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Kara A, Büyükcam A, Sütçü M, Sali E, Bozdemir ŞE, Kara M, İlarslan EÇ, Kaya C, Karakaşlılar S, Sönmez G, Kara SS, Bedir T, Albayrak E, Kara TT, Çelebi S, Öz FN, Karbuz A, Somer A, Alabaz D, Tezer H, Özdemir H, Çiftçi E. The effectiveness of topical 1% lidocaine with systemic oral analgesics for ear pain with acute otitis media. Int J Pediatr Otorhinolaryngol 2022; 156:111116. [PMID: 35325846 DOI: 10.1016/j.ijporl.2022.111116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is one of the most common childhood infections. Ear pain, the main symptom of AOM, results in parents frequently seeking medical assistance for their children. The aim of this study was to compare the effectiveness of topical 1% lidocaine ear drops administered with oral analgesics with that of oral analgesics alone. METHODS This multicenter randomized, open-labeled study was conducted at 15 centers with 184 pediatric AOM patients with bilateral ear pain (aged 1-5 years) between May 1, 2016, and June 31, 2018. All patients received oral paracetamol or ibuprofen and topical 1% lidocaine, which was administered to each ear according to the randomization list. The ear pain score was evaluated within 48 h using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, and the patients were followed up for 10 days. RESULTS The median age was 31.8 months (min-max, 12-84.2 months). Of those patients enrolled, 22.3% received paracetamol, and 24.5% received paracetamol with lidocaine ear drops; 23.4% received ibuprofen, and 29.9% received ibuprofen with lidocaine ear drops. Lower pain scores were significantly measured at baseline and 10th minutes by a reduction 25% (RR 13.64, 95% CI 4.47-41.63, p = 0.001, RR 0.14, 95% CI 0.06-0.35, p = 0.001) and 50% (RR 4.76, 95% CI 1.63-13.87, p = 0.004, RR 0.14, 95% CI 0.05-0.4, p = 0.001) in the paracetamol and lidocaine versus paracetamol groups and the ibuprofen and lidocaine versus ibuprofen groups, respectively. No serious side effects were evident during follow-up. CONCLUSION This randomized study suggests that topical 1% lidocaine ear drops with paracetamol or ibuprofen seems to provide effective and rapid relief for children presenting with ear pain attributed to AOM.
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Affiliation(s)
- Ateş Kara
- Hacettepe Medical University, Department of Pediatric Infectious Disease, Ankara, Turkey.
| | - Ayşe Büyükcam
- Hacettepe Medical University, Department of Pediatric Infectious Disease, Ankara, Turkey.
| | - Murat Sütçü
- Konya Training Training and Research Hospital, Department of Pediatric Infectious Disease, Konya, Turkey.
| | - Enes Sali
- Şanlı Urfa Training and Research Hospital, Department of Pediatric Infectious Disease, Şanlıurfa, Turkey.
| | - Şefika Elmas Bozdemir
- Kayseri Training and Research Hospital, Department of Pediatric Infectious Disease, Kayseri, Turkey.
| | - Manolya Kara
- İstanbul Medical University, Department of Pediatric Infectious Disease, İstanbul, Turkey.
| | | | - Cemil Kaya
- Şanlıurfa Training and Research Hospital, Department of Pediatrics, Şanlıurfa, Turkey.
| | | | - Gülsüm Sönmez
- Çukurova Medical University, Department of Pediatric Infectious Disease, Adana, Turkey.
| | - Soner Sertan Kara
- Erzurum Regional Training and Research Hospital, Department of Pediatric Infectious Disease, Erzurum, Turkey.
| | - Tuğba Bedir
- Gazi Medical University, Department of Pediatric Infectious Disease, Ankara, Turkey.
| | - Eda Albayrak
- Recep Tayip Erdoğan Medical University, Department of Pediatrics, Rize, Turkey.
| | - Tuğçe Tural Kara
- Ankara Training and Research Hospital, Department of Pediatric Infectious Disease, Ankara, Turkey.
| | - Solmaz Çelebi
- Uludağ Medical University, Department of Pediatric Infectious Disease, Bursa, Turkey.
| | - Fatma Nur Öz
- Fırat Medical University, Department of Pediatric Infectious Disease, Elazığ, Turkey.
| | - Adem Karbuz
- Ok Meydanı Training and Research Hospital, Department of Pediatric Infectious Disease, İstanbul, Turkey.
| | - Ayper Somer
- Kayseri Training and Research Hospital, Department of Pediatric Infectious Disease, Kayseri, Turkey.
| | - Derya Alabaz
- Çukurova Medical University, Department of Pediatric Infectious Disease, Adana, Turkey.
| | - Hasan Tezer
- Medical University, Department of Pediatric Infectious Disease, Ankara, Turkey.
| | - Halil Özdemir
- Ankara Medical University, Department of Pediatric Infectious Disease, Ankara, Turkey.
| | - Ergin Çiftçi
- Ankara Medical University, Department of Pediatric Infectious Disease, Ankara, Turkey.
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Michel O. Pain Relief by Analgesic Eardrops: Paradigm Shift in the Treatment of Acute Otitis Media? Drug Res (Stuttg) 2021; 71:363-371. [PMID: 34098586 DOI: 10.1055/a-1494-3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute otitis media is a common middle ear infection in children with the predominant symptoms of hearing impairment and pain. If antibiotics are given, they need time to have an effect on the inflammation, so the focus is on pain control. For pain management local anesthetics have the advantage of lesser systemic side effects but are still subject to scrutiny. In this review the literature between 2000 and 2020 was systematically searched for investigating studies and recommendation in guidelines against the background of the mode of action. 11 clinical studies, 2 guidelines and 5 reports resp. reviews could be identified. Contraindications and side effects were not found in these studies. The analgesic ear drops showed in placebo-controlled studies a relatively short duration of action when applied once but rapid onset of action. There is evidence that analgesic ear drops could provide a first-line analgesia in otitis media without systemic adverse effects such as gastrointestinal disturbance and nausea and could support an antibiotic-saving wait-and-see attitude. The review shows a change in attitude towards the recommendation to include local anesthetics ear drops in otitis media but still there is a lack in treatment protocols which go beyond a single administration. The results do not yet show a significant paradigm shift. The reviews revealed indications that a more adapted galenic preparation could give more effectiveness. Pharmaceutical research in this field should be intensified to exploit the analgesic potential of local anesthetic ear drops in acute otitis media.
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Affiliation(s)
- Olaf Michel
- Universitair Ziekenhuis - Vrije Universiteit Brussel UZ-VUB
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Eltayeb NE, Şen F, Lasri J, Hussien MA, Elsilk SE, Babgi BA, Gökce H, Sert Y. Hirshfeld Surface analysis, spectroscopic, biological studies and molecular docking of (4E)-4-((naphthalen-2-yl)methyleneamino)-1,2-dihydro-2,3-dimethyl-1-phenylpyrazol-5-one. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2019.127315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Treatment. Pediatr Infect Dis J 2019; 38:S10-S21. [PMID: 31876601 DOI: 10.1097/inf.0000000000002452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines. METHODS A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts. RESULTS Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics. CONCLUSIONS AOM should be managed on a case-by-case basis that takes account of the child's age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.
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Yang R, Saarinen R, Okonkwo OS, Hao Y, Mehta M, Kohane DS. Transtympanic Delivery of Local Anesthetics for Pain in Acute Otitis Media. Mol Pharm 2019; 16:1555-1562. [PMID: 30840478 DOI: 10.1021/acs.molpharmaceut.8b01235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute otitis media (AOM) commonly causes pain and distress in children. Existing analgesic ototopical drops have limited effectiveness due to the impermeable nature of the tympanic membrane. We developed a local drug delivery system to provide sustained pain relief in patients with AOM, achieved by applying a single dose of a hydrogel formulation onto the tympanic membrane. Successful drug delivery across intact tympanic membranes was demonstrated using the amino-amide anesthetic, bupivacaine, and a highly potent site 1 sodium channel blocker anesthetic, tetrodotoxin. The chemical permeation enhancers incorporated in the delivery system increased the permeability of the tympanic membrane to the anesthetics considerably. The drug levels measured using a previously developed ex vivo model reflect the potential for highly effective local anesthesia.
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Affiliation(s)
- Rong Yang
- Department of Anesthesiology, Division of Critical Care Medicine , Children's Hospital Boston, Harvard Medical School , 300 Longwood Avenue , Boston , Massachusetts 02115 , United States
| | - Riitta Saarinen
- Department of Anesthesiology, Division of Critical Care Medicine , Children's Hospital Boston, Harvard Medical School , 300 Longwood Avenue , Boston , Massachusetts 02115 , United States
| | - Obiajulu S Okonkwo
- Department of Anesthesiology, Division of Critical Care Medicine , Children's Hospital Boston, Harvard Medical School , 300 Longwood Avenue , Boston , Massachusetts 02115 , United States
| | - Yi Hao
- Department of Anesthesiology, Division of Critical Care Medicine , Children's Hospital Boston, Harvard Medical School , 300 Longwood Avenue , Boston , Massachusetts 02115 , United States
| | - Manisha Mehta
- Department of Anesthesiology, Division of Critical Care Medicine , Children's Hospital Boston, Harvard Medical School , 300 Longwood Avenue , Boston , Massachusetts 02115 , United States
| | - Daniel S Kohane
- Department of Anesthesiology, Division of Critical Care Medicine , Children's Hospital Boston, Harvard Medical School , 300 Longwood Avenue , Boston , Massachusetts 02115 , United States
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The Needle-Less Treatment of Pain and Anxiety in the Pediatric Patient. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schilder AGM, Marom T, Bhutta MF, Casselbrant ML, Coates H, Gisselsson-Solén M, Hall AJ, Marchisio P, Ruohola A, Venekamp RP, Mandel EM. Panel 7: Otitis Media: Treatment and Complications. Otolaryngol Head Neck Surg 2017; 156:S88-S105. [PMID: 28372534 DOI: 10.1177/0194599816633697] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
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Affiliation(s)
- Anne G M Schilder
- 1 evidENT, Ear Institute, University College London, London, United Kingdom.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tal Marom
- 3 Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Mahmood F Bhutta
- 4 Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Margaretha L Casselbrant
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harvey Coates
- 6 Department of Otolaryngology, School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia
| | - Marie Gisselsson-Solén
- 7 Department of Clinical Sciences, Division of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden
| | - Amanda J Hall
- 8 University Hospitals Bristol NHS Foundation Trust and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Paola Marchisio
- 9 Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aino Ruohola
- 10 Department of Pediatrics, University of Turku, Turku, Finland
| | - Roderick P Venekamp
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen M Mandel
- 5 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Rodríguez MC, Villamor P, Castillo T. Assessment and management of pain in pediatric otolaryngology. Int J Pediatr Otorhinolaryngol 2016; 90:138-149. [PMID: 27729121 DOI: 10.1016/j.ijporl.2016.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/10/2016] [Accepted: 09/13/2016] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Pain is a disease by itself and it's a public health concern of major implication in children, not just because of the emotional component of the child and his family, but also due to the potential morbidity and mortality involving it. A proper assessment of pain it's a challenge in the pediatric population, due to their lack of understanding and verbalization of hurt. Additionally, a satisfactory treatment of pediatric pain can be arduous due to a lack of clinical knowledge, insufficient pediatric research, and the fear to opioid side effects and addiction. OBJECTIVES The aim of this review is to address the current definitions of pain, its physiological mechanisms and the consequences of its inadequate management, as well as, to guide the clinicians in the assessment and management of pain in the pediatric population at otolaryngology services. METHODOLOGY Narrative review by selective MeSH search terms: Children, Pediatrics, Otolaryngology, Pain measurement, Pain Management, Analgesics and Analgesia, from databases: MEDLINE/PubMed, Cochrane, ISI, Current Contents, Scielo and LILACS, between January 2000 and May 2016. RESULTS 129 articles were reviewed according to the requirements of the objectives. Pain measurement is a challenge in children as there are no physical signs that constitute an absolute or specific indicator of pain, and its diagnosis must rely on physiological, behavioral and self-report methods. Regarding treatment, a suitable alternative are the non-pharmacological cognitive/behavioral therapies helped by pharmacological therapies tailored to the severity of pain and the child's age. We provide evidence-based recommendations on pain treatment, including non-opioid analgesics, opioid analgesics and adjuvant medicines to improve the management of pain in children in otolaryngology services. CONCLUSIONS We present a global review about assessment and management of pain in pediatric otolaryngology, which leads to future specific reviews on each topic. Research gaps on pain assessment and pharmacological interventions in neonates, infants and children are very wide and it should be promoted ethical and safe research on pain control in this population.
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Affiliation(s)
- Maria Claudia Rodríguez
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Perla Villamor
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Tatiana Castillo
- Department of Otolaryngology, Hospital Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
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Mujica-Mota MA, Bezdjian A, Salehi P, Schermbrucker J, Daniel SJ. Assessment of ototoxicity of intratympanic administration of Auralgan in a chinchilla animal model. Laryngoscope 2014; 125:1444-8. [PMID: 25476895 DOI: 10.1002/lary.25080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/21/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Auralgan (benzocaine and antipyrine) is an over-the-counter otic drug commonly used for otalgia. Nevertheless, there is limited evidence about the effects of the drug on hearing function and cochlear morphology in the presence of a tympanic membrane perforation. The aim of the present study was to assess the cytotoxicity of Auralgan using cultured auditory cells (HEI-OC1) and to examine its effects on hearing function and cochlear morphology after intratympanic administration in a chinchilla model. STUDY DESIGN Animal experiment. METHODS Cell viability and DNA labeling assays were conducted to investigate the cytotoxic effect of the drug on cultured auditory cells (HEI-OC1). To examine the possible drug ototoxic effect in vivo, chinchillas received intratympanic injection of Auralgan in one ear, whereas the contralateral control ear received saline. Outcome measures included auditory brainstem response and postmortem cochlear morphology. RESULTS A dose-dependent toxic effect of Auralgan was noted on cultured cells. Animal experiments showed an inflammatory reaction in the experimental ears and facial paralysis in 80% of the animals on the side receiving transtympanic injection of Auralgan (P < .05). Auditory brainstem response testing demonstrated a 30- to 50-dB hearing threshold shift across all frequencies tested (P < .05). Control ears showed no inflammation or significant threshold shift. Microscopy showed damage to the hair cells and stria vascularis with bleeding in the perilymphatic space in the experimental ears and damage to the hair cells. CONCLUSIONS Auralgan was cytotoxic to cultured auditory cells. It promoted an inflammatory reaction and seemed to be ototoxic when given via transtympanic injection in an animal model. LEVEL OF EVIDENCE NA
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Affiliation(s)
- Mario A Mujica-Mota
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Aren Bezdjian
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Pezhman Salehi
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
| | - Jonah Schermbrucker
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada
| | - Sam J Daniel
- McGill Auditory Sciences Laboratory, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Montreal Children's Hospital, Montreal, Quebec, Canada
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Thomas NM, Brook I. Otitis media: an update on current pharmacotherapy and future perspectives. Expert Opin Pharmacother 2014; 15:1069-83. [PMID: 24793547 DOI: 10.1517/14656566.2014.903920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Acute otitis media (AOM) is the most common childhood bacterial infection and also the leading cause of conductive hearing loss in children. Currently, there is an urgent need for developing novel therapeutic agents for treating AOM. AREAS COVERED Structured search of current literature. PubMed was searched for published literature in areas of pharmacotherapeutics, preventive therapies and complementary treatments for OM. The intent of this review is to provide a comprehensive evaluation of therapeutics for AOM, including preventive modalities and complementary medicine. EXPERT OPINION the management of AOM in young children is still evolving and depends on patterns of bacterial colonization and antimicrobial resistance in the community. The introduction of vaccinations against potential respiratory tract pathogens has altered the frequency of recovery of pathogens causing ear infections in children. Even though not all patients require antimicrobial therapy to overcome their infection, these agents improve symptoms faster and lead to fewer treatment failures. Further studies are warranted to evaluate which patients would best benefit from antimicrobial therapy.
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Affiliation(s)
- Nicole M Thomas
- Uniformed Services University of the Health Sciences, Department of Pediatrics , Bethesda, MD , USA
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