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Robinson M, Burgner D, Lin A, Jacoby P, Eikelboom R, Vijayasekaran S, Brennan-Jones CG. Risk of otitis media in offspring following maternal prenatal stress exposure. Int J Pediatr Otorhinolaryngol 2024; 182:112022. [PMID: 38941719 DOI: 10.1016/j.ijporl.2024.112022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/12/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVES There is limited but consistent evidence that suggests prenatal factors, including maternal stress, may contribute to susceptibility for otitis media. We aimed to determine the effect of multiple life stress events during pregnancy on risk of acute and recurrent otitis media in offspring at three and five years of age. METHODS Exposure data on stressful life events were collected from pregnant women in a longitudinal prospective pregnancy cohort study, at 18 and 34 weeks' gestation. We used longitudinal regression models stratified by offspring sex to examine associations between the number, type and timing of maternal prenatal stress events and the likelihood of any OM in addition to recurrent OM infection at age three and five years, adjusting for pre-specified prenatal sociodemographic and environmental confounders. RESULTS Each additional stressful life event in pregnancy was associated with increased risk of any OM at both ages (3 years: OR = 1.07, 95%CI = 1.02, 1.12; 5 years: OR = 1.07, 95%CI = 1.02, 1.12), with larger effect sizes for recurrent otitis media (3 years: OR = 1.11, 95%CI = 1.05, 1.17; 5 years: OR = 1.09, 95%CI = 1.04, 1.14). Risk of offspring otitis media did not differ with timing of stress nor by offspring sex. Specific types of stress (pregnancy and relationship problems, issues with other children) were each associated with increased risk of recurrent OM at age three and five years. CONCLUSIONS We observed a dose-response relationship between maternal stressful life events in pregnancy and the risk for offspring otitis media in the preschool years, most marked for recurrent otitis media.
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Affiliation(s)
- Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Australia.
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Paediatrics, Monash University, Clayton, Australia
| | - Ashleigh Lin
- School of Population and Global Health, The University of Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Robert Eikelboom
- Ear Sciences Centre, Medical School, The University of Western Australia, Australia; Ear Science Institute Australia, Perth, Australia; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Shyan Vijayasekaran
- Perth ENT Centre, Perth, Australia; Otolaryngology Head and Neck Surgery, Perth Children's Hospital, Perth, Australia; Medical School, The University of Western Australia, Australia
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Gisselsson-Solen M, Gunasekera H, Hall A, Homoe P, Kong K, Sih T, Rupa V, Morris P. Panel 1: Epidemiology and global health, including child development, sequelae and complications. Int J Pediatr Otorhinolaryngol 2024; 178:111861. [PMID: 38340606 DOI: 10.1016/j.ijporl.2024.111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition. DATA SOURCES Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023. REVIEW METHODS We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised. RESULTS Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups. CONCLUSION Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review. IMPLICATIONS FOR PRACTICE The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.
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Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
| | - Hasantha Gunasekera
- Children's Hospital Westmead Clinical School, University of Sydney, Australia
| | | | - Preben Homoe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zeeland University Hospital, Koege, Denmark
| | - Kelvin Kong
- School of Medicine and Public Health, Newcastle, Australia
| | - Tania Sih
- Medical School University of Sao Paolo, Brazil
| | | | - Peter Morris
- Menzies School of Health Research Charles Darwin University Darwin, Australia
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Altamimi AA, Brennan-Jones CG, Robinson M, Kuthubutheen J, Herbert H, Tran TT, Veselinović T, Edmunds M, Oremulé B, Alenezi EM, Richmond PC, Choi RS, Li I. A hospital-based asynchronous ENT telehealth service for children with otitis media: Cost-minimisation and improved access. J Telemed Telecare 2024:1357633X231223994. [PMID: 38295365 DOI: 10.1177/1357633x231223994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
AIM The purpose of this study is to explore the effectiveness of a hospital-based asynchronous ear, nose, and throat (ENT) telehealth service (the Ear Portal) in reducing cost and improving access for children with otitis media. METHODS Participants were recruited to the Ear Portal from a tertiary hospital ENT waiting list. Ear and hearing assessments were conducted during appointments by the Ear Portal research assistant, and data was stored for an asynchronous review by the Ear Portal multidisciplinary team. A cost-minimisation analysis was conducted for the Ear Portal and the standard care pathways. Waiting times to provide care for both pathways were calculated for children with semi-urgent (i.e. Category 2) and non-urgent (i.e. Category 3) referrals. RESULTS The running cost for the Ear Portal was $67.70 for initial appointments and $37.34 for follow-up appointments. Conversely, the running cost for the standard care pathway was $154.65 for initial appointments and $86.10 for follow-up appointments. A total of 223 appointments were required to offset the initial Ear Portal investment of $19,384.00. The median waiting time for the Ear Portal from initial contact to care plan delivery was <30 days, whereas the median waiting times for children in the standard care pathway were 291 days (interquartile range (IQR) = 117) for Category 2 and 371 days (IQR = 311) for Category 3 referrals. CONCLUSION Under the current circumstances, the Ear Portal service can reduce costs for the health care system by reducing marginal costs per patient in addition to providing ENT specialist care within the clinically recommended timeframes.
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Affiliation(s)
- Ali Ah Altamimi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Life Sciences, Kuwait University, Kuwait
| | - Christopher G Brennan-Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
| | - Jafri Kuthubutheen
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Hayley Herbert
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | | | - Tamara Veselinović
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Melinda Edmunds
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Allied Health, Curtin University, Perth, Western Australia
| | - Babatunde Oremulé
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Eman Ma Alenezi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Peter C Richmond
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- Medical School, The University of Western Australia, Perth, Western Australia
- Perth Children's Hospital, Perth, Western Australia
| | - Robyn Sm Choi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia
- School of Human Sciences, The University of Western Australia, Perth, Western Australia
| | - Ian Li
- School of Management and Marketing, Curtin University, Perth, Western Australia
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Altamimi AAH, Robinson M, Alenezi EMA, Veselinović T, Choi RSM, Brennan‐Jones CG. Recurrent otitis media and behaviour problems in middle childhood: A longitudinal cohort study. J Paediatr Child Health 2024; 60:12-17. [PMID: 37961922 PMCID: PMC10952300 DOI: 10.1111/jpc.16518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/12/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
AIM To investigate the long-term effects of early-life recurrent otitis media (OM) and subsequent behavioural problems in children at the age of 10 years. METHODS Data from the Raine Study, a longitudinal pregnancy cohort, were used to categorise children into those with three or more episodes of OM (rOM group) and those without a history of recurrent OM in the first 3 years of life (reference group). The parent report Strengths and Difficulties Questionnaire was used to assess child behaviour at the age of 10 years. Parental questionnaires were used to report past and present diagnoses of various mental health and developmental conditions, including attention, anxiety, depression, learning, and speech-language problems. Multiple linear and logistic models were used to analyse the data and were adjusted for a fixed set of key confounding variables. RESULTS The linear regression analysis revealed significant, independent associations between a history of recurrent OM and higher Strengths and Difficulties Questionnaire scores, including total, internalising, externalising, emotional, attention/hyperactivity and peer problems subscales. Logistic regression analyses revealed an independent increased likelihood for children in the rOM group to have a diagnosis of attention, anxiety, learning and speech-language problems. CONCLUSION Children at 10 years of age with an early history of recurrent OM are more likely to exhibit attentional and behavioural problems when compared to children without a history of recurrent OM. These findings highlight the association between early-life recurrent OM and later behavioural problems that may require professional allied health-care interventions.
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Affiliation(s)
- Ali AH Altamimi
- Telethon Kids InstituteThe University of Western AustraliaPerthWestern AustraliaAustralia
- School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Faculty of Life SciencesKuwait UniversityKuwait CityKuwait
| | - Monique Robinson
- Telethon Kids InstituteThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Eman MA Alenezi
- Telethon Kids InstituteThe University of Western AustraliaPerthWestern AustraliaAustralia
- School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Faculty of Allied Health SciencesKuwait UniversityKuwait CityKuwait
| | - Tamara Veselinović
- Telethon Kids InstituteThe University of Western AustraliaPerthWestern AustraliaAustralia
- School of Human SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Robyn SM Choi
- Telethon Kids InstituteThe University of Western AustraliaPerthWestern AustraliaAustralia
- School of Human SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia
- School of Allied HealthFaculty of Health Sciences, Curtin UniversityPerthWestern AustraliaAustralia
| | - Christopher G Brennan‐Jones
- Telethon Kids InstituteThe University of Western AustraliaPerthWestern AustraliaAustralia
- School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
- Audiology DepartmentPerth Children's HospitalPerthWestern AustraliaAustralia
- School of Allied HealthFaculty of Health Sciences, Curtin UniversityPerthWestern AustraliaAustralia
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Pelton SI, Hullegie S, Leach AJ, Marchisio P, Marom T, Sabharwal V, Shaikh N, Tähtinen PA, Venekamp RP. ISOM 2023 Research Panel 5: Interventions- Vaccines and prevention, medical and surgical treatment, and impact of COVID-19 pandemic. Int J Pediatr Otorhinolaryngol 2024; 176:111782. [PMID: 38000342 PMCID: PMC10842145 DOI: 10.1016/j.ijporl.2023.111782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/05/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To identify and synthesize key research advances from the literature published between 2019 and 2023 on the advances in preventative measures, and medical and surgical treatment of uncomplicated otitis media (OM) including the impact of the COVID-19 pandemic on OM management. DATA SOURCES Medline (PubMed), Embase, and the Cochrane Library. REVIEW METHODS All relevant original articles published in English between June 2019 and February 2023 were identified. Studies related to guideline adherence, impact of treatment on immune response and/or microbiology, tympanoplasty, Eustachian tube balloon dilatation, mastoidectomy procedures, and those focusing on children with Down's syndrome or cleft palate were excluded. MAIN FINDINGS Of the 9280 unique records screened, 64 were eligible for inclusion; 23 studies related to medical treatment, 20 to vaccines, 13 to surgical treatment, 6 to prevention (excl. vaccines) and 2 to the impact of COVID-19 on OM management. The level of evidence was judged 2 in 11 studies (17.2 %) and 3 or 4 in the remaining 53 studies (82.8 %) mainly due to the observational design, study limitations or low sample sizes. Some important advances in OM management have been made in recent years. Video discharge instructions detailing the identification and management of pain and fever for parents of children with acute otitis media (AOM) was more effective than paper instructions in reducing symptomatology; compared to placebo, levofloxacin solution was more effective for treating chronic suppurative otitis media, whereas AOM recurrences during two years of follow-up did not differ between children with recurrent AOM who received tympanostomy tube (TT) insertion or medical management. Further, novel pneumococcal conjugate vaccines (PCV) schedules for preventing OM in Aboriginal children appeared ineffective, and a protein-based pneumococcal vaccine had no added value over PCV13 for preventing AOM in native American infants. During the COVID-19 pandemic, a decline in OM and TT case volumes and complications was observed. IMPLICATION FOR PRACTICE AND FUTURE RESEARCH Whether the observed impact of the COVID-19 pandemic on OM management extends to the post-pandemic era is uncertain. Furthermore, the impact of the pandemic on the conduct of urgently needed prospective methodologically rigorous interventional studies aimed at improving OM prevention and treatment remains to be elucidated since the current report consisted of studies predominantly conducted in the pre-pandemic era.
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Affiliation(s)
- Stephen I Pelton
- Department of Pediatrics, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Saskia Hullegie
- Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Vishakha Sabharwal
- Department of Pediatrics, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Nader Shaikh
- Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paula A Tähtinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, Department of General Practice and Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
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6
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Altamimi AA, Robinson M, Alenezi EM, Kuthubutheen J, Veselinović T, Bernabei G, Cayley T, Choi RS, Brennan-Jones CG. The Impact of Waiting Times on Behavioral Outcomes for Children with Otitis Media: Results from an Urban Ear, Nose, and Throat Telehealth Service. TELEMEDICINE REPORTS 2023; 4:359-365. [PMID: 38098782 PMCID: PMC10719648 DOI: 10.1089/tmr.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/17/2023]
Abstract
Aim Children with otitis media (OM) experience long waiting times to access Australia's public hospitals due to limited capacity. The aim of this article is to utilize an Ear, Nose, and Throat (ENT) telehealth service (the Ear Portal) to examine whether delayed access to specialist care is associated with poorer behavioral outcomes for children with OM. Methods Participants in the study included 45 children who were referred to ENT specialists due to recurrent and persistent OM. Children were triaged as semiurgent with a target time-to-assessment of 90 days or nonurgent with a target time-to-assessment of 365 days. The behavioral outcomes of children were assessed using the parent report Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics and adjusted multiple linear regression models were used to compare children who received access to the service within the time-to-assessment target of their triage category ("on-boundary"; n = 17) and outside the time-to-assessment target ("off-boundary"; n = 28). Spearman correlation analysis was used to explore the relationship between the internalizing, externalizing, and total SDQ scores as a function of waiting times in days. Results Borderline or abnormal SDQ scores ranged from 24.4% to 42.2% across the study participants. The regression analysis showed a statistically significant association between the off-boundary group and higher scores (i.e., poorer) on the peer, emotional, conduct, internalizing, and total problems subscales. Further, lengthy waiting times were significantly correlated with higher internalizing problems. These findings indicate that longer waiting times may lead to poorer behavioral outcomes for children with OM. Clinical Trial Registration: (ACTRN1269000039189p). Conclusion Children with recurrent and persistent OM referred to ENT outpatient care were found to have significantly more behavioral difficulties if their waiting times exceeded the recommended timeframes for their triaged referrals. Additionally, they experienced more internalizing problems that correlated with longer waiting times. This highlights the calls for alterations in current clinical practice given the lengthy waiting times in Australia's public hospitals.
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Affiliation(s)
- Ali A.H. Altamimi
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Medical School, The University of Western Australia, Perth, Australia
- Faculty of Life Sciences, Kuwait University, Kuwait City, Kuwait
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Eman M.A. Alenezi
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Medical School, The University of Western Australia, Perth, Australia
- Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
| | - Jafri Kuthubutheen
- Medical School, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Tamara Veselinović
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Audiology, School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Greta Bernabei
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Tanisha Cayley
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Robyn S.M. Choi
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Audiology, School of Human Sciences, The University of Western Australia, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Christopher G. Brennan-Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Medical School, The University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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Runge A, Straif S, Banki Z, Borena W, Muellauer B, Brunner J, Gottfried T, Schmutzhard J, Dudas J, Risslegger B, Randhawa A, Lass-Flörl C, von Laer D, Riechelmann H. Viral infection in chronic otitis media with effusion in children. Front Pediatr 2023; 11:1124567. [PMID: 37234860 PMCID: PMC10208354 DOI: 10.3389/fped.2023.1124567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/17/2023] [Indexed: 05/28/2023] Open
Abstract
Background The role of respiratory viruses in chronic otitis media with effusion (COME) in children is not clearly defined. In our study we aimed to investigate the detection of respiratory viruses in middle ear effusions (MEE) as well as the association with local bacteria, respiratory viruses in the nasopharynx and cellular immune response of children with COME. Methods This 2017-2019 cross-sectional study included 69 children aged 2-6 undergoing myringotomy for COME. MEE and nasopharyngeal swabs were analyzed via PCR and CT-values for the genome and loads of typical respiratory viruses. Immune cell populations and exhaustion markers in MEE related to respiratory virus detection were studied via FACS. Clinical data including the BMI was correlated. Results Respiratory viruses were detected in MEE of 44 children (64%). Rhinovirus (43%), Parainfluenzavirus (26%) and Bocavirus (10%) were detected most frequently. Average Ct values were 33.6 and 33.5 in MEE and nasopharynx, respectively. Higher detection rates correlated with elevated BMI. Monocytes were elevated in MEE (9.5 ± 7.3%/blood leucocytes). Exhaustion markers were elevated on CD4+ and CD8+ T cells and monocytes in MEE. Conclusion Respiratory viruses are associated with pediatric COME. Elevated BMI was associated with increased rates of virus associated COME. Changes in cell proportions of innate immunity and expression of exhaustion markers may be related to chronic viral infection.
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Affiliation(s)
- Annette Runge
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Sonja Straif
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Zoltan Banki
- Institute of Virology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - Wegene Borena
- Institute of Virology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - Brigitte Muellauer
- Institute of Virology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - Juergen Brunner
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Faculty of Medicine and Dental Medicine, Danube Private Univeristy Krems, Krems-Stein, Austria
| | - Timo Gottfried
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jozsef Dudas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Brigitte Risslegger
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Avneet Randhawa
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, United States
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dorothee von Laer
- Institute of Virology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Altamimi AAH, Robinson M, McKinnon EJ, Alenezi EMA, Veselinović T, Choi RSM, Brennan-Jones CG. The association between otitis media in early childhood with later behaviour and attention problems: A longitudinal pregnancy cohort. Int J Pediatr Otorhinolaryngol 2023; 168:111545. [PMID: 37043962 DOI: 10.1016/j.ijporl.2023.111545] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES The present study aims to investigate the association between an early history of recurrent otitis media (OM) with or without ventilation tube insertion (VTI) and later behavioural problems in childhood and adolescence. METHODS Parental reports in a longitudinal pregnancy cohort were used to classify children into three groups; recurrent OM without VTI (rOM group; n = 276), recurrent OM with VTI (VTI group; n = 62), and no history of early-life recurrent OM as a reference group (n = 1485). The Child Behaviour Checklist (CBCL) was administered at ages 5, 8, 10, and 13 years and data were analysed for psychological wellbeing. Mixed-effects regression modelling was used to investigate the associations between a history of rOM and CBCL T-scores across all ages for rOM and VTI groups compared to the reference group. All analyses were controlled for a wide range of confounding variables. RESULTS The analyses revealed a significant association between recurrent OM and behavioural problems. While there was a general decline in scores (i.e. improvement) observed over the duration of the follow-up period, children in the rOM group displayed significantly higher scores for internalising and externalising behaviours at ages five, eight and 10 years. Attention scores were significantly higher across all ages in the rOM group. A transient increase in internalising behaviour was observed in the VTI group at ages eight and 10 years. Logistic regression models showed an increased overall likelihood for the rOM group only to fall within the abnormal clinical range for internalising and externalising behaviours. CONCLUSION Early-life recurrent OM with and without VTI was associated with increased behavioural and attention problems in early and late childhood. This suggests that recurrent OM can have a significant impact on children's behaviour and attention that can persist into early adolescence.
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Affiliation(s)
- Ali A H Altamimi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; The University of Western Australia, Perth, Western Australia, Australia; Faculty of Life Sciences, Kuwait University, Kuwait.
| | - Monique Robinson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth J McKinnon
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Eman M A Alenezi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; The University of Western Australia, Perth, Western Australia, Australia; Faculty of Allied Health Sciences, Kuwait University, Kuwait
| | - Tamara Veselinović
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; The University of Western Australia, Perth, Western Australia, Australia
| | - Robyn S M Choi
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; The University of Western Australia, Perth, Western Australia, Australia
| | - Christopher G Brennan-Jones
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; The University of Western Australia, Perth, Western Australia, Australia; Perth Children's Hospital, Perth, Western Australia, Australia; School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Nano-silver composite antibacterial gel in the treatment of otitis media. APPLIED NANOSCIENCE 2022. [DOI: 10.1007/s13204-022-02729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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