otorhinolaryngol 2016; 86:93-6. [PMID: 27260589 PMCID: PMC5734610 DOI: 10.1016/j.ijporl.2016.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Many different OME treatment trials have been published using different outcomes measures to evaluate the success of particular interventions. We set out to identify the variation in reporting of outcome measures in OME trials that exists at present. This has been achieved by reviewing published trials to determine which outcome measures have been reported. METHOD The literature review was carried out using PUBMED database (1980 to 2013). Data were collected on the treatment outcomes reported, with particular focus on the methods of assessment and the number of treatment outcomes used in each study. RESULTS The 171 studies identified used 12 broad treatment outcome measures. The most common outcome measure was OME resolution (48%) followed by hearing level (36%). Only 95 studies used a single outcome measure, with 76 studies using between 2 and 4 outcome measures. The method of assessment varied between studies that used the same treatment outcome measures. CONCLUSION OME treatment trials report a wide range of measures and comparison across studies is thus difficult. Establishing a core set of outcome measures to be reported by all trials in the future could be useful, and would allow comprehensive comparison of different studies and minimise potential for reporting bias.
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Affiliation(s)
| | | | - John P Birchall
- Nottingham University Hospitals, UK; Otology and Hearing Group, The University of Nottingham, UK
| | - Johanna G Barry
- Nottingham University Hospitals, UK; MRC Institute of Hearing Research Clinical Section, The University of Nottingham, UK
| | - Matija Daniel
- Nottingham University Hospitals, UK; Otology and Hearing Group, The University of Nottingham, UK
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Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD. Clinical Practice Guideline: Otitis Media with Effusion Executive Summary (Update). Otolaryngol Head Neck Surg 2016; 154:201-14. [PMID: 26833645 DOI: 10.1177/0194599815624407] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated "Clinical Practice Guideline: Otitis Media with Effusion." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 18 recommendations developed emphasize diagnostic accuracy, identification of children who are most susceptible to developmental sequelae from otitis media with effusion, and education of clinicians and patients regarding the favorable natural history of most otitis media with effusion and the lack of efficacy for medical therapy (eg, steroids, antihistamines, decongestants). An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth R Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Robyn Coggins
- Society for Middle Ear Disease, Pittsburgh, Pennsylvania, USA
| | - Lisa Gagnon
- Connecticut Pediatric Otolaryngology, Madison, Connecticut, USA
| | | | - David Hoelting
- American Academy of Family Physicians, Pender, Nebraska, USA
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ann W Kummer
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Spencer C Payne
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dennis S Poe
- Department of Otology and Laryngology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maria Veling
- University of Texas-Southwestern Medical Center/Children's Medical Center-Dallas, Dallas, Texas, USA
| | - Peter M Vila
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Sandra A Walsh
- Consumers United for Evidence-based Healthcare, Davis, California, USA
| | - Maureen D Corrigan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Rosenfeld RM, Shin JJ, Schwartz SR, Coggins R, Gagnon L, Hackell JM, Hoelting D, Hunter LL, Kummer AW, Payne SC, Poe DS, Veling M, Vila PM, Walsh SA, Corrigan MD. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg 2016; 154:S1-S41. [PMID: 26832942 DOI: 10.1177/0194599815623467] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This update of a 2004 guideline codeveloped by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Pediatrics, and the American Academy of Family Physicians, provides evidence-based recommendations to manage otitis media with effusion (OME), defined as the presence of fluid in the middle ear without signs or symptoms of acute ear infection. Changes from the prior guideline include consumer advocates added to the update group, evidence from 4 new clinical practice guidelines, 20 new systematic reviews, and 49 randomized control trials, enhanced emphasis on patient education and shared decision making, a new algorithm to clarify action statement relationships, and new and expanded recommendations for the diagnosis and management of OME. PURPOSE The purpose of this multidisciplinary guideline is to identify quality improvement opportunities in managing OME and to create explicit and actionable recommendations to implement these opportunities in clinical practice. Specifically, the goals are to improve diagnostic accuracy, identify children who are most susceptible to developmental sequelae from OME, and educate clinicians and patients regarding the favorable natural history of most OME and the clinical benefits for medical therapy (eg, steroids, antihistamines, decongestants). Additional goals relate to OME surveillance, hearing and language evaluation, and management of OME detected by newborn screening. The target patient for the guideline is a child aged 2 months through 12 years with OME, with or without developmental disabilities or underlying conditions that predispose to OME and its sequelae. The guideline is intended for all clinicians who are likely to diagnose and manage children with OME, and it applies to any setting in which OME would be identified, monitored, or managed. This guideline, however, does not apply to patients <2 months or >12 years old. ACTION STATEMENTS The update group made strong recommendations that clinicians (1) should document the presence of middle ear effusion with pneumatic otoscopy when diagnosing OME in a child; (2) should perform pneumatic otoscopy to assess for OME in a child with otalgia, hearing loss, or both; (3) should obtain tympanometry in children with suspected OME for whom the diagnosis is uncertain after performing (or attempting) pneumatic otoscopy; (4) should manage the child with OME who is not at risk with watchful waiting for 3 months from the date of effusion onset (if known) or 3 months from the date of diagnosis (if onset is unknown); (5) should recommend against using intranasal or systemic steroids for treating OME; (6) should recommend against using systemic antibiotics for treating OME; and (7) should recommend against using antihistamines, decongestants, or both for treating OME.The update group made recommendations that clinicians (1) should document in the medical record counseling of parents of infants with OME who fail a newborn screening regarding the importance of follow-up to ensure that hearing is normal when OME resolves and to exclude an underlying sensorineural hearing loss; (2) should determine if a child with OME is at increased risk for speech, language, or learning problems from middle ear effusion because of baseline sensory, physical, cognitive, or behavioral factors; (3) should evaluate at-risk children for OME at the time of diagnosis of an at-risk condition and at 12 to 18 months of age (if diagnosed as being at risk prior to this time); (4) should not routinely screen children for OME who are not at risk and do not have symptoms that may be attributable to OME, such as hearing difficulties, balance (vestibular) problems, poor school performance, behavioral problems, or ear discomfort; (5) should educate children with OME and their families regarding the natural history of OME, need for follow-up, and the possible sequelae; (6) should obtain an age-appropriate hearing test if OME persists for 3 months or longer OR for OME of any duration in an at-risk child; (7) should counsel families of children with bilateral OME and documented hearing loss about the potential impact on speech and language development; (8) should reevaluate, at 3- to 6-month intervals, children with chronic OME until the effusion is no longer present, significant hearing loss is identified, or structural abnormalities of the eardrum or middle ear are suspected; (9) should recommend tympanostomy tubes when surgery is performed for OME in a child <4 years old; adenoidectomy should not be performed unless a distinct indication exists (nasal obstruction, chronic adenoiditis); (10) should recommend tympanostomy tubes, adenoidectomy, or both when surgery is performed for OME in a child ≥4 years old; and (11) should document resolution of OME, improved hearing, or improved quality of life when managing a child with OME.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Jennifer J Shin
- Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Seth R Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Robyn Coggins
- Society for Middle Ear Disease, Pittsburgh, Pennsylvania, USA
| | - Lisa Gagnon
- Connecticut Pediatric Otolaryngology, Madison, Connecticut, USA
| | | | - David Hoelting
- American Academy of Family Physicians, Pender, Nebraska, USA
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ann W Kummer
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Spencer C Payne
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dennis S Poe
- Department of Otology and Laryngology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maria Veling
- University of Texas-Southwestern Medical Center/Children's Medical Center-Dallas, Dallas, Texas, USA
| | - Peter M Vila
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Davis, California, USA
| | - Maureen D Corrigan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Tanaka Y, Enomoto H, Takada K, Inoue M, Ogawara N, Takahashi M, Oridate N. [Newborn Hearing Screening and Subsequent Diagnostic Evaluation: Analysis and Outcomes of 6,063 Infants Born in a Community Hospital]. NIHON JIBIINKOKA GAKKAI KAIHO 2016; 119:187-95. [PMID: 27244904 DOI: 10.3950/jibiinkoka.119.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A retrospective study was conducted to examine the implementation status of newborn hearing screening (NHS) of 6,063 infants born in a single community hospital in Japan between 2005 and 2013. An automated auditory brainstem response device was used for NHS and an auditory brainstem response was mainly used for further diagnostic evaluation. Although the participation rate in the NHS was 88.8% in 2013, increasing year by year, it failed to reach 100% probably because NHS is a charged option under the current Japanese healthcare system. Among 40 (0.66%) infants who finally failed their NHS, 34 were referred for subsequent diagnostic evaluation and the remaining 6 were lost to follow-up. Thirty-one of these 34 were diagnosed as having hearing impairment and 3 (0.05%) were identified as having normal hearing, which is considered as a false positive. Both the final referral rate and the hearing impairment rate were significantly higher in the high-risk than in the low-risk group. Compared to the previous national report, the rate of bilateral hearing impairment (0.33%) was significantly higher in this study. Ten (38.5%) out of 26 in the high-risk group were most often diagnosed with otitis media with effusion (OME), while 4 (50%) out of 8 in the low-risk group were diagnosed as having sensorineural hearing loss. Seven (35%) out of 20 with bilateral hearing impairment attained a normal hearing level at a median age of 18 months. Although the primary aim of NHS is early detection of congenital permanent hearing loss, OME is observed commonly in NHS-failed infants. It is therefore important to examine the middle ear status carefully as part of the diagnostic evaluation. Thirty-four infants underwent further diagnostic evaluation at a median age of 46 days, and hearing aids were given in 10 of them at a median age of 5.6 months without delay. Because high-risk patients often tend to be lost to follow-up, otolaryngologists have to give a detailed explanation to caregivers and to build a solid support system for children with hearing impairment.
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Bruce I, Harman N, Williamson P, Tierney S, Callery P, Mohiuddin S, Payne K, Fenwick E, Kirkham J, O'Brien K. The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation. Health Technol Assess 2016; 19:1-374. [PMID: 26321161 DOI: 10.3310/hta19680] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. OBJECTIVES To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. DESIGN The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. SETTING The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. PARTICIPANTS Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. RESULTS The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. CONCLUSIONS There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. FUNDING The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
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Affiliation(s)
- Iain Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicola Harman
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
| | - Paula Williamson
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK.,Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Jamie Kirkham
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
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Burton MJ, Rosenfeld RM. Extracts from The Cochrane Library: Antihistamines and/or decongestants for otitis media with effusion (OME) in children. Otolaryngol Head Neck Surg 2016; 136:11-3. [PMID: 17210325 DOI: 10.1016/j.otohns.2006.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Accepted: 10/30/2006] [Indexed: 11/25/2022]
Abstract
The “Cochrane Corner” is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology- head and neck surgery, with invited commentary to highlight implications for clinical decision making. This installment features a Cochrane Review entitled “Antihistamines and/or decongestants for otitis media with effusion (OME) in children,” which recommends against treatment because of no demonstrable benefits but significant potential for harm. © 2007 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- Martin J Burton
- Department of Otolaryngology, University of Oxford and The Radcliffe Infirmary, Oxford, UK
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Pau BC, Ng DK. Prevalence of otitis media with effusion in children with allergic rhinitis, a cross sectional study. Int J Pediatr Otorhinolaryngol 2016; 84:156-60. [PMID: 27063773 DOI: 10.1016/j.ijporl.2016.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Otitis media with effusion (OME) may be caused by various factors including Eustachian tube dysfunction, inflammatory response as well as atopy. Allergic rhinitis (AR), a common chronic disorder in children, is associated with swelling of the mucosa and can therefore result in Eustachian tube dysfunction. This study aims to compare the prevalence of OME in subjects with and without AR. METHOD Children aged 4-12 were recruited from the clinics at Kwong Wah Hospital, Hong Kong. Subjects recruited were interviewed and a questionnaire filled in regarding nasal obstruction, rhinorrhea, sneezing, itching of the nose and/or post nasal discharge (ARIR document). The children were then examined by a doctor using a pneumatic otoscopy and a portable tympanometer. Children found to have OME were offered a follow-up visit 3 months later. RESULTS 12 out of 159 (7.5%) of the AR group were found to have OME compared with 3 out of 185 (1.6%) in the non-AR group, p=0.016. During the 2nd visit at 3 months, 85.7% of the AR subjects showed resolution of their OME. CONCLUSIONS Our data showed a significant difference in the prevalence of OME between AR and non-AR subjects. Of the 185 non AR subjects (Control group), 3 was found to have OME, suggesting a point prevalence of OME of 1.6% in the community in Hong Kong. OME is more likely to occur in children with allergic rhinitis and it may be wiser to manage OME in these individuals differently.
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Affiliation(s)
- Benjamin C Pau
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Daniel K Ng
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong SAR, China.
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Capaccio P, Torretta S, Marciante GA, Marchisio P, Forti S, Pignataro L. Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss. Clin Exp Otorhinolaryngol 2016; 9:33-8. [PMID: 26976024 PMCID: PMC4792239 DOI: 10.21053/ceo.2016.9.1.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/13/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. Methods This prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. Results There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). Conclusion Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.
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Affiliation(s)
- Pasquale Capaccio
- Department of Biomedical Surgical and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universita' degli Studi di Milano, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universita' degli Studi di Milano, Milan, Italy
| | - Givlia Anna Marciante
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universita' degli Studi di Milano, Milan, Italy
| | - Paola Marchisio
- Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universita' degli Studi di Milano, Milan, Italy
| | - Stella Forti
- Department of Biomedical Surgical and Dental Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universita' degli Studi di Milano, Milan, Italy
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universita' degli Studi di Milano, Milan, Italy
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Hamre H, Glockmann A, Schwarz R, Riley D, Baars E, Kiene H, Kienle G. Antibiotikaverbrauch bei Kindern mit akuten Atemwegs- oder Ohrinfekten: eine prospektive Beobachtungsstudie zum Vergleich zwischen anthroposophischer und konventioneller Behandlung in der hausärztlichen Routineversorgung. ACTA ACUST UNITED AC 2016. [DOI: 10.14271/dms-20637-de] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Steele KM, Carreiro JE, Viola JH, Conte JA, Ridpath LC. Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study. J Osteopath Med 2015; 114:436-47. [PMID: 24917631 DOI: 10.7556/jaoa.2014.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Childhood acute otitis media (AOM) is highly prevalent. Its usual sequela of middle ear effusion (MEE) can lead to conductive hearing loss, for which surgery is commonly used. OBJECTIVE To evaluate the efficacy of an osteopathic manipulative treatment (OMT) protocol on MEE resolution following an episode of AOM. The authors hypothesized that OMT provided adjunctively to standard care for young children with AOM would reduce the duration of MEE following the onset of AOM. METHODS We compared standard care only (SCO) and standard care plus OMT (SC+OMT) for the duration of MEE following AOM. Patients were aged 6 months to 2 years. The SC+OMT group received OMT during 3 weekly visits. Weekly tympanometric and acoustic reflectometer (AR) readings were obtained from all patients. RESULTS There were 52 patients enrolled, with 43 completing the study and 9 dropping out. No demographic differences were noted. Only ears from each patient with abnormal tympanograms at entry were included. There were 76 ears in the tympanogram analysis (38 from SCO; 38 from SC+OMT) and 61 ears in the AR data analysis (31 from SCO; 30 from SC+OMT). Dependence of bilateral ear disease noted in AR readings was accounted for in statistical analysis. Tympanogram data demonstrated a statistically significant improvement in MEE at visit 3 in patients in the SC+OMT group (odds ratio, 2.98; 95% confidence interval, 1.16, 7.62; χ(2) test for independence, P=.02). The AR data analysis showed statistically significant improvement at visit 3 for the SC+OMT group (z=2.05; P=.02). There was no statistically significant change in MEE before or immediately after the OMT protocol. CONCLUSION A standardized OMT protocol administered adjunctively with standard care for patients with AOM may result in faster resolution of MEE following AOM than standard treatment alone. (ClinicalTrials.gov number NCT00520039.).
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Affiliation(s)
- Karen M Steele
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Jane E Carreiro
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Judith Haug Viola
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Josephine A Conte
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
| | - Lance C Ridpath
- From the Department of Osteopathic Medical Education (Dr Steele) and the Department of Assessment and Educational Development (Mr Ridpath) at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg; the Department of Osteopathic Manipulative Medicine (OMM) at the University of New England College of Osteopathic Medicine in Biddeford, Maine (Dr Carreiro); the Department of Emergency Medicine at Duke University in Durham, North Carolina (Dr Viola); and the Maine Dartmouth Family Medicine Residency in Augusta, Maine (Dr Conte). Dr Steele is now retired from WVSOM as professor emerita and has established a private OMM practice
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Zanoletti E, Cazzador D, Faccioli C, Sari M, Bovo R, Martini A. Intracranial venous sinus thrombosis as a complication of otitis media in children: Critical review of diagnosis and management. Int J Pediatr Otorhinolaryngol 2015; 79:2398-403. [PMID: 26590005 DOI: 10.1016/j.ijporl.2015.10.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/30/2015] [Accepted: 10/31/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Otogenic lateral sinus thrombosis (LST) is a rare intracranial complication of acute otitis media (AOM), which can lead to severe neurological sequelae and death. The aim of this study was to analyze the clinical presentation, management and outcome of LST in children, investigating a possible correlation between clinical aspects, radiological findings and anatomical variations. METHODS At a tertiary Italian hospital, a retrospective review was conducted on the medical records of eight patients diagnosed with otogenic LST over a 3-year period. Four children were males and mean age was 4.7 years. RESULTS All patients had a history of otitis media at diagnosis and 4/8 presented also with more than one neurological sign or symptom. Mastoiditis signs were detected in 5/8 patients. Thrombosis was diagnosed by computed tomography, enhanced magnetic resonance and magnetic resonance venography. Treatment was medical, alone or combined with surgery. Medical treatment consisted in anticoagulants eventually combined with anti-edema medication on clinical basis. Mastoidectomy and/or myringotomy±trans-tympanic drainage placement were performed in 7/8 patients. Complete vessel recanalization was obtained in 6/8 children after a median follow-up time of 4.8 months. No complications, neither clinical sequelae occurred. In our series, neurological signs and symptoms were significantly associated with the presence of hypoplasia of the contralateral venous sinus (p=0.029). CONCLUSION LST is a severe condition occurring even in absence of otological signs, and despite adequate antibiotic therapy for AOM, which should be ruled out and promptly treated. A dominant neurological presentation is associated in our series with anatomical variations of cerebral sinus venous drainage patterns. This should be carefully evaluated and considered in diagnosis, treatment planning and prognosis.
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Affiliation(s)
- Elisabetta Zanoletti
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy.
| | - Diego Cazzador
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Chiara Faccioli
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Marianna Sari
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Roberto Bovo
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
| | - Alessandro Martini
- Department of Neuroscience, Operative Unit of Otolaryngology, Padova University, via Giustiniani 2, Padova, Italy
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Kautz-Freimuth S, Redaèlli M, Samel C, Civello D, Altin SV, Stock S. Parental views on acute otitis media (AOM) and its therapy in children--results of an exploratory survey in German childcare facilities. BMC Pediatr 2015; 15:199. [PMID: 26620979 PMCID: PMC4666068 DOI: 10.1186/s12887-015-0516-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/24/2015] [Indexed: 01/08/2023] Open
Abstract
Background Acute otitis media (AOM) is one of the main reasons for medical consultation and antibiotic use during childhood. Although 80 % of AOM cases are self-limiting, antibiotic prescription is still high, either for physician- or for parent-related factors. This study aims to identify parental knowledge about, beliefs and attitudes towards, and experiences with AOM and its therapy and thus to gain insights into parents’ perspectives within the German health care system. Methods An exploratory survey was conducted among German-speaking parents of children aged 2 to 7 years who sent their children to a childcare facility. Childcare facilities were recruited by convenience sampling in different urban and rural sites in Germany, and all parents with children at those facilities were invited to participate. Data were evaluated using descriptive statistical analyses. Results One-hundred-thirty-eight parents participated. Of those, 75.4 % (n = 104) were AOM-experienced and 75.4 % (n = 104) had two or more children. Sixty-six percent generally agree that bacteria cause AOM. 20.2 % generally agree that viruses cause AOM. 30.5 % do not generally agree that viruses cause AOM. Eight percent generally agree that AOM resolves spontaneously, whereas 53.6 % do not generally agree. 92.5 % generally (45.7 %) and partly (42.8 %) agree that AOM needs antibiotic treatment. With respect to antibiotic effects, 56.6 % generally agree that antibiotics rapidly relieve earache. 60.1 % generally agree that antibiotics affect the gastrointestinal tract and 77.5 % generally agree that antibiotics possibly become ineffective after frequent use. About 40 % generally support and about 40 % generally reject a “wait-and-see” strategy for AOM treatment. Parental-reported experiences reveal that antibiotics are by far more often prescribed (70.2 %) than actively requested by parents (26.9 %). Conclusions Parental views on AOM, its therapy, and antibiotic effects reveal uncertainties especially with respect to causes, the natural course of the disease and antibiotic effects on AOM. These results indicate that more evidence-based information is needed if parents’ health literacy in the treatment of children with AOM is to be enhanced. The discrepancy between reported parental requests for antibiotics and reported actual prescriptions contradicts the hypothesis of high parental influence on antibiotic use in AOM. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0516-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany. .,Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Christina Samel
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Daniele Civello
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Sibel V Altin
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
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Mohiuddin S, Payne K, Fenwick E, O'Brien K, Bruce I. A model-based cost-effectiveness analysis of a grommets-led care pathway for children with cleft palate affected by otitis media with effusion. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2015; 16:573-587. [PMID: 24906214 DOI: 10.1007/s10198-014-0610-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 05/08/2014] [Indexed: 06/03/2023]
Abstract
There is a paucity of evidence to guide the management of otitis media with effusion (OME), which is a common problem causing significant hearing impairment in children with cleft palate. The insertion of grommets is currently being used to correct hearing impairment and prevent complications of unmanaged OME, but there is ongoing discussion about whether the benefits of grommets outweigh the costs and risks. A decision-tree model was developed to assess the surgical insertion of grommets with two non-surgical alternatives (hearing-aids and do-nothing strategies) in cleft palate children with persistent bilateral OME. The model assumed a 2-year time horizon and a UK National Health Service perspective. Outcomes were valued using quality-adjusted life-years (QALYs) estimated by linking utility values with potential hearing gains measured in decibels. Multiple data sources were used, including reviews of the clinical effectiveness, resource use and utility literature, and supplemented with expert opinion. Uncertainty in the model parameters was assessed using probabilistic sensitivity analysis. Expected value of perfect information analysis was used to calculate the potential value of future research. The results from the probabilistic sensitivity analysis indicated that the grommets strategy was associated with an incremental cost-effectiveness ratio of £9,065 per QALY gained compared with the do-nothing strategy, and the hearing-aids strategy was extended dominated by the grommets strategy. The population expected value of perfect information was £5,194,030 at a willingness to pay threshold of £20,000 per QALY, implying that future research could be potentially worthwhile. This study found some evidence that the insertion of grommets to manage cleft palate children with bilateral OME is likely to be cost-effective, but further research is required to inform this treatment choice.
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Affiliation(s)
- Syed Mohiuddin
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, University of Manchester, Manchester, UK,
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Occurrence of otitis media in children and assessment of treatment options. The Journal of Laryngology & Otology 2015; 129:779-83. [PMID: 26072993 DOI: 10.1017/s0022215115001127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Otitis media is a more frequent occurrence in children, and the disease may progress from an acute to chronic state if appropriate and timely intervention is not initiated. METHODS A total of 212 children aged 6 months to 10 years were examined and treated for otitis media, in a 13-month hospital-based study. RESULTS Acute otitis media was diagnosed in 130 (61.3 per cent) of the patients. There were 82 (38.7 per cent) chronic suppurative otitis media cases. The incidence of acute otitis media and chronic suppurative otitis media in the first year of life was 54.6 per cent and 45.1 per cent respectively. Chronic suppurative otitis media patients were assigned to one of three treatment groups. Recovery occurred in 70.4 per cent of amoxicillin-treated patients, in 88.9 per cent of amoxicillin-clavulanic acid treated patients and in 96.4 per cent of culture and antibiotic sensitivity test patients. Relapses were seen only in the amoxicillin (five cases) and amoxicillin-clavulanic acid (two cases) groups. CONCLUSION The success rate in patients treated with antibiotics makes this option mandatory for an established diagnosis.
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Nourizadeh N, Ghazvini K, Gharavi V, Nourizadeh N, Movahed R. Evaluation of nasopharyngeal microbial flora and antibiogram and its relation to otitis media with effusion. Eur Arch Otorhinolaryngol 2015; 273:859-63. [DOI: 10.1007/s00405-015-3637-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/22/2015] [Indexed: 11/29/2022]
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Kitamura K, Iino Y, Kamide Y, Kudo F, Nakayama T, Suzuki K, Taiji H, Takahashi H, Yamanaka N, Uno Y. Clinical Practice Guidelines for the diagnosis and management of acute otitis media (AOM) in children in Japan – 2013 update. Auris Nasus Larynx 2015; 42:99-106. [DOI: 10.1016/j.anl.2014.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/05/2014] [Accepted: 09/18/2014] [Indexed: 11/28/2022]
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Iino Y, Yoshida N, Kato T, Kakizaki K, Miyazawa T, Kakuta H. Clinical effects of clarithromycin on persistent inflammation following Haemophilus influenzae-positive acute otitis media. Acta Otolaryngol 2015; 135:217-25. [PMID: 25649881 DOI: 10.3109/00016489.2014.975893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Additional treatment with clarithromycin (CAM) reduced persistent middle ear inflammation after acute otitis media (AOM) caused by Haemophilus influenzae in children. CAM is a treatment option for persistent inflammation following AOM and to prevent continuing otitis media with effusion. OBJECTIVE We conducted a clinical study to evaluate a new method of treatment for persistent inflammation after AOM in children. METHODS H. influenzae-infected children with AOM were treated acutely with antimicrobial agents, after which those still demonstrating effusion of the middle ear cavity received additional treatment with carbocysteine (S-CMC) alone or S-CMC combined with clarithromycin (CAM) for 1 week. The two regimens were compared in terms of clinical effects. RESULTS After the initial acute treatment, many patients still showed abnormal otoscopic findings. At the completion of additional treatment, there were no significant differences between the two treatment groups. However, 1 week after completion of additional treatment, the prevalence of a diminished light reflex was significantly lower in the CAM + S-CMC group than in the S-CMC group (p = 0.017). The prevalence of redness of the tympanic membrane also tended to be lower in the combined treatment group than in those receiving a single drug (p = 0.097).
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Affiliation(s)
- Yukiko Iino
- Department of Otolaryngology, Jichi Medical University, Saitama Medical Center , Saitama
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142
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Heidemann CH, Lauridsen HH, Kjeldsen AD, Faber CE, Johansen ECJ, Godballe C. Quality-of-Life Differences among Diagnostic Subgroups of Children Receiving Ventilating Tubes for Otitis Media. Otolaryngol Head Neck Surg 2015; 153:636-43. [PMID: 25676152 DOI: 10.1177/0194599815569491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The pathological picture may differ considerably between diagnostic subgroups of children with otitis media receiving ventilating tubes. The aims of this study are to investigate differences in quality of life among diagnostic subgroups of children treated with ventilating tubes and to investigate possible predictors for clinical success. STUDY DESIGN Longitudinal observational study. SETTING Secondary care units. METHODS Four hundred ninety-one families were enrolled in the study. The Otitis Media-6 questionnaire was applied in the assessment of child quality of life. Caregivers completed questionnaires at 7 time points from before treatment to 18-month follow-up. Logistic regression analysis was used to investigate possible predictors for clinical success. RESULTS Response rates ranged from 96% to 81%; diagnostic distribution: 15% recurrent acute otitis media (rAOM), 47% otitis media with effusion (OME), and 38% mixed diagnosis of rAOM and OME (rAOM/OME). There were no significant differences between children diagnosed with rAOM and children diagnosed with rAOM/OME. However, these children had a significantly poorer quality of life at baseline compared with children diagnosed with only OME. Factors associated with clinical success included a diagnosis of rAOM, number of interrupted nights, physician visits, and canceled social activities due to OM. CONCLUSIONS Results highlight the importance of distinguishing between diagnostic subgroups of children having ventilating tube treatment. A diagnosis of rAOM was found to predict baseline quality of life. Children with rAOM with or without OME were found to suffer significantly more than children with only OME before treatment. Factors associated with disease severity were found to predict clinical success.
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Affiliation(s)
- Christian Hamilton Heidemann
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Henrik Hein Lauridsen
- Research Unit for Clinical Biomechanics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anette Drøhse Kjeldsen
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Christian Emil Faber
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | | | - Christian Godballe
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
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143
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Preciado D. Microbiology, Antimicrobial Susceptibility, and Antibiotic Treatment. OTITIS MEDIA: STATE OF THE ART CONCEPTS AND TREATMENT 2015. [PMCID: PMC7123468 DOI: 10.1007/978-3-319-17888-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Diego Preciado
- Department of Pediatric Otolaryngology, Childrens National Medical Center, Washington, District of Columbia USA
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144
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Otitis Media and Externa. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_79-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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145
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The relationship between preoperative tympanograms and intraoperative ear examination results in children. Eur Arch Otorhinolaryngol 2014; 272:3651-4. [DOI: 10.1007/s00405-014-3421-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022]
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146
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Minovi A, Dazert S. Diseases of the middle ear in childhood. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc11. [PMID: 25587371 PMCID: PMC4273172 DOI: 10.3205/cto000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Middle ear diseases in childhood play an important role in daily ENT practice due to their high incidence. Some of these like acute otitis media or otitis media with effusion have been studied extensively within the last decades. In this article, we present a selection of important childhood middle ear diseases and discuss the actual literature concerning their treatment, management of complications and outcome. Another main topic of this paper deals with the possibilities of surgical hearing rehabilitation in childhood. The bone-anchored hearing aid BAHA(®) and the active partially implantable device Vibrant Soundbridge(®) could successfully be applied for children. In this manuscript, we discuss the actual literature concerning clinical outcomes of these implantable hearing aids.
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Affiliation(s)
- Amir Minovi
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth Hospital, Bochum, Germany
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147
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Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:243801. [PMID: 25505919 PMCID: PMC4251819 DOI: 10.1155/2014/243801] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022]
Abstract
Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P < 0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.
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148
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Rettig E, Tunkel DE. Contemporary concepts in management of acute otitis media in children. Otolaryngol Clin North Am 2014; 47:651-72. [PMID: 25213276 DOI: 10.1016/j.otc.2014.06.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acute otitis media (AOM) is a common disease of childhood. AOM is most appropriately diagnosed by careful otoscopy with an understanding of clinical signs and symptoms. The distinction between AOM and chronic otitis media with effusion should be emphasized. Treatment should include pain management, and initial antibiotic treatment should be given to those most likely to benefit, including young children, children with severe symptoms, and those with otorrhea and/or bilateral AOM. Tympanostomy tube placement may be helpful for those who experience frequent episodes of AOM or fail medical therapy. Recent practice guidelines may assist the clinician with such decisions.
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Affiliation(s)
- Eleni Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - David E Tunkel
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Room 6161B, Baltimore, MD 21287-0910, USA.
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149
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Mohiuddin S, Schilder A, Bruce I. Economic evaluation of surgical insertion of ventilation tubes for the management of persistent bilateral otitis media with effusion in children. BMC Health Serv Res 2014; 14:253. [PMID: 24927784 PMCID: PMC4112653 DOI: 10.1186/1472-6963-14-253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 06/10/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The surgical insertion of Ventilation Tubes (VTs) for the management of persistent bilateral Otitis Media with Effusion (OME) in children remains a contentious issue due to the varying opinions regarding the risks and benefits of this procedure. The aim of this study was to evaluate the economic impact of VTs insertion for the management of persistent bilateral OME in children, providing an additional perspective on the management of one of the commonest medical conditions of childhood. METHODS A decision-tree model was constructed to assess the cost-effectiveness of VTs strategy compared with the Hearing Aids (HAs) alone and HAs plus VTs strategies. The model used data from published sources, and assumed a 2-year time horizon and UK NHS perspective for costs. Outcomes were computed as Quality-Adjusted Life-Years (QALYs) by attaching a utility value to the total potential gains in Hearing Level in decibels (dBHL) over 12 and 24 months. Modelling uncertainty in the specification of decision-tree probabilities and QALYs was performed through Monte Carlo simulation. Expected Value of Perfect Information (EVPI) and partial EVPI (EVPPI) analyses were conducted to estimate the potential value of future research and uncertainty associated with the key parameters. RESULTS The VTs strategy was more effective and less costly when compared with the HAs plus VTs strategy, while the incremental cost-effectiveness ratio for the VTs strategy compared with the HAs strategy was £ 5,086 per QALY gained. At the willingness-to-pay threshold of £ 20,000 per QALY, the probability that the VTs strategy is likely to be more cost-effective was 0.58. The EVPI value at population level of around £ 9.5 million at the willingness-to-pay threshold of £ 20,000 indicated that future research in this area is potentially worthwhile, while the EVPPI analysis indicated considerable uncertainty surrounding the parameters used for computing the QALYs for which more precise estimates would be most valuable. CONCLUSIONS The VTs strategy is a cost-effective option when compared with the HAs alone and HAs plus VTs strategies, but the need for additional information from future study is evident to inform this surgical treatment choice. Future studies of surgical and non-surgical treatment of OME in childhood should evaluate the economic impact of pertinent interventions to provide greater context.
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Affiliation(s)
- Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anne Schilder
- UCL Ear, Nose and Throat Clinical Trials Programme, University College London, Gower Street, London WC1E 6BT, UK
| | - Iain Bruce
- Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
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150
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Heidemann CH, Lauridsen HH, Kjeldsen AD, Faber CE, Johansen ECJ, Godballe C. Caregiver Quality of Life and Daily Functioning in Relation to Ventilating Tube Treatment. Otolaryngol Head Neck Surg 2014; 151:341-7. [PMID: 24732686 DOI: 10.1177/0194599814529911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/11/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Caregiver quality of life and daily functioning may improve after ventilating tube treatment in children with otitis media. The aims of this study are to assess possible changes in caregiver quality of life and daily functioning in relation to ventilating tube treatment and to investigate possible predictors for clinical success. STUDY DESIGN Longitudinal observational study. SETTING Secondary care units. METHODS Four hundred ninety-one families were enrolled in the study. The Caregiver Impact Questionnaire was applied in the assessment of caregiver quality of life. Caregivers completed questionnaires at baseline and at 1, 3, 6, 12, and 18 months' follow-up. Variables on caregiver daily functioning comprised 4 weeks' history of number of interrupted nights, absenteeism, cancelled social activities, and doctor visits as a result of otitis media in the child. RESULTS Response rates ranged from 96% to 79%. Significant improvements in disease-specific quality of life were seen after treatment. The poorest baseline quality of life was found in caregivers of children with recurrent acute otitis media. Significant improvements were found on all variables on daily functioning. Predictors for caregiver-perceived clinical success included child sex, number of interrupted nights, doctor visits, absenteeism, and cancelled social activities. CONCLUSION Results of this study support the notion that caregivers of children with otitis media with defined surgical indications improve their quality of life and daily functioning after ventilating tube treatment. Factors related to caregiver functioning and disease severity were found to be associated with caregivers experiencing important improvements after treatment.
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Affiliation(s)
- Christian Hamilton Heidemann
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Henrik Hein Lauridsen
- Research Unit for Clinical Biomechanics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Anette Drøhse Kjeldsen
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Christian Emil Faber
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | | | - Christian Godballe
- Department of ENT Head & Neck Surgery, Odense University Hospital, Odense C, Denmark Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
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