1
|
Modée Borgström A, Mogensen H, Engmér Berglin C, Knutsson J, Bonnard Å. Occurrence of mucosa-affecting diseases of the upper airways in middle ear cholesteatoma patients: a nationwide case-control study. Eur Arch Otorhinolaryngol 2024; 281:4081-4087. [PMID: 38517544 PMCID: PMC11266238 DOI: 10.1007/s00405-024-08567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/18/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Exploring a possible link between upper airway inflammation and the development of cholesteatoma by studying the association between mucosa-affecting diseases of the upper airways and cholesteatoma surgery. METHODS This is a nationwide case-control study of 10,618 patients who underwent surgery for cholesteatoma in Sweden between 1987 and 2018. The cases were identified in the National Patient Register and 21,235 controls matched by age, sex and place of residency were included from national population registers. Odds ratios (OR) and corresponding 95% confidence intervals were used to assess the association between six types of mucosa-affecting diseases of the upper airways and cholesteatoma surgery. RESULTS Chronic rhinitis, chronic sinusitis and nasal polyposis were more common in cholesteatoma patients than in controls (OR 1.5 to 2.5) as were both adenoid and tonsil surgery (OR > 4) where the strongest association was seen for adenoid surgery. No association was seen between allergic rhinitis and cholesteatoma. CONCLUSION This study supports an association between mucosa-affecting diseases of the upper airways and cholesteatoma. Future studies should aim to investigate the mechanisms connecting mucosa-affecting diseases of the upper airways and cholesteatoma formation regarding genetic, anatomical, inflammatory and mucosa properties.
Collapse
Affiliation(s)
- Agnes Modée Borgström
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden.
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Engmér Berglin
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Knutsson
- Department of Otolaryngology, Västerås Hospital, Västerås, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Region Västmanland, Centre for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Åsa Bonnard
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of ENT, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Boaitey KP, Bakhit M, Hoffmann TC. Mapping the evidence about the natural history of acute infections commonly seen in primary care and managed with antibiotics: a scoping review. BMC Infect Dis 2024; 24:721. [PMID: 39044144 PMCID: PMC11264388 DOI: 10.1186/s12879-024-09526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Knowing the natural history of acute infections in primary care, defined as the course of a disease over time in the absence of specific therapy or treatment, can inform clinicians' and patients' expectations about illness recovery, but this evidence is fragmented across the literature. This scoping review aimed to map existing research and research gaps relevant to the natural history of acute infections. METHODS We searched MEDLINE, Embase and CENTRAL using a 2-phase hierarchical search approach. In Phase A, we focused on identifying systematic reviews synthesising natural history data for eligible infections (acute respiratory, urinary, and skin and soft tissue) and systematic reviews of treatment effectiveness (of RCTs with placebo or no treatment arm, or cohort studies). For infections without existing reviews, in Phase B, we searched for primary studies (placebo-controlled RCTs or cohort studies). Two reviewers independently screened and extracted the data (study characteristics, outcome data - e.g., symptom duration, proportion with resolution at various time points). RESULTS We identified 40 systematic reviews, reporting on 45 infections, most commonly (90%) respiratory tract infections. Six (15%) of these aimed to synthesise natural history information. Most reviews reported the proportion of participants with symptom resolution at various time point/s, with 58% providing data on mean symptom duration. Recovery data show the spontaneous resolution of some infections in some people. We found no eligible studies for cellulitis, ecthyma, carbuncle, and erysipelas. CONCLUSIONS Our review has shown that natural history evidence exists for many common acute infections. It can be utilised by clinicians in implementing patient-centred antibiotic stewardship strategies in primary care. Future research should focus on generating natural history evidence for skin and soft tissue infections and urinary tract infections.
Collapse
Affiliation(s)
- Kwame Peprah Boaitey
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia.
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4226, Australia
| |
Collapse
|
3
|
Zwierz A, Domagalski K, Masna K, Burduk P. Maximal medical treatment of adenoid hypertrophy: a prospective study of preschool children. Eur Arch Otorhinolaryngol 2024; 281:2477-2487. [PMID: 38291243 DOI: 10.1007/s00405-024-08459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE This study aimed to examine the effectiveness of the combined maximal medical treatment for adenoid hypertrophy in preschool children. METHODS Sixty-four children underwent one-year combined therapy with intranasal mometasone furoate, oral desloratadine, nasal saline irrigation, and bacteriotherapy. Additionally, decongestion drops were applied during scheduled breaks. RESULTS Of the 64 treated children, 72% showed clinical improvement in adenoid symptoms while 28% did not improve and underwent surgery. These groups differed significantly in terms of the overall reduction in ailments after treatment (p < 0.001), infection rate (p < 0.001), catarrh severity (p < 0.001) and nasal patency (p < 0.001). Endoscopic examination confirmed that responders experienced, on average, a decrease of 8.4% in the adenoid/choana ratio and an improvement in mucosal coverage of the adenoid. These effects were not observed in the group of children whose parents opted for surgery after nine months of conservative treatment. CONCLUSIONS The proposed new schema of long-term maximal medical treatment with the use of combined intermittent treatment of intranasal mometasone furoate and decongestion drops, oral desloratadine, nasal saline irrigation, and bacteriotherapy can be attempted in patients with adenoid hypertrophy symptoms, and responders may avoid the need for surgery. The applied treatment breaks resulted in a low number of therapeutic side effects.
Collapse
Affiliation(s)
- Aleksander Zwierz
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland.
| | - Krzysztof Domagalski
- Department of Immunology, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, 87-100, Torun, Poland
| | - Krystyna Masna
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Phoniatrics and Audiology, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, University Hospital No 2, Ujejskiego Street 75, 85-168, Bydgoszcz, Poland
| |
Collapse
|
4
|
Yu X, Zhang H, Zong S, Xiao H. Allergy in pathogenesis of Eustachian Tube Dysfunction. World Allergy Organ J 2024; 17:100860. [PMID: 38274710 PMCID: PMC10809091 DOI: 10.1016/j.waojou.2023.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/12/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Eustachian tube dysfunction (ETD) is a condition where the Eustachian tube (ET) fails to function normally, resulting in symptoms such as aural fullness, tinnitus, autophony, and hearing loss. ETD can further lead to middle ear diseases such as otitis media effusion and adhesive otitis media, which is becoming more common in the field of otology. Although the pathogenesis of ETD remains unclear, recent animal studies and clinical experiments have found allergic reactions and allergic diseases are closely related to the occurrence of ETD. As the mucosa of the ET is continuous with that of the nasopharynx and tympanic cavity, it is reasonable to assume that the immunological basis of the ET itself is similar to that of respiratory allergic diseases. However, due to the special anatomical location and complex pathogenesis of the ET, there is still no unified diagnostic gold standard. Additionally, there is an ongoing debate regarding whether ETD can be classified as a distinct disease or even an allergic disease. Furthermore, the effectiveness of anti-allergic therapy in patients with ETD is yet to be fully understood. Therefore, this review elaborates on the possible mechanisms of allergic reactions in the occurrence and development of ETD, and explores the potential role of anti-allergic therapy in managing this condition, in order to provide new insights into the pathogenesis and prevention of ETD.
Collapse
Affiliation(s)
| | | | - Shimin Zong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hongjun Xiao
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
5
|
Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 77] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
Collapse
Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
| |
Collapse
|
6
|
Effectiveness of Surgical Approach of Insertion Ventilation Tubes (Tympanostomy) and Adenoidectomy in Comparison with Non-Surgical Approach (Watchful Waiting Approach) in Children at the Age between 1 and 6 and Who Suffer from Otitis Media with Effusion (OME) in 12-Month Period of Observation-The Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312502. [PMID: 34886228 PMCID: PMC8657213 DOI: 10.3390/ijerph182312502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Otitis media with effusion (OME) is one of the most common diseases in childhood. The objective was to assess clinically the effectiveness of the surgical approach (tube insertion with adenoidectomy) in comparison with the non-surgical approach (watchful waiting) during a 12-month observation period. (2) Methods: This study was retrospective and obtained approval from the bioethics committee. The criteria of inclusion in the first group (surgical approach) were: (1) a diagnosis of chronic otitis media with effusion in children aged between 1 and 6 years; (2) their medical history showed that they had undergone adenoidectomy and tympanostomy with the insertion of ventilation tubes (VTs). The criteria for inclusion in the second group (non-surgery) were similar to the first group except that their medical history showed they had not undergone adenoidectomy or tympanostomy with the insertion of VTs. There were 422 children included in the surgical group and 50 children in the non-surgical group, and the period of observation was 12 months. (3) Results: For the entire surgical group, the number of healthy days ranged from 20 to 365, with a mean of 328.0 days (SD = 91.4).In the non-surgical group, the number of healthy days ranged from 13 to 365, with a mean of 169.2 days (SD = 127.3). The difference in the number of healthy days was statistically significant (p < 0.001). The certainty of treatment in the first group was higher than in the second group, and the number of days without recurrence was significantly higher than in the second group. In the first group, there were 71 recurrences from 422 children (16.8%), and, in the second subgroup, there were 40 recurrences of acute otitis media (AOM) from 50 children (80%). The RR was 0.21. (4) Conclusions: The surgical approach in children aged 1-6 years who have been diagnosed with otitis media with effusion is reasonable and beneficial for the child.
Collapse
|
7
|
McDonough M, Hathi K, Corsten G, Chin CJ, Campisi P, Cavanagh J, Chadha N, Graham ME, Husein M, Johnson LB, Jones J, Korman B, Manoukian J, Nguyen LHP, Sommer DD, Strychowsky J, Uwiera T, Yunker W, Hong P. Choosing Wisely Canada - pediatric otolaryngology recommendations. J Otolaryngol Head Neck Surg 2021; 50:61. [PMID: 34715936 PMCID: PMC8557011 DOI: 10.1186/s40463-021-00533-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
The Choosing Wisely Canada campaign raises awareness amongst physicians and patients regarding unnecessary or inappropriate tests and treatments. Using an online survey, members of the Pediatric Otolaryngology Subspecialty Group within the Canadian Society of Otolaryngology – Head & Neck Surgery developed a list of nine evidence based recommendations to help physicians and patients make treatment decisions regarding common pediatric otolaryngology presentations: (1) Don’t routinely order a plain film x-ray in the evaluation of nasal fractures; (2) Don’t order imaging to distinguish acute bacterial sinusitis from an upper respiratory infection; (3) Don’t place tympanostomy tubes in most children for a single episode of otitis media with effusion of less than 3 months duration; (4) Don’t routinely prescribe intranasal/systemic steroids, antihistamines or decongestants for children with uncomplicated otitis media with effusion; (5) Don’t prescribe oral antibiotics for children with uncomplicated tympanostomy tube otorrhea or uncomplicated acute otitis externa; (6) Don’t prescribe codeine for post-tonsillectomy/adenoidectomy pain relief in children; (7) Don’t administer perioperative antibiotics for elective tonsillectomy in children; (8) Don’t perform tonsillectomy for children with uncomplicated recurrent throat infections if there have been fewer than 7 episodes in the past year, 5 episodes in each of the past 2 years, or 3 episodes in each of the last 3 years; and (9) Don’t perform endoscopic sinus surgery for uncomplicated pediatric chronic rhinosinusitis prior to failure of maximal medical therapy and adenoidectomy.
Collapse
Affiliation(s)
| | - Kalpesh Hathi
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Gerard Corsten
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada
| | - Christopher J Chin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada
| | - Paolo Campisi
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Cavanagh
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Newfoundland, Canada
| | - Neil Chadha
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - M Elise Graham
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Murad Husein
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Liane B Johnson
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada
| | - Jodi Jones
- Department of Otolaryngology - Head & Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bruce Korman
- Department of Surgery, Otolaryngology/Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - John Manoukian
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Doron D Sommer
- Department of Surgery, Otolaryngology/Head & Neck Surgery Division, McMaster University, Hamilton, Ontario, Canada
| | - Julie Strychowsky
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Trina Uwiera
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Warren Yunker
- Section of Otolaryngology - Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Paul Hong
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5850/5920 University Ave, Halifax, Nova Scotia, B3K 6R8 PO Box 9700, Canada.
| |
Collapse
|
8
|
Joshi K. Is nasal balloon autoinflation an effective treatment for children with glue ear? Arch Dis Child 2021; 106:923-925. [PMID: 33455904 DOI: 10.1136/archdischild-2020-320622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Kiran Joshi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
9
|
Can party balloons replace autoinflation balloons to treat glue ear? A technical comparison. BJGP Open 2021; 5:BJGPO.2020.0178. [PMID: 33589466 PMCID: PMC8278505 DOI: 10.3399/bjgpo.2020.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/19/2021] [Indexed: 11/08/2022] Open
Abstract
Background Autoinflation balloons are used to treat patients with otitis media with effusion (OME) to help avoid surgery. Aim To compare the ability of party balloons with Otovent balloons to produce sufficient pressure for a Valsalva manoeuvre. Design & setting Pressure testing was used to determine the number of times each balloon could produce pressures sufficient for a Valsalva manoeuvre. Subsequently, Otovent balloons were compared with spherical party balloons in a pilot clinical trial of 12 healthy adults. Method Each balloon was inflated 20 times and the maximum pressure was recorded. Three balloons of each type were tested to 50 inflations to assess pressures over persistent use. Results Otovent balloons’ mean inflation pressure was 93 mmHg (95% confidence interval [CI] = 89 to 97 mmHg) on first inflation, dropping to 83 mmHg (95% CI = 80 to 86 mmHg) after 20 inflations. Two types of spherical party balloon required mean inflation pressures of 84 mmHg (95% CI = 77 to 90 mmHg) and 108 mmHg (95% CI = 97 to 119 mmHg) on first inflation, dropping to 74 mmHg (95% CI = 68 to 81 mmHg) and 83 mmHg (95% CI = 77 to 88 mmHg) after 20 inflations. In the pilot trial, there was no difference between the ability of Otovent and spherical balloons (χ2 = 0.24, P = 0.89) to produce the sensation of a Valsalva manoeuvre. Conclusion Otovent balloons can be used more than the 20 times quoted by the manufacturer. The two spherical balloons produced similar pressures to Otovent balloons, indicating potentially the same clinical effect. The pilot study suggests a potential use of spherical party balloons instead of Otovent balloons as a cost-efficient treatment.
Collapse
|
10
|
Calatayud-Sáez FM, Calatayud B, Calatayud A. Effects of the Traditional Mediterranean Diet in Patients with Otitis Media with Effusion. Nutrients 2021; 13:2181. [PMID: 34202888 PMCID: PMC8308248 DOI: 10.3390/nu13072181] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Otitis media with effusion (OME) is common in pediatric primary care consultations. Its etiology is multifactorial, although it has been proven that inflammation factors mediate and that immunity is in a phase of relative immaturity. The objective of this study was to assess the effects of the Traditional Mediterranean Diet (TMD) modulating inflammation and immunity in patients diagnosed with OME. MATERIALS AND METHODS A analysis as a single-group pre-test/post-test was conducted on 40 girls and 40 boys between 18 months and 5 years old. Tympanometry normalization was the main test to control the benefit of diet. Clinical and therapeutic variables were studied through evaluation questionnaires, a quality test of the diet, as well as various anthropometric parameters. RESULTS At the end of one year, tympanometry had normalized in 85% of patients. The remaining 15% had normal audiometry and/or associated symptoms had decreased. Likewise, episodes of recurrent colds decreased from 5.96 ± 1.41 to 2.55 ± 0.37; bacterial complications of 3.09 ± 0.75 to 0.61 ± 0.06 and persistent nasal obstruction of 1.92 ± 0.27 to 0.26 ± 0.05. The degree of satisfaction of the families with the program was very high. CONCLUSIONS The application of the Traditional Mediterranean Diet could have promising effects in the prevention and treatment of otitis media with effusion.
Collapse
|
11
|
Adamczyk P, Narożna B, Szczepankiewicz A, Bręborowicz A, Pucher B, Kotowski M, Sroczyński J, Kałużna-Młynarczyk A, Szydłowski J. Decreased miRNA-320e correlates with allergy in children with otitis media with effusion. Auris Nasus Larynx 2021; 48:1061-1066. [PMID: 33812758 DOI: 10.1016/j.anl.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 03/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Otitis media with effusion (OME) is a common childhood disease and the main cause of conductive hearing loss in this age group. Many factors predispose to OME but allergy is still widely disputed. The answer may lay in the molecular mechanisms of ear exudate formation and the recent studies showed miRNAs might take part in it. MiRNAs are also potent regulators of allergic response. As miRNAs are present in the middle ear, we hypothesized their expression differs between allergic and non-allergic patients and reflects the difference in pathomechanism of effusion formation between these two groups. MATERIALS AND METHODS This study aimed to establish the expression of 5 different miRNAs (miR-223-3p, miR-451a, miR-16-5p, miR-320e, miR-25-3p) in ear exudates in children diagnosed with OME. The allergy group consisted of 18 patients whereas the non-allergic group had 36 patients. MicroRNA was isolated from the middle ear fluid collected during myringotomy and transcribed into cDNA. MiRNA expression was measured with TaqMan™ MicroRNA Assays and analyzed with DataAssist software. The comparative CT method was used for calculating the relative quantification of gene expression based on the endogenous control gene expression (U6 snRNA-001973). RESULTS MiR-320e expression was significantly decreased in allergic children with OME. Other studied miRNAs also showed reduced expression in allergic children, but the decrease was not significant. CONCLUSIONS MiRNA expression differs between children with and without allergy in the course of OME, but further studies are needed to explain the exact role of miR-320e and its target genes in OME pathology in allergic patients.
Collapse
Affiliation(s)
- Paulina Adamczyk
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland.
| | - Beata Narożna
- Laboratory of Molecular and Cell Biology, Department of Pediatric Pulmonology, Allergy and Clinical Immunology, IIIrd Department of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Aleksandra Szczepankiewicz
- Laboratory of Molecular and Cell Biology, Department of Pediatric Pulmonology, Allergy and Clinical Immunology, IIIrd Department of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Anna Bręborowicz
- Department of Pediatric Pulmonology, Allergy and Clinical Immunology, IIIrd Department of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Beata Pucher
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Michał Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Jakub Sroczyński
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Agata Kałużna-Młynarczyk
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| | - Jarosław Szydłowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, Szpitalna 27/33 60-572 Poznań, Poland
| |
Collapse
|
12
|
Ranakusuma RW, McCullough AR, Safitri ED, Pitoyo Y, Widyaningsih W, Del Mar CB, Beller EM. Oral prednisolone for acute otitis media in children: a pilot, pragmatic, randomised, open-label, controlled study (OPAL study). Pilot Feasibility Stud 2020; 6:121. [PMID: 32874679 PMCID: PMC7455987 DOI: 10.1186/s40814-020-00671-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/19/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Acute otitis media (AOM) is associated with high antibiotic prescribing rates. Antibiotics are somewhat effective in improving pain and middle ear effusion (MEE); however, they have unfavourable effects. Alternative treatments, such as corticosteroids as anti-inflammatory agents, are needed. Evidence for the efficacy of these remains inconclusive. We conducted a pilot study to test feasibility of a proposed large-scale randomised controlled trial (RCT) to assess the efficacy of corticosteroids for AOM. METHODS We conducted a pilot, pragmatic, parallel, open-label RCT of oral corticosteroids for paediatric AOM in primary and secondary/tertiary care centres in Indonesia. Children aged 6 months-12 years with AOM were randomised to either prednisolone or control (1:1). Physicians were blinded to allocation. Our objectives were to test the feasibility of our full RCT procedures and design, and assess the mechanistic effect of corticosteroids, using tympanometry, in suppressing middle ear inflammation by reducing MEE. RESULTS We screened 512 children; 62 (38%) of 161 eligible children were randomised and 60 were analysed for the primary clinical outcome. All study procedures were completed successfully by healthcare personnel and parents/caregivers, despite time constraints and high workload. All eligible, consenting children were appropriately randomised. One child did not take the medication and four received additional oral corticosteroids. Our revised sample size calculation verified 444 children are needed for the full RCT. Oral corticosteroids did not have any discernible effects on MEE resolution and duration. There was no correlation between pain or other symptoms and MEE change. However, prednisolone may reduce pain intensity at day 3 (Visual Analogue Scale mean difference - 7.4 mm, 95% confidence interval (CI) - 13.4 to - 1.3, p = 0.018), but cause drowsiness (relative risk (RR) 1.8, 95% CI 1.1 to 2.8, p = 0.016). Tympanometry curves at day 7 may be improved (RR 1.8, 95% CI 1.0 to 2.9). We cannot yet confirm these as effects of corticosteroids due to insufficient sample size in this pilot study. CONCLUSIONS It is feasible to conduct a large, pragmatic RCT of corticosteroids for paediatric AOM in Indonesia. Although oral corticosteroids may reduce pain and improve tympanometry curves, it requires an adequately powered clinical trial to confirm this. TRIAL REGISTRATION Study registry number: ACTRN12618000049279. Name of registry: the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of registration: 16 January 2018.
Collapse
Affiliation(s)
- Respati W. Ranakusuma
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Amanda R. McCullough
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| | - Eka D. Safitri
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Yupitri Pitoyo
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Widyaningsih Widyaningsih
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr. Cipto Mangunkusumo General Hospital – Faculty of Medicine Universitas Indonesia, Diponegoro 71, Jakarta, 10430 Indonesia
| | - Christopher B. Del Mar
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| | - Elaine M. Beller
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, QLD 4226 Australia
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Eustachian tube dysfunction (ETD) presents with symptoms of aural fullness and pressure, muffled hearing, tinnitus, and otalgia. When severe, it can lead to many common ear disorders such as otitis media with effusion, tympanic membrane retraction/perforation, and cholesteatoma. These diseases are prevalent in both the pediatric and adult population and significantly impact quality of life. The pathophysiology of ETD in the absence of an obstructive lesion has long been debated but is thought to be related to functional obstruction (i.e., inefficient tensor veli palatini muscle) and/or nasal cavity and nasopharyngeal inflammation. In the acute setting, the most common cause of nasal inflammation is an upper respiratory infection. When symptoms become chronic, however, the inflammation is thought to be associated with nasal irritants such as nasal allergens, i.e., allergic rhinitis (AR). The purpose of this review is to summarize our current understanding of the relationship between allergy and ETD. RECENT FINDINGS Past studies are either lacking or have reported equivocal findings regarding the relationship between allergy and ETD, and the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis has deemed the current level of evidence linking AR and ETD as low quality. A more recent study using a large adult population dataset did support an association between AR and ETD, but did not find that all cases of ETD are related to allergies. Furthermore, current evidence suggests that the use of medications that can decrease intranasal inflammation, such as intranasal corticosteroids or oral antihistamines, does not result in significant symptomatic improvement in patients with ETD. However, these studies included all patients with ETD, and evidence is lacking regarding the treatment effect of these medications on the subset of patients with concurrent AR and ETD. Current best evidence does support an association between AR and ETD; however, not all patients with ETD suffer from AR, and vice versa. Further research is necessary to understand the mechanism behind this positive association and to elucidate the cause of chronic ETD in patients without associated allergies.
Collapse
Affiliation(s)
| | - Patricia A Loftus
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA.
| |
Collapse
|
14
|
Pineda-Gea F. Aspectos clinicoepidemiológicos de las patologías ambulatorias del oído frecuentes en adultos. REVISTA ORL 2020. [DOI: 10.14201/orl.23063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
RESUMEN Introducción y objetivo: La patología otorrinolaringología tiene una alta incidencia en afecciones agudas como crónicas en la consulta externa de ORL, pese a esto, no existen datos estadísticos exactos, confiables y estandarizados sobre el perfil epidemiológico de las patologías otológicas ambulatorias en nuestro medio. El objetivo de este estudio fue describir las características clínicas, epidemiológicas, de tratamiento y seguimiento pro-pios de las tres patologías otológicas ambulatorias diagnosticadas frecuentemente en la consulta otorrinolaringológica en nuestra región. Método: Se realizó un estudio observa-cional retrospectivo, en 312 pacientes con patologías otológicas, las variables estudiadas fueron procesadas a través del programa estadístico IBM-SPSS®, aplicando una técnica estadística descriptiva. Resultados: Los tres diagnósticos más frecuentes en consulta externa fueron: otitis media crónica en el 60.6%, predomino en mujeres con el 44%; 12.8% presbiacusia, en la cual no hubo distinción de sexo y 12.17% otomicosis afectando a muje-res en el 65.7%. Tuvieron una mayor prevalencia en mayores de 51 años, procedentes del área urbana, sin ninguna formación profesional, manifestándose como hipoacusia, oto-rrea, otalgia y prurito ótico, referidas de manera aislada o en combinación. Se evidenció que la otomicroscopía, impedanciometría y audiometría tonal liminal fueron las principales técnicas otológicas realizadas para el diagnóstico. El tratamiento farmacológico en proce-sos infecciosos fue ciprofloxacino oral y ótico, fluconazol oral asociado clotrimazol o clioquinol ótico, se observó la prescripción de loratadina en el 91.5% de los pacientes con OMC, 40% en los pacientes con presbiacusia y un 73.6 % en pacientes con otomico-sis. Las principales complicaciones clínicas se encontraron en pacientes con OMC tras una segunda evaluación, las cuales fueron parálisis facial 2.1%y colesteatoma adquirido asociado a otomastoiditis crónica en el 0.96%.Discusión: La prevalencia y afectación en cuanto al sexo por OMC, presbiacusia y otomicosis discrepa con lo obtenido en otras investigaciones aunque su prevalencia con respecto a la edad se asemeja a lo reportado por otros investigadores Las técnicas complementarias de diagnóstico y el tratamiento se alinean a lo descrito en la literatura, pese a esto, se identificó la prescripción de antihista-mínico las cual no fue fundamentada en el expediente clínico, se observó que el uso de antibióticos tópico en combinación por vía oral no fue del todo eficaz para evitar reagudi-zaciones. Conclusiones: Los diagnósticos más frecuentes fueron OMC, presbiacusia y otomicosis, prevalecieron en mujeres entre la quinta década de vida. El tratamiento diag-nóstico y terapéutico de las patologías ambulatorias de etiología infecciosa coincide con la literatura, salvo la prescripción de antihistamínicos la cual fue común en el grupo pobla-cional, así mismo se identificó que el uso significativo de antibióticos orales, más allá de la terapia tópica, no es del todo eficaz para evitar recidivas y complicaciones.
Collapse
|
15
|
Komi DEA, Khomtchouk K, Santa Maria PL. A Review of the Contribution of Mast Cells in Wound Healing: Involved Molecular and Cellular Mechanisms. Clin Rev Allergy Immunol 2020; 58:298-312. [PMID: 30729428 DOI: 10.1007/s12016-019-08729-w] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mast cells (MCs), apart from their classic role in allergy, contribute to a number of biologic processes including wound healing. In particular, two aspects of their histologic distribution within the skin have attracted the attention of researchers to study their wound healing role; they represent up to 8% of the total number of cells within the dermis and their cutaneous versions are localized adjacent to the epidermis and the subdermal vasculature and nerves. At the onset of a cutaneous injury, the accumulation of MCs and release of proinflammatory and immunomodulatory mediators have been well documented. The role of MC-derived mediators has been investigated through the stages of wound healing including inflammation, proliferation, and remodeling. They contribute to hemostasis and clot formation by enhancing the expression of factor XIIIa in dermal dendrocytes through release of TNF-α, and contribute to clot stabilization. Keratinocytes, by secreting stem cell factor (SCF), recruit MCs to the site. MCs in return release inflammatory mediators, including predominantly histamine, VEGF, interleukin (IL)-6, and IL-8, that contribute to increase of endothelial permeability and vasodilation, and facilitate migration of inflammatory cells, mainly monocytes and neutrophils to the site of injury. MCs are capable of activating the fibroblasts and keratinocytes, the predominant cells involved in wound healing. MCs stimulate fibroblast proliferation during the proliferative phase via IL-4, vascular endothelial growth factor (VEGF), and basic fibroblast growth factor (bFGF) to produce a new extracellular matrix (ECM). MC-derived mediators including fibroblast growth factor-2, VEGF, platelet-derived growth factor (PDGF), TGF-β, nerve growth factor (NGF), IL-4, and IL-8 contribute to neoangiogenesis, fibrinogenesis, or reepithelialization during the repair process. MC activation inhibition and targeting the MC-derived mediators are potential therapeutic strategies to improve wound healing through reduced inflammatory responses and scar formation.
Collapse
Affiliation(s)
- Daniel Elieh Ali Komi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kelly Khomtchouk
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA
| | - Peter Luke Santa Maria
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Stanford University, 801 Welch Rd, Stanford, CA, 94305, USA.
| |
Collapse
|
16
|
Myringotomy and tube insertion combined with balloon eustachian tuboplasty for the treatment of otitis media with effusion in children. Eur Arch Otorhinolaryngol 2020; 277:1281-1287. [PMID: 32002612 DOI: 10.1007/s00405-020-05828-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to clarify the role and safety of balloon eustachian tuboplasty (BET) in the treatment of otitis media with effusion (OME) in children. METHODS This retrospective study was performed between January 2017 and February 2018. The study covered 25 OME patients treated with BET combined with myringotomy and tube insertion (MTI), designated as the BET group, and 24 OME patients treated with MTI during the same period considered as the controls. In addition, all patients received adenoidectomy if found with adenoid hypertrophy. The air-bone conduction gap (ABG) and curative effect were compared between the two groups. Tubomanometry (TMM) results were recorded preoperatively to confirm existence of eustachian tube dysfunction (ETD). Otologic history and examination results of all patients were carefully recorded before the operation, at 6, 12 and 18 months postoperatively. RESULTS Six months after surgery, ABG difference between the two groups was less than 1 dB HL. At 12 months after the operation, ABG in the BET group was smaller than that in the control group. There was a marked ABG deterioration (from 10.1 to 15.9 dB HL) in the control group compared to that in BET. Statistically significant differences in ABG difference between the two groups were observed 18 months after surgery with cured and total effective rates of BET at 76.1 and 93.5%, respectively. In the control group, these rates were 60.9 and 89.1% respectively. No serious complications and tympanic perforations were found in all subjects. CONCLUSION MTI combined with BET is effective and safe in the treatment of children with OME. Compared to simple MTI, application of BET can effectively extend improvement period and increase cured rate, especially after removal of the ventilation tube. Directly benefit from the ventilation tube, the curative effect was close during the period of tube retention. Considering the sample size and follow-up time of this study, related studies targeting large cohorts are needed in the future to validate the benefits of BET in children with OME.
Collapse
|
17
|
Roditi RE, Caradonna DS, Shin JJ. The Proposed Usage of Intranasal Steroids and Antihistamines for Otitis Media with Effusion. Curr Allergy Asthma Rep 2019; 19:47. [PMID: 31486909 DOI: 10.1007/s11882-019-0879-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW To examine the role of allergy medications in the treatment of otitis media with effusion (OME), focusing on use of intranasal steroids and antihistamines. RECENT FINDINGS There has been ongoing controversy regarding the role of allergy in the development of OME. Treatment of OME with medications commonly used for allergic symptomatology has been studied. Proposed treatment options include decongestants, mucolytics, oral steroids, topical steroids, antihistamines, and antibiotics. We begin by evaluating the proposed association between allergy and OME, and then evaluate intranasal steroids and oral antihistamine therapy in the treatment of OME. The role of the adenoid and concurrent nasal symptomatology is also addressed. The preponderance of data suggests that neither intranasal steroids nor antihistamines improve the long-term clearance of isolated OME and are therefore not recommended. However, data are notably limited with regard to improvement rates in OME in patients specifically with concurrent allergy and/or adenoid hypertrophy. Future studies of medications for OME would ideally incorporate study designs controlling for both allergic rhinitis and adenoid hypertrophy, to better understand the impact of these medications on OME in these subgroups of patients.
Collapse
Affiliation(s)
- Rachel E Roditi
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham & Women's Hospital, 45 Francis Street ASB II, Boston, MA, 02115, USA
| | - David S Caradonna
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, 110 Francis Street, Suite 6E, Boston, MA, 02115, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Brigham & Women's Hospital, 45 Francis Street ASB II, Boston, MA, 02115, USA.
| |
Collapse
|
18
|
Francis NA, Waldron CA, Cannings-John R, Thomas-Jones E, Winfield T, Shepherd V, Harris D, Hood K, Fitzsimmons D, Roberts A, Powell CV, Gal M, Jones S, Butler CC. Oral steroids for hearing loss associated with otitis media with effusion in children aged 2-8 years: the OSTRICH RCT. Health Technol Assess 2019; 22:1-114. [PMID: 30407151 DOI: 10.3310/hta22610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Children with hearing loss associated with otitis media with effusion (OME) are commonly managed through surgical intervention, hearing aids or watchful waiting. A safe, inexpensive, effective medical treatment would enhance treatment options. Small, poorly conducted trials have found a short-term benefit from oral steroids. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of a 7-day course of oral steroids in improving hearing at 5 weeks in children with persistent OME symptoms and current bilateral OME and hearing loss demonstrated by audiometry. DESIGN Double-blind, individually randomised, placebo-controlled trial. SETTING Ear, nose and throat outpatient or paediatric audiology and audiovestibular medicine clinics in Wales and England. PARTICIPANTS Children aged 2-8 years, with symptoms of hearing loss attributable to OME for at least 3 months, a diagnosis of bilateral OME made on the day of recruitment and audiometry-confirmed hearing loss. INTERVENTIONS A 7-day course of oral soluble prednisolone, as a single daily dose of 20 mg for children aged 2-5 years or 30 mg for 6- to 8-year-olds, or matched placebo. MAIN OUTCOME MEASURES Acceptable hearing at 5 weeks from randomisation. Secondary outcomes comprised acceptable hearing at 6 and 12 months, tympanometry, otoscopic findings, health-care consultations related to OME and other resource use, proportion of children who had ventilation tube (grommet) surgery at 6 and 12 months, adverse effects, symptoms, functional health status, health-related quality of life, short- and longer-term cost-effectiveness. RESULTS A total of 389 children were randomised. Satisfactory hearing at 5 weeks was achieved by 39.9% and 32.8% in the oral steroid and placebo groups, respectively (absolute difference of 7.1%, 95% confidence interval -2.8% to 16.8%; number needed to treat = 14). This difference was not statistically significant. The secondary outcomes were consistent with the picture of a small or no benefit, and we found no subgroups that achieved a meaningful benefit from oral steroids. The economic analysis showed that treatment with oral steroids was more expensive and accrued fewer quality-adjusted life-years than treatment as usual. However, the differences were small and not statistically significant, and the sensitivity analyses demonstrated large variation in the results. CONCLUSIONS OME in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. Discussions about watchful waiting and other interventions will be enhanced by this evidence. The findings of this study suggest that any benefit from a short course of oral steroids for OME is likely to be small and of questionable clinical significance, and that the treatment is unlikely to be cost-effective and, therefore, their use cannot be recommended. FUTURE WORK Studies exploring optimal approaches to sharing natural history data and enhancing shared decision-making are needed for this condition. TRIAL REGISTRATION Current Controlled Trials ISRCTN49798431 and EudraCT 2012-005123-32. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 61. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Nick A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Thomas Winfield
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Amanda Roberts
- Cardiff & Vale University Health Board, Child Health Directorate, St David's Children Centre, Cardiff, UK
| | - Colin Ve Powell
- Department of General Paediatrics, Children's Hospital for Wales, Cardiff, UK
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah Jones
- Involving People Network, Health and Care Research Wales, Cardiff, UK
| | - Christopher C Butler
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Blanc F, Ayache D, Calmels MN, Deguine O, François M, Leboulanger N, Lescanne E, Marianowski R, Nevoux J, Nicollas R, Tringali S, Tessier N, Franco-Vidal V, Bordure P, Mondain M. Management of otitis media with effusion in children. Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 135:269-273. [PMID: 29759911 DOI: 10.1016/j.anorl.2018.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Société française d'ORL et de chirurgie cervico-faciale clinical practice guidelines concern the management of otitis media with effusion (OME) in children under the age of 12 years. They are based on extensive review of MEDLINE and Cochrane Library publications in English or French from 1996 to 2016 concerning the methods of diagnosis and assessment of otitis media with effusion, as well as the efficacy of tympanostomy tubes and medical and surgical treatments of OME.
Collapse
Affiliation(s)
- F Blanc
- Service d'ORL, hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France.
| | - D Ayache
- Service d'ORL, fondation Rothschild, 75019 Paris, France
| | - M N Calmels
- Service d'ORL, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
| | - O Deguine
- Service d'ORL, hôpital Purpan, CHU de Toulouse, 31059 Toulouse, France
| | - M François
- Service d'ORL, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - N Leboulanger
- Service d'ORL, hôpital Necker, AP-HP, 75015 Paris, France
| | - E Lescanne
- Service d'ORL, CHU de Tours, 37000 Tours, France
| | | | - J Nevoux
- Service d'ORL, hôpital Kremlin-Bicêtre, AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - R Nicollas
- Service d'ORL pédiatrique, AP-HM La Timone, 13005 Marseille, France
| | - S Tringali
- Service d'ORL, CHU de Lyon, 69003 Lyon, France
| | - N Tessier
- Service d'ORL, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | | | - P Bordure
- Service d'ORL, CHU de Nantes, 44093 Nantes, France
| | - M Mondain
- Service d'ORL, hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France
| |
Collapse
|
20
|
Vanneste P, Page C. Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review. J Otol 2019; 14:33-39. [PMID: 31223299 PMCID: PMC6570640 DOI: 10.1016/j.joto.2019.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/17/2019] [Accepted: 01/25/2019] [Indexed: 12/20/2022] Open
Abstract
Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases) tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed.
Collapse
Affiliation(s)
- Pauline Vanneste
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Hospital, Amiens, France
| | - Cyril Page
- Department of Otorhinolaryngology and Head & Neck Surgery, Amiens University Hospital, Amiens, France
| |
Collapse
|
21
|
Nasal balloon autoinflation for glue ear in primary care: a qualitative interview study. Br J Gen Pract 2018; 69:e24-e32. [PMID: 30510093 DOI: 10.3399/bjgp18x700217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Nasal balloon autoinflation is an effective, non-surgical treatment for symptomatic children with glue ear, although uptake is variable and evidence about acceptability and feasibility is limited. AIM To explore parent and healthcare professional views and experiences of nasal balloon autoinflation for children with glue ear in primary care. DESIGN AND SETTING Qualitative study using semi-structured interviews with a maximum-variety sample of parents, GPs, and practice nurses. The study took place between February 2013 and September 2014. METHOD Semi-structured face-to-face and telephone interviews were audiorecorded, transcribed verbatim, and analysed using inductive thematic analysis. RESULTS In all, 14 parents, 31 GPs, and 19 nurses were included in the study. Parents described the nasal balloon as a natural, holistic treatment that was both acceptable and appealing to children. GPs and nurses perceived the method to be a low-cost, low-risk strategy, applicable to the primary care setting. Good instruction and demonstration ensured children mastered the technique and engaged with the treatment, but uncertainties were raised about training provision and potential impact on the GP consultation. Making nasal balloon autoinflation part of a child's daily routine enhances compliance, but difficulties can arise if children are unwell or refuse to cooperate. CONCLUSION Nasal balloon autoinflation is an acceptable, low-cost treatment option for children with glue ear in primary care. Provision of educational materials and demonstration of the method are likely to promote uptake and compliance. Wider use of the nasal balloon has the potential to enhance early management, and may help to fill the management gap arising from forthcoming changes to care pathways.
Collapse
|
22
|
The Influence of Age on the Relationship Between Allergic Rhinitis and Otitis Media. Curr Allergy Asthma Rep 2018; 18:68. [PMID: 30343453 DOI: 10.1007/s11882-018-0826-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To examine the relationship between otitis media, allergic rhinitis, and age. RECENT FINDINGS Otitis media and allergic rhinitis are prevalent conditions with a controversial relationship. Some data suggest that these entities are significantly associated, either through allergic rhinitis inducing Eustachian tube dysfunction or through allergic pathophysiology simultaneously occurring intranasally and in the ear. Other studies, however, have refuted this relationship. For example, treatment with antihistamines does not reliably improve OME, making causation and association challenging to establish. Age may have an effect on the nature of the relationship between allergic rhinitis and otitis media, by impacting both the individual conditions and their association. Epidemiological, immunological, and adenoidal studies have suggested that differences occur with age, and this review encapsulates the related data and publications. We begin by evaluating how allergic rhinitis and otitis media each are affected by age, then evaluate the role that age may have in the relationship between the two conditions. Adult and pediatric literature are evaluated so as to include the full impact of age across patients' lifespan. Age induces changes in immunity, patterns of inflammation, and susceptibility to both allergic rhinitis and otitis media with effusion. Age may also be an effect modifier which impacts the nature of the relationship between these two conditions. The influence of age on the association between these highly prevalent conditions remains a topic of active study.
Collapse
|
23
|
Francis NA, Cannings-John R, Waldron CA, Thomas-Jones E, Winfield T, Shepherd V, Harris D, Hood K, Fitzsimmons D, Roberts A, Powell C, Gal M, Butler CC. Oral steroids for resolution of otitis media with effusion in children (OSTRICH): a double-blinded, placebo-controlled randomised trial. Lancet 2018; 392:557-568. [PMID: 30152390 PMCID: PMC6099122 DOI: 10.1016/s0140-6736(18)31490-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/21/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Children with persistent hearing loss due to otitis media with effusion are commonly managed by surgical intervention. A safe, cheap, and effective medical treatment would enhance treatment options. Underpowered, poor-quality trials have found short-term benefit from oral steroids. We aimed to investigate whether a short course of oral steroids would achieve acceptable hearing in children with persistent otitis media with effusion and hearing loss. METHODS In this individually randomised, parallel, double-blinded, placebo-controlled trial we recruited children aged 2-8 years with symptoms attributable to otitis media with effusion for at least 3 months and with confirmed bilateral hearing loss. Participants were recruited from 20 ear, nose, and throat (ENT), paediatric audiology, and audiovestibular medicine outpatient departments in England and Wales. Participants were randomly allocated (1:1) to sequentially numbered identical prednisolone (oral steroid) or placebo packs by use of computer-generated random permuted block sizes stratified by site and child's age. The primary outcome was audiometry-confirmed acceptable hearing at 5 weeks. All analyses were by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN49798431. FINDINGS Between March 20, 2014, and April 5, 2016, 1018 children were screened, of whom 389 were randomised. 200 were assigned to receive oral steroids and 189 to receive placebo. Hearing at 5 weeks was assessed in 183 children in the oral steroid group and in 180 in the placebo group. Acceptable hearing was observed in 73 (40%) children in the oral steroid group and in 59 (33%) in the placebo group (absolute difference 7% [95% CI -3 to 17], number needed to treat 14; adjusted odds ratio 1·36 [95% CI 0·88-2·11]; p=0·16). There was no evidence of any significant differences in adverse events or quality-of-life measures between the groups. INTERPRETATION Otitis media with effusion in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. A short course of oral prednisolone is not an effective treatment for most children aged 2-8 years with persistent otitis media with effusion, but is well tolerated. One in 14 children might achieve improved hearing but not quality of life. Discussions about watchful waiting and other interventions will be supported by this evidence. FUNDING National Institute for Health Research (NIHR) Health Technology Assessment programme.
Collapse
Affiliation(s)
- Nick A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK.
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Cherry-Ann Waldron
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Tom Winfield
- Swansea Centre for Health Economics, College of Human Health Sciences, Swansea University, Singleton Park, Swansea, UK
| | - Victoria Shepherd
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Debbie Harris
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Deborah Fitzsimmons
- Swansea Centre for Health Economics, College of Human Health Sciences, Swansea University, Singleton Park, Swansea, UK
| | - Amanda Roberts
- Cardiff and Vale University Health Board, Child Health Directorate, St David's Children Centre, Cowbridge Road East, Cardiff, UK
| | - Colin Powell
- Department of General Paediatrics, Children's Hospital for Wales, Heath Park, Cardiff, UK
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| |
Collapse
|
24
|
Simon F, Haggard M, Rosenfeld RM, Jia H, Peer S, Calmels MN, Couloigner V, Teissier N. International consensus (ICON) on management of otitis media with effusion in children. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:S33-S39. [PMID: 29398506 DOI: 10.1016/j.anorl.2017.11.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/31/2022]
Abstract
Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection. Children can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) thus requiring treatment. Although many meta-analyses and national guidelines have been issued, management remains difficult to standardize, and use of surgical and medical treatments continue to vary. We convened an international consensus conference as part of the 2017 International Federation of Oto-rhino-laryngological Societies Congress, to identify best practices in OME management. Overall, regional differences were minor and consensual management was obtained on several important issues. At initial assessment, although a thorough medical examination is necessary to seek reflux, allergy or nasal obstruction symptoms; an age-appropriate auditory test is the only assessment required in children without abnormal history. Non-surgical treatments poorly address the underlying problem of an age-dependent dysfunctional Eustachian tube; auto-inflation seems to be the only beneficial, low-risk and low-cost non-surgical therapy. There was a clear international recommendation against using steroids, antibiotics, decongestants or antihistamines to treat OME, because of side-effects, cost issues and no convincing evidence of long-term effectiveness. Decisions to insert tympanostomy ventilation tubes should be based on an auditory test but also take into account the child's context and overall hearing difficulties. Tubes significantly improve hearing and reduce the number of recurrent AOM with effusion while in place. Adjuvant adenoidectomy should be considered in children over four years of age, and in those with significant nasal obstruction or infection.
Collapse
Affiliation(s)
- F Simon
- Department of Pediatric Otolaryngology, hôpital Necker-Enfants-Malades, Paris-Descartes University, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - M Haggard
- Department of Psychology, Cambridge University, Downing Street, Cambridge CB2 3EB, United Kingdom
| | - R M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, 450, Clarkson avenue, MSC 126, Brooklyn, NY 11203, United States of America
| | - H Jia
- Department of Otolaryngology, Shanghai Ninth People's Hospital & Shanghai Jiaotong University School of Medicine, 639, Zhizaoju Road, Shanghai 200011, China
| | - S Peer
- Department of Pediatric Otolaryngology, Red Cross War Memorial Children's Hospital, University of Cape Town,, Rondebosch, Cape Town 7700, South Africa
| | - M-N Calmels
- Department of Otolaryngology, Purpan Hospital, Paul-Sabatier-Toulouse-3 University, CHU de Toulouse, 1, place du Dr-Baylac, 31059 Toulouse, France
| | - V Couloigner
- Department of Pediatric Otolaryngology, hôpital Necker-Enfants-Malades, Paris-Descartes University, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - N Teissier
- Department of Pediatric Otolaryngology, hôpital Robert-Debré, Paris-Diderot University, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
| |
Collapse
|
25
|
Cioffi L, Gallo P, D'Avino A, Carlomagno F, Aloi G, D'Onofrio A, Del Gaizo D, Giuliano M, De Franchis R, Sandomenico ML, Pecoraro A. Clinical Improvement of Subacute and Chronic Otitis Media With Effusion Treated With Hyaluronic Acid Plus Hypertonic Solution via Nasal Lavage: A Randomized Controlled Trial. Glob Pediatr Health 2017; 4:2333794X17725983. [PMID: 28894768 PMCID: PMC5582658 DOI: 10.1177/2333794x17725983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/12/2017] [Indexed: 12/22/2022] Open
Abstract
Background. This study, a randomized controlled trial, aims to demonstrate a clinically significant improvement in subacute and chronic otitis media with effusion through the administration of hyaluronic acid associated with hypertonic solution compared with the administration of hypertonic solution alone. The setting was an outpatient clinic of 20 primary care pediatrician offices affiliated with the 3 Local Health Units (Azienda Sanitaria Locale) of Naples. Materials and Methods. The study was conducted for 6 months, from October 2014 to the end of March 2015. The study saw the participation of 20 pediatricians who were experts in pneumatic otoscopy, each of whom enrolled 15 children. Each investigator was randomized to carry out the treatment with 3% hypertonic solution or high-molecular-weight hyaluronic acid + 3% hypertonic solution. Results. A total of 275 children were enrolled, of whom 11(equal to 4% ) were lost to follow-up. A total of 264 children completed the trial according to the protocol, 120 in the hyaluronic acid + hypertonic solution group and 144 in the hypertonic solution group. Hyaluronic acid associated with hypertonic solution and hypertonic solution alone administered by nasal lavage have proven to be safe and effective in the treatment of prolonged otitis media with effusion (initial score of −0.5, final score of 0.9, P < 001, for the hypertonic + hyaluronic acid group; initial score of −0.3, final score of 0.2, P < .001, for the hypertonic solution group). Though starting from a less favorable initial clinical score (−0.5 vs −0.3, P < .016), hyaluronic acid associated with hypertonic solution resulted in a significant increase in clinical healing (0.9 vs 0.2, P < .001). One interesting outcome was the significant reduction in the consumption of drugs (cortisone and antibiotics) during the follow-up.
Collapse
Affiliation(s)
- Luigi Cioffi
- FIMP (Italian Federation Pediatric Doctors), Naples, Italy
| | - Patrizia Gallo
- FIMP (Italian Federation Pediatric Doctors), Naples, Italy
| | | | | | - Giuseppe Aloi
- FIMP (Italian Federation Pediatric Doctors), Naples, Italy
| | | | | | - Maria Giuliano
- FIMP (Italian Federation Pediatric Doctors), Naples, Italy
| | | | | | | |
Collapse
|
26
|
Gilani S, Shin JJ. The Burden and Visit Prevalence of Pediatric Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2017; 157:1048-1052. [DOI: 10.1177/0194599817721177] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Pediatric chronic rhinosinusitis has a substantial impact, but its epidemiology has yet to be elucidated. Our objectives were (1) to determine the associated national visit burden and (2) to assess its frequency relative to other frequent childhood otolaryngological illnesses. Study Design Analysis of national survey databases. Setting Ambulatory care settings in the United States, 2005 to 2012. Subjects and Methods Cases with a diagnosis of chronic rhinosinusitis were assessed in total and as a proportion of all visits reported in National Ambulatory Medical Care Surveys. To place these data into context, results for acute rhinosinusitis, allergic rhinitis, upper respiratory tract infection, and otitis media were also extracted and compared. Data specific to individual age group and calendar year were assessed. Results Chronic rhinosinusitis accounted for 5.6 million visits per annum (range, 3.7-7.5 million) among patients 0 to 20 years of age. Children in the >5- to 10-year-old and >10- to 15-year-old age groups were more likely to be affected ( P < .001). Among all visits, chronic rhinosinusitis was diagnosed in 2.1% (95% confidence interval [CI], 1.9%-2.4%), acute rhinosinusitis in 0.6% (95% CI, 0.5%-0.7%), allergic rhinitis in 2.6% (95% CI, 2.3%-2.8%), upper respiratory tract infection in 8.0% (95% CI, 7.5%-8.4%), and otitis media in 6.7% (95% CI, 6.5%-7.1%). Chronic rhinosinusitis visits were significantly more prevalent than for acute rhinosinusitis (relative risk, 3.40; 95% CI, 2.70-4.10; P < .0001). Among those >15 to 20 years of age, chronic rhinosinusitis was 2.18-fold (95% CI, 1.65-2.70) more frequently diagnosed than otitis media. Conclusions The visit burden from pediatric chronic rhinosinusitis exceeds that of acute rhinosinusitis and equals the burden from allergic rhinitis.
Collapse
Affiliation(s)
- Sapideh Gilani
- Division of Otolaryngology, Department of Surgery, University of California, San Diego, California, USA
| | - Jennifer J. Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Abstract
IgE-mediated allergy plays a well-established role in both nasal and pulmonary diseases due to the common epithelium and shared mediator responses of the upper and lower airways. This "unified airway" concept has also been described in other sites within the head and neck that contain similar respiratory mucosa: the middle ear and the larynx. This review will highlight the data suggesting a role for IgE-mediated allergic disease in chronic laryngopharyngeal and middle ear disease and the role for allergy testing to aid in diagnosis and treatment of these disorders.
Collapse
|
28
|
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.
Collapse
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.
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Venekamp RP, Burton MJ, van Dongen TMA, van der Heijden GJ, van Zon A, Schilder AGM. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev 2016; 2016:CD009163. [PMID: 27290722 PMCID: PMC7117560 DOI: 10.1002/14651858.cd009163.pub3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Otitis media with effusion (OME) is characterised by an accumulation of fluid in the middle ear behind an intact tympanic membrane, without the symptoms or signs of acute infection. Since most cases of OME will resolve spontaneously, only children with persistent middle ear effusion and associated hearing loss potentially require treatment. Previous Cochrane reviews have focused on the effectiveness of ventilation tube insertion, adenoidectomy, nasal autoinflation, antihistamines, decongestants and corticosteroids in OME. This review, focusing on the effectiveness of antibiotics in children with OME, is an update of a Cochrane review published in 2012. OBJECTIVES To assess the benefits and harms of oral antibiotics in children up to 18 years with OME. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 3); PubMed; Ovid EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 April 2016. SELECTION CRITERIA Randomised controlled trials comparing oral antibiotics with placebo, no treatment or therapy of unproven effectiveness in children with OME. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS Twenty-five trials (3663 children) were eligible for inclusion. Two trials did not report on any of the outcomes of interest, leaving 23 trials (3258 children) covering a range of antibiotics, participants, outcome measures and time points for evaluation. Overall, we assessed most studies as being at low to moderate risk of bias.We found moderate quality evidence (six trials including 484 children) that children treated with oral antibiotics are more likely to have complete resolution at two to three months post-randomisation (primary outcome) than those allocated to the control treatment (risk ratio (RR) 2.00, 95% confidence interval (CI) 1.58 to 2.53; number needed to treat to benefit (NNTB) 5). However, there is evidence (albeit of low quality; five trials, 742 children) indicating that children treated with oral antibiotics are more likely to experience diarrhoea, vomiting or skin rash (primary outcome) than those allocated to control treatment (RR 2.15, 95% CI 1.29 to 3.60; number needed to treat to harm (NNTH) 20).In respect of the secondary outcome of complete resolution at any time point, we found low to moderate quality evidence from five meta-analyses, including between two and 14 trials, of a beneficial effect of antibiotics, with a NNTB ranging from 3 to 7. Time periods ranged from 10 to 14 days to six months.In terms of other secondary outcomes, only two trials (849 children) reported on hearing levels at two to four weeks and found conflicting results. None of the trials reported data on speech, language and cognitive development or quality of life. Low quality evidence did not show that oral antibiotics were associated with a decrease in the rate of ventilation tube insertion (two trials, 121 children) or in tympanic membrane sequelae (one trial, 103 children), while low quality evidence indicated that children treated with antibiotics were less likely to have acute otitis media episodes within four to eight weeks (five trials, 1086 children; NNTB 18) and within six months post-randomisation (two trials, 199 children; NNTB 5). It should, however, be noted that the beneficial effect of oral antibiotics on acute otitis media episodes within four to eight weeks was no longer significant when we excluded studies with high risk of bias. AUTHORS' CONCLUSIONS This review presents evidence of both benefits and harms associated with the use of oral antibiotics to treat children up to 16 years with OME. Although evidence indicates that oral antibiotics are associated with an increased chance of complete resolution of OME at various time points, we also found evidence that these children are more likely to experience diarrhoea, vomiting or skin rash. The impact of antibiotics on short-term hearing is uncertain and low quality evidence did not show that oral antibiotics were associated with fewer ventilation tube insertions. Furthermore, we found no data on the impact of antibiotics on other important outcomes such as speech, language and cognitive development or quality of life.Even in situations where clear and relevant benefits of oral antibiotics have been demonstrated, these must always be carefully balanced against adverse effects and the emergence of bacterial resistance. This has specifically been linked to the widespread use of antibiotics for common conditions such as otitis media.
Collapse
Affiliation(s)
- Roderick P Venekamp
- University Medical Center UtrechtJulius Center for Health Sciences and Primary Care & Department of OtorhinolaryngologyHeidelberglaan 100UtrechtNetherlands3508 GA
| | - Martin J Burton
- UK Cochrane CentreSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
| | - Thijs MA van Dongen
- University Medical Center UtrechtDepartment of Otorhinolaryngology & Julius Center for Health Sciences and Primary CareUtrechtNetherlands
| | - Geert J van der Heijden
- Academic Center for Dentistry Amsterdam (ACTA)Department of Social Dentistry5th Floor, Room 5N03Gustav Mahlerlaan 3004AmsterdamNetherlands1081LA
| | - Alice van Zon
- University Medical Center UtrechtDepartment of Otorhinolaryngology & Julius Center for Health Sciences and Primary CareUtrechtNetherlands
| | - Anne GM Schilder
- University Medical Center UtrechtDepartment of Otorhinolaryngology & Julius Center for Health Sciences and Primary CareUtrechtNetherlands
- Faculty of Brain Sciences, University College LondonevidENT, Ear Institute330 Grays Inn RoadLondonUKWC1X 8DA
| | | |
Collapse
|
32
|
Williamson I, Vennik J, Harnden A, Voysey M, Perera R, Breen M, Bradley B, Kelly S, Yao G, Raftery J, Mant D, Little P. An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care. Health Technol Assess 2016; 19:1-150. [PMID: 26377389 DOI: 10.3310/hta19720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment. OBJECTIVE To determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children. DESIGN A pragmatic, two-arm, open randomised controlled trial. SETTING Forty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013. PARTICIPANTS School children aged 4-11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears. INTERVENTION Three hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1-3 months plus usual care, or usual care alone. MAIN OUTCOME MEASURES The proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes. RESULTS At 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference -0.42; p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted. CONCLUSION We found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.
Collapse
Affiliation(s)
- Ian Williamson
- Primary Medical Care, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Medical Care, University of Southampton, Southampton, UK
| | - Anthony Harnden
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Merryn Voysey
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Rafael Perera
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Maria Breen
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Brendan Bradley
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Sadie Kelly
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Guiqing Yao
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - James Raftery
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - David Mant
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Paul Little
- Primary Medical Care, University of Southampton, Southampton, UK
| |
Collapse
|
33
|
Waldron CA, Thomas-Jones E, Cannings-John R, Hood K, Powell C, Roberts A, Tomkinson A, Fitzsimmons D, Gal M, Harris D, Shepherd V, Butler CC, Francis N. Oral steroids for the resolution of otitis media with effusion (OME) in children (OSTRICH): study protocol for a randomised controlled trial. Trials 2016; 17:115. [PMID: 26931619 PMCID: PMC4774139 DOI: 10.1186/s13063-016-1236-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/17/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Otitis media with effusion (OME) is an accumulation of fluid in the middle ear affecting about 80 % of children by the age of 4 years. While OME usually resolves spontaneously, it can affect speech, behaviour and development. Children with persistent hearing loss associated with OME are usually offered hearing aids or insertion of ventilation tubes through the tympanic membrane. Oral steroids may be a safe and effective treatment for OME, which could be delivered in primary care. Treatment with oral steroids has the potential to benefit large numbers of children and reduce the burden of care on them and on health services. However, previous trials have either been too small with too short a follow-up period, or of too poor quality to give a definite answer. The aim of the Oral Steroids for the Resolution of Otitis Media with Effusion in Children (OSTRICH) trial is to determine if a short course of oral steroids improves the hearing of children with OME in the short and longer term. METHODS/DESIGN A total of 380 participants (children of 2 to 8 years of age) are recruited from Hospital Ear, Nose and Throat departments in Wales and England. A trained clinician seeks informed consent from parents of children with symptoms for at least 3 months that are attributable to OME and with confirmed bilateral hearing loss at study entry. Participants are randomised to a course of oral steroid or a matched placebo for 1 week. Outcomes include audiometry, tympanometry and otoscopy assessments; symptoms; adverse effects; functional health status; quality of life; resource use; and cost effectiveness. Participants are followed up at 5 weeks, and at 6 and 12 months after the day of randomisation. The primary outcome is audiometry-confirmed satisfactory hearing at 5 weeks. DISCUSSION An important evidence gap exists regarding the clinical and cost effectiveness of short courses of oral steroid treatment for OME. Identifying an effective, safe, nonsurgical intervention for OME in children for use in primary care would be of great benefit to children, their families and the NHS. TRIAL REGISTRATION ISRCTN ISRCTN49798431 (Registered 7 December 2012).
Collapse
Affiliation(s)
- Cherry-Ann Waldron
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XW, UK.
| | - Emma Thomas-Jones
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XW, UK.
| | - Rebecca Cannings-John
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XW, UK.
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Colin Powell
- Department of General Paediatrics, Children's Hospital for Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Amanda Roberts
- Cardiff and Vale University Health Board, Child Health Directorate, St David's Children Centre, Cowbridge Road East, Cardiff, CF11 9XB, UK.
| | - Alun Tomkinson
- Ear, Nose and Throat/Head and Neck Department, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.
| | - Deborah Fitzsimmons
- College of Human Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Micaela Gal
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Debbie Harris
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XW, UK.
| | - Victoria Shepherd
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, 7th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4XW, UK.
| | - Christopher C Butler
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Nicholas Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| |
Collapse
|
34
|
Williamson I, Vennik J, Harnden A, Voysey M, Perera R, Kelly S, Yao G, Raftery J, Mant D, Little P. Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial. CMAJ 2015; 187:961-969. [PMID: 26216608 PMCID: PMC4577342 DOI: 10.1503/cmaj.141608] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Otitis media with effusion is a common problem that lacks an evidence-based nonsurgical treatment option. We assessed the clinical effectiveness of treatment with a nasal balloon device in a primary care setting. METHODS We conducted an open, pragmatic randomized controlled trial set in 43 family practices in the United Kingdom. Children aged 4-11 years with a recent history of ear symptoms and otitis media with effusion in 1 or both ears, confirmed by tympanometry, were allocated to receive either autoinflation 3 times daily for 1-3 months plus usual care or usual care alone. Clearance of middle-ear fluid at 1 and 3 months was assessed by experts masked to allocation. RESULTS Of 320 children enrolled, those receiving autoinflation were more likely than controls to have normal tympanograms at 1 month (47.3% [62/131] v. 35.6% [47/132]; adjusted relative risk [RR] 1.36, 95% confidence interval [CI] 0.99 to 1.88) and at 3 months (49.6% [62/125] v. 38.3% [46/120]; adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). Autoinflation produced greater improvements in ear-related quality of life (adjusted between-group difference in change from baseline in OMQ-14 [an ear-related measure of quality of life] score -0.42, 95% CI -0.63 to -0.22). Compliance was 89% at 1 month and 80% at 3 months. Adverse events were mild, infrequent and comparable between groups. INTERPRETATION Autoinflation in children aged 4-11 years with otitis media with effusion is feasible in primary care and effective both in clearing effusions and improving symptoms and ear-related child and parent quality of life. TRIAL REGISTRATION ISRCTN, No. 55208702.
Collapse
Affiliation(s)
- Ian Williamson
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Jane Vennik
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Anthony Harnden
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Merryn Voysey
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Rafael Perera
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Sadie Kelly
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Guiqing Yao
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - David Mant
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences (Williamson, Vennik, Little), Faculty of Medicine, University of Southampton, Aldermoor Close, Southampton, UK; Nuffield Department of Primary Care Health Sciences (Harnden, Voysey, Perera, Kelly, Mant), University of Oxford, Oxford, UK; Faculty of Medicine (Yao, Raftery), University of Southampton, Southampton General Hospital, Southampton, UK
| |
Collapse
|
35
|
Fortnum H, Leighton P, Smith MD, Brown L, Jones M, Benton C, Marder E, Marshall A, Sutton K. Assessment of the feasibility and clinical value of further research to evaluate the management options for children with Down syndrome and otitis media with effusion: a feasibility study. Health Technol Assess 2015; 18:1-147, v-vi. [PMID: 25270051 DOI: 10.3310/hta18600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is clinical uncertainty of the benefits and costs of different treatment options for children with Down syndrome who have glue ear. This study was designed to assess the extent of this lack of knowledge and determine if pursuing further information would be practical, beneficial and cost-effective. OBJECTIVES To assess the level and practical effect of current uncertainty around treatment options for children with Down syndrome and glue ear. To assess the feasibility of studying the options for management of glue ear in children with Down syndrome via a randomised controlled trial (RCT) or multicentre prospective cohort study by evaluating the willingness of (1) parents to agree to randomisation for their children and (2) clinicians to recruit participants to a definitive study. To undertake value of information analyses to demonstrate the potential economic benefit from undertaking further research. DESIGN A feasibility study exploring the views of parents of children with Down syndrome and professionals who have responsibility for the health and education of children with Down syndrome, on the participation in, and value of, future research into interventions for glue ear. Data were collected from parents via self-completed questionnaires, face-to-face interviews and focus groups and from professionals via online questionnaires and a Delphi review exercise. Development of economic models to represent clinical pathways of care and a RCT informed a value of information (VOI) analysis. SETTING UK (professionals); East Midlands region of the UK (parents). PARTICIPANTS Parents of children aged 1-11 years with Down syndrome (n = 156). Professionals including audiologists, ear, nose and throat surgeons, audiological physicians, speech and language therapists, and teachers of the deaf (n = 128). MAIN OUTCOME MEASURES Quantitative and qualitative data on parental views and experiences of glue ear and its effects; interventions and treatment received; taking part in research and factors that would encourage or discourage participation; and the importance of various outcome domains to them and for their children. For professionals: information on caseloads; approaches to clinical management; opinions on frequency and significance of the consequences of glue ear for this population; importance of different outcome measures; opinions of interventions and their role in future research; views on health research; facilitators and barriers to recruitment, and participation in research involving RCTs. RESULTS The complexity of the experience and individual characteristics of children with Down syndrome poses challenges for the design of any future research but these challenges were not considered by professionals to raise sufficient barriers to prevent it being undertaken. Parents were generally supportive of the need for, and value of, research but identified practical and emotional issues that would need addressing. Glue ear was considered to impact more on speech, language and communication than on hearing. Outcome measures for future research would need to evaluate these elements but measures should be designed specifically for the population. Parents and professionals identified randomisation as a significant barrier to participation. The VOI analyses identified lack of data as problematic but concluded that a future trial involving surgical intervention would be feasible at costs of < £650,000. CONCLUSIONS Future research into the benefits of interventions for glue ear in children with Down syndrome would be feasible and could be cost-effective but should be carefully designed to facilitate and maximise participation from parents and professionals responsible for recruitment. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Heather Fortnum
- National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Nottingham, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Murray D Smith
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Lisa Brown
- National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Nottingham, UK
| | - Matthew Jones
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Claire Benton
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | - Kate Sutton
- Nottinghamshire Healthcare, County Health Partnerships, Nottingham, UK
| |
Collapse
|
36
|
Songu M, Ozkul Y, Kirtay S, Arslanoglu S, Ozkut M, Inan S, Onal K. Effects of oral intake of cetirizine HCl and desloratadine molecules on the middle ear mucosa: an experimental animal study. Eur Arch Otorhinolaryngol 2014; 271:833-8. [PMID: 24526000 DOI: 10.1007/s00405-014-2928-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
We have planned to demonstrate histopathologic effects of mid- or long-term oral use of desloratadine and cetirizine HCl molecules on middle ear mucosa of rats. Thirty-six rats were randomized equally into six groups. Desloratadine groups received once daily doses of 1 mg/ml desloratadine for 30 (D30 Group) or 60 (D60 Group) days. The Cetirizine study groups were given once daily doses of 1 mg/ml cetirizine for 30 (S30 Group) or 60 (S60 Group) days. Control groups were given 2 cc physiologic saline using orogastric gavage method through a 12 G gavage catheter for 30 (K30 Group) or 60 (K60) days. At the end of 30 days, D30, S30 and K30 Groups were sacrificed. Tissue samples harvested from groups were evaluated between 1 and 4 Grades for histological characteristics of middle ear canal, eardrum, middle ear epithelium and connective tissue, edema, vascular congestion and inflammatory cells. In the control group no pathological finding was encountered in rats sacrificed on 30 and 60 days. No statistical difference was observed when groups were compared on external ear epithelial tissue, external ear sebaceous gland, middle ear inflammation, and middle ear capillary dilatation both on 30 and 60 days. Tympanic membrane collagen was more evident in D30 and D60 groups when compared with C30 and C60 groups. Comparison of histopathological grading results between 30 and 60 days revealed no significant changes. In conclusion, oral intake of cetirizine and desloratadine preparations has effects of tympanic membrane collagen, degrees of edema and vascular congestion being more prominent with desloratadine molecule.
Collapse
Affiliation(s)
- Murat Songu
- Department of Otorhinolaryngology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey,
| | | | | | | | | | | | | |
Collapse
|
37
|
Bonney AG, Goldman RD. Antihistamines for children with otitis media. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:43-46. [PMID: 24452559 PMCID: PMC3994816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
QUESTION Otitis media is a very common condition in pediatrics and can be quite distressing for children and their parents. Is there a role for antihistamines and decongestants in the management of acute otitis media orotitis media with effusion in children? ANSWER Traditionally, antihistamines and decongestants have been used in the treatment of otitis media;however, recent guidelines, which are based on study findings with negative results, recommend against routine use. No antihistamine-decongestant combination has been shown to be of clinically significant benefit,and there are potential adverse events that need to be taken into account.
Collapse
Affiliation(s)
- Asha G Bonney
- BC Children's Hospital, Department of Pediatrics, Room K4-226, Ambulatory Care Bldg, 4480 Oak St, Vancouver, BC V6H 3V4.
| | | |
Collapse
|
38
|
|
39
|
Perera R, Glasziou PP, Heneghan CJ, McLellan J, Williamson I. Autoinflation for hearing loss associated with otitis media with effusion. Cochrane Database Syst Rev 2013:CD006285. [PMID: 23728660 DOI: 10.1002/14651858.cd006285.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2006.Otitis media with effusion (OME) or 'glue ear' is an accumulation of fluid in the middle ear, in the absence of acute inflammation or infection. It is the commonest cause of acquired hearing loss in childhood and the usual reason for insertion of 'grommets'. Potential treatments include decongestants, mucolytics, steroids, antihistamines and antibiotics. Autoinflation devices have been proposed as a simple mechanical means of improving 'glue ear'. OBJECTIVES To assess the effectiveness of autoinflation compared with no treatment in children and adults with otitis media with effusion. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 12 April 2013. SELECTION CRITERIA We selected randomised controlled trials that compared any form of autoinflation to no autoinflation in individuals with 'glue ear'. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed risk of bias and extracted data from included studies. MAIN RESULTS Eight studies, with a total of 702 participants, met the inclusion criteria. Overall, the studies were predominantly assessed as being at low or unclear risk of bias; unclear risk was mainly due lack of information. There was no evidence of selective reporting.Pooled estimates favoured the intervention, but did not show a significant effect on tympanometry (type C2 and B) at less than one month, nor at more than one month. Similarly, there were no significant changes for discrete pure-tone audiometry and non-discrete audiometry. Pooled estimates favoured, but not significantly, the intervention for the composite measure of tympanogram or audiometry at less than one month; at more than one month the result became significant (RRI 1.74, 95% CI 1.22 to 2.50). Subgroup analysis based on the type of intervention showed a significant effect using a Politzer device under one month (RRI 7.07, 95% CI 3.70 to 13.51) and over one month (RRI 2.25, 95% CI 1.67 to 3.04).None of the studies demonstrated a significant difference in the incidence of side effects between interventions. AUTHORS' CONCLUSIONS All of the studies were small, of limited treatment duration and had short follow-up. However, because of the low cost and absence of adverse effects it is reasonable to consider autoinflation whilst awaiting natural resolution of otitis media with effusion. Primary care could prove a beneficial place to evaluate such interventions and there is ongoing research in this area. Further research should also consider the duration of treatment, the long-term impact on developmental outcomes in children and additional quality of life outcome measures for children and families.
Collapse
Affiliation(s)
- Rafael Perera
- Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK, OX2 6GG
| | | | | | | | | |
Collapse
|
40
|
Abstract
Earache, a common emergency department presentation, may be caused by a variety of conditions, some distant from the ear. This article discusses the diagnosis and treatment of acute otitis media, otitis media with effusion, otitis externa, otitis media with ruptured tympanic membrane or tympanostomy tubes, malignant otitis externa, mastoiditis and petrositis, traumatic ruptured tympanic membrane, cerumen impactions, and foreign bodies in the ears.
Collapse
|
41
|
van Zon A, van der Heijden GJ, van Dongen TMA, Burton MJ, Schilder AGM. Antibiotics for otitis media with effusion in children. Cochrane Database Syst Rev 2012:CD009163. [PMID: 22972136 DOI: 10.1002/14651858.cd009163.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) is characterised by an accumulation of fluid in the middle ear behind an intact tympanic membrane, without the symptoms or signs of acute infection. In approximately one in three children with OME, however, a bacterial pathogen is identified in the middle ear fluid. In most cases, OME causes mild hearing impairment of short duration. When experienced in early life and when episodes of (bilateral) OME persist or recur, the associated hearing loss may be significant and have a negative impact on speech development and behaviour. Since most cases of OME will resolve spontaneously, only children with persistent middle ear effusion and associated hearing loss potentially require treatment. Previous Cochrane reviews have focused on the effectiveness of ventilation tube insertion, adenoidectomy, autoinflation, antihistamines, decongestants, and oral and topical intranasal steroids in OME. This review focuses on the effectiveness of antibiotics in children with OME. OBJECTIVES To assess the effects of antibiotics in children up to 18 years with OME. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 22 February 2012. SELECTION CRITERIA Randomised controlled trials comparing oral antibiotics with placebo, no treatment or therapy of unproven effectiveness. Our primary outcome was complete resolution of OME at two to three months. Secondary outcomes included resolution of OME at other time points, hearing, language and speech, ventilation tube insertion and adverse effects. DATA COLLECTION AND ANALYSIS Two authors independently extracted data using standardised data extraction forms and assessed the quality of the included studies using the Cochrane 'Risk of bias' tool. We presented dichotomous results as risk differences as well as risk ratios, with their 95% confidence intervals. If heterogeneity was greater than 75% we did not pool data. MAIN RESULTS We included 23 studies (3027 children) covering a range of antibiotics, participants, outcome measures and time points of evaluation. Overall, we assessed the studies as generally being at low risk of bias.Our primary outcome was complete resolution of OME at two to three months. The differences (improvement) in the proportion of children having such resolution (risk difference (RD)) in the five individual included studies ranged from 1% (RD 0.01, 95% CI -0.11 to 0.12; not significant) to 45% (RD 0.45, 95% CI 0.25 to 0.65). Results from these studies could not be pooled due to clinical and statistical heterogeneity.Pooled analysis of data for complete resolution at more than six months was possible, with an increase in resolution of 13% (RD 0.13, 95% CI 0.06 to 0.19).Pooled analysis was also possible for complete resolution at the end of treatment, with the following increases in resolution rates: 17% (RD 0.17, 95% CI 0.09 to 0.24) for treatment for 10 days to two weeks, 34% (RD 0.34, 95% CI 0.19 to 0.50) for treatment for four weeks, 32% (RD 0.32, 95% CI 0.17 to 0.47) for treatment for three months, and 14% (RD 0.14, 95% CI 0.03 to 0.24) for treatment continuously for at least six months.We were unable to find evidence of a substantial improvement in hearing as a result of the use of antibiotics for otitis media with effusion; nor did we find an effect on the rate of ventilation tube insertion. We did not identify any trials that looked at speech, language and cognitive development or quality of life. Data on the adverse effects of antibiotic treatment reported in six studies could not be pooled due to high heterogeneity. Increases in the occurrence of adverse events varied from 3% (RD 0.03, 95% CI -0.01 to 0.07; not significant) to 33% (RD 0.33, 95% CI 0.22 to 0.44) in the individual studies. AUTHORS' CONCLUSIONS The results of our review do not support the routine use of antibiotics for children up to 18 years with otitis media with effusion. The largest effects of antibiotics were seen in children treated continuously for four weeks and three months. Even when clear and relevant benefits of antibiotics have been demonstrated, these must be balanced against the potential adverse effects when making treatment decisions. Immediate adverse effects of antibiotics are common and the emergence of bacterial resistance has been causally linked to the widespread use of antibiotics for common conditions such as otitis media.
Collapse
Affiliation(s)
- Alice van Zon
- Department of Otorhinolaryngology & Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, Netherlands.
| | | | | | | | | |
Collapse
|
42
|
Lee HJ, Park SK, Choi KY, Park SE, Chun YM, Kim KS, Park SN, Cho YS, Kim YJ, Kim HJ. Korean clinical practice guidelines: otitis media in children. J Korean Med Sci 2012; 27:835-48. [PMID: 22876048 PMCID: PMC3410229 DOI: 10.3346/jkms.2012.27.8.835] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/26/2012] [Indexed: 11/20/2022] Open
Abstract
Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.
Collapse
Affiliation(s)
- Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Su-Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea
| | | | - Kyu-Sung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea
| | - Shi-Nae Park
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Jae Kim
- Department Healthcare Center, Kyobo Life Insurance Co., Seoul, Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| |
Collapse
|