Incidence and risk factors of acute otitis media and otitis media with effusion in children of different age groups

Risk factors for persistent otitis media with effusion in children: a case-control study

Background

Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion.

Methods

Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group.

Results

A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at <1 year of age (odds ratio=9.96; 95% confidence interval=2.44-39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively.

Conclusion

Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Pediatric otorhinolaryngology emergencies at the Jos University Teaching Hospital: Study of frequency, management, and outcomes

Background:

Studies from Nigeria on pediatric otorhinolaryngology (ORL) emergencies are rare in literature with most focusing on emergencies involving individual systems.

Objective:

The aim of this study is to determine the prevalence of all ORL emergencies among children in our region to provide a baseline data for future health planning.

Patients and Methods:

This is a 1-year retrospective cross-sectional study of patients aged 16 years and below presenting to the Accident and Emergency Department of the Jos University Teaching Hospital, Jos, Nigeria.

Results:

A total of 203 otolaryngology emergencies were attended of which 129 (63.5%) were pediatric emergencies. Records of 87 patients were retrievable with age range 2 months to 15 years (mean 3.44 years; standard deviation ± 3.35). There were 55 males and 32 females with a male to female ratio of 1.7:1. The majority of cases were aged under 5 years (64; 73.6%). Acute tonsillitis accounted for 32 (36.7%) cases with 6 (6.9%) having peritonsillar abscesses. Acute pharyngitis accounted for 11 (12.6%) presentations followed closely by foreign bodies (FBs) in the ear with 10 (11.5%) presentations. FB in the throat occurred in 4 (4.6%) patients who had removal under general anesthesia. Three (3.4%) cases of maxillofacial injuries occurred as a result of insurgent terror attacks and 3.4% presented following corrosive substance ingestion. Conservative management was commenced in 76 (87.4%) patients, 23 (26.4%) had surgery with 68 (78.2%) admitted and discharged, 18 (20.7%) treated as outpatients, and 1 (1.1%) died on admission. Otolaryngologists attended most (95.4%) patients.

Conclusion:

Pediatric ORL emergencies are common in our region involving a wide range of pathologies. Expansion is required in the ORL training of the emergency room physician to enhance emergency services.

Emergency Otorhinolaryngolocal cases in Medical College, Kolkata-A statistical analysis

At the round the clock entergency of the Deparment of Otorhinolaryngology, Medical College, Kolkata, different types of cases are managed everyday. The various emergency conditions encountered by us in last four years are gathered and analyzed in this study. The different problems and their modes of management are discussed here.

Prediction of 8-month MEE from neonatal risk factors and test results in SCBU and full-term babies

The incidence and persistence of middle ear effusion (MEE) may be affected by children's birth history and environment. Factors such as bottle-feeding, presence of parental smoking, admission to special care and a history of colds are all thought to increase the risk of persistent MEE. The aim of the present study was to determine those risk factors and neonatal test results that best predict presence of MEE (as measured by 220 Hz tympanometry) at 8 months of age. One hundred Special Care Baby Unit (SCBU) and non-SCBU babies were assessed neonatally and at 8 months of age with tympanometry. At each assessment, various risk factors were collected. Failure of 8-month tympanometry was best predicted by neonatal (660 Hz) tympanometry and the presence or absence of breast-feeding for SCBU babies. This provides further evidence that 660 Hz tympanometry may provide information about neonatal MEE. For non-SCBU babies the risk of failing 8-month tympanometry was most significantly affected by a history of colds and parental smoking. The number of babies with each combination of risk factors in the present study is rather small and this has caused confidence intervals (CIs) to be wide and some unexpected results. However, an extended study with a larger and more balanced sample may facilitate accurate prediction neonatally of those children at risk of 8-month MEE.

Tympanometry and otoacoustic emissions in a cohort of special care neonates

Otoacoustic emission (OAE) screening and oto-admittance testing (678 Hz probe tone) were performed on both ears of 84 special care neonates, as part of a larger study of middle-ear effusion in neonates and infants. OAE results, tympanometry, and acoustic reflex results are all strongly and significantly associated. No evidence was found of any maturational effects in the results. Based on the findings, a tentative classification scheme for neonatal tympanograms is suggested. We conclude that 678 Hz tympanometry is a useful indicator of middle-ear status in very young babies, and that middle-ear effusion does strongly affect OAEs in neonates. OAEs are also strongly affected by negative middle-ear pressure (MEP), and mean MEP in ears failing OAE screens was significantly more negative than in those passing. The prevalence of abnormal tympanometry, which may indicate middle-ear effusion or dysfunction, was 20% of ears (29% of babies) in this group. It appears that middle-ear effusion could account for about half of the ears failing an OAE screen on the special care baby unit. We also find that length of stay on the special care baby unit is an important risk factor for development of middle-ear effusion: those on the unit for over 30 days have about four times the risk of bilateral abnormal tympanometry.