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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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2
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Assiri K, Hudise J, Obeid A. Risk Factors for Chronic and Recurrent Otitis Media in Children: A Review Article. Indian J Otolaryngol Head Neck Surg 2024; 76:1464-1469. [PMID: 38440639 PMCID: PMC10908946 DOI: 10.1007/s12070-023-04256-5] [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: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 03/06/2024] Open
Abstract
Otitis media is an inflammation of the mucous membrane of the middle ear, which includes mastoid air cells, the middle ear cavity, the Eustachian tube, and the mastoid antrum. Otitis media can be either acute, less than six weeks, or chronic, which lasts for more than six weeks. Recurrent otitis media refers to three episodes of the disease occurring within six months or four episodes within one year. There are many risk factors for otitis media among children; however, some of such factors may vary based on the type of otitis media. To highlight the risk factors of chronic and recurrent otitis media in pediatrics. Scientific databases were used to search for articles related to our objective. Various terms were used for the search process. The types of articles included in our review were original articles, review articles, meta-analyses, and systematic reviews written in the English language and concerned with our subject. The topic was discussed under four main titles; the first overviewed the prevalence and risk factors of otitis media, the second title discussed chronic otitis media and its risk factors, the third title discussed recurrent otitis media and its risk factors, and the last title discussed the risk factors of both chronic and recurrent otitis media. There are various risk factors for chronic and recurrent otitis media, and they include allergy, passive smoking, male gender, and snoring. Also, genetics may have a common role, but this needs further investigation.
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Affiliation(s)
- Kholood Assiri
- Otorhinolaryngology - Rhinology and Skull Base Surgery consultant, King Faisal Medical City for Southern Regions, Abha, Saudi Arabia
| | - Jibril Hudise
- Otorhinolaryngology - Facial Plastic and Reconstructive Surgery Consultant, King Faisal Medical City for Southern Regions, Abha, Saudi Arabia
| | - Ali Obeid
- Otorhinolaryngology Senior Registrar, Ministry of Health , Abha, Saudi Arabia
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3
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Moradi A, Soltani R, Shamsi M, Moradzadeh R. Effects of online social media on improving mothers' behaviors towards preventing their children's otitis media based on the PRECED model: a randomized educational intervention trial. BMC Pediatr 2023; 23:216. [PMID: 37147633 PMCID: PMC10161150 DOI: 10.1186/s12887-023-04016-y] [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: 11/09/2022] [Accepted: 04/16/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Otitis media is one of the most common diseases in children, especially those under 2 years of age. This study aimed to investigate the effect of educational intervention based on the PRECEDE model on mothers' preventive behaviors of middle ear infections in infants. METHODS This study was conducted as an educational randomized controlled trial on 88 mothers with infants referred to health centers in Arak, Iran. Sampling from September 2021 to February 2022 selected trough stratified random sampling who were assigned to two groups of experimental = 44 and control = 44. The data collection tool was a reliable and valid questionnaire that included demographic information, constructs of PRECEDE model regarding otitis media, and preventive behaviors. The experimental group received 4 training sessions (each session 60 min) through WhatsApp social network. Information was collected through an online questionnaire before and 3 months after the educational intervention from both groups. Data analysis was also performed with SPSS version 23. RESULTS Before the educational intervention there was no significant difference between the experimental and control groups in the otitis media preventive behaviors and structures of PRECEDE model (p > 0.05). After the educational intervention, in the experimental group the average score of knowledge from 0.49 to 0.81, attitude from 4.01 to 4.58, enabling factors from 0.72 to 0.85, reinforcing factors from 3.31 to 3.91 and behavior from 3.25 to 3.66 increased significantly (p < 0.001). CONCLUSIONS PRECEDE-based education with controlling, monitoring and follow-up during the program was effective in promoting the preventive behaviors of otitis media. Therefore, due to the side effects of otitis media, especially in vulnerable periods such as childhood, it is recommended that trainings based on this model be carried out in other health care centers and clinics in order to maintain children health. TRIAL REGISTRATION This trial has been registered at the Iranian Registry of Clinical Trials, IRCT20210202050228N1. Prospectively registered at 2021-May-21, (2021/05/21) available at: URL: https://en.irct.ir/trial/54073 .
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Affiliation(s)
- Atefeh Moradi
- Student Research Committee, Department of Health Education, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Raheleh Soltani
- Department of Health Education, Faculty of Health, Arak University of Medical Sciences, Arak, Iran.
| | - Mohsen Shamsi
- Department of Health Education, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Rahmatallah Moradzadeh
- Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
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4
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Association between maternal insecticide use and otitis media in one-year-old children in the Japan Environment and Children's Study. Sci Rep 2022; 12:1365. [PMID: 35079075 PMCID: PMC8789766 DOI: 10.1038/s41598-022-05433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Otitis media (OM) is common among young children and is related to hearing loss. We investigated the association between maternal insecticide use, from conception to the first and second/third trimesters, and OM events in children in the first year of age. Data from Japan Environment and Children's Study were used in this prospective cohort study. Characteristics of patients with and without history of OM during the first year of age were compared. The association between history of OM in the first year and insecticide use was evaluated using logistic regression analysis. The study enrolled 98,255 infants. There was no significant difference in the frequency of insecticide use between groups. Insecticide use of more than once a week from conception to the first trimester significantly increased the occurrence of OM in children in the first year (odds ratio [OR] = 1.30, 95% confidence interval [CI] 1.01–1.67). The association between OM in the first year and insecticide use from conception to the first trimester was only significant in the group without daycare attendance (OR 1.76, 95% CI 1.30–2.38). Maternal insecticide use more than once a week from conception to the first trimester significantly increased OM risk in offspring without daycare attendance.
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5
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van Ingen G, le Clercq CMP, Jaddoe VWV, Moll HA, Duijts L, Raat H, Baatenburg de Jong RJ, van der Schroeff MP. Identifying distinct trajectories of acute otitis media in children: A prospective cohort study. Clin Otolaryngol 2021; 46:788-795. [PMID: 33555145 PMCID: PMC8248120 DOI: 10.1111/coa.13736] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 01/24/2021] [Indexed: 01/09/2023]
Abstract
Objectives To identify possibly distinct acute otitis media (AOM) trajectories in childhood and identify determinants associated with specific AOM trajectories. To explore which child will become prone to recurrent AOM episodes and which will not. Design Population‐based prospective cohort study among 7863 children from birth until 10 years and their mothers. Methods This study was embedded in the Generation R Study: a population‐based prospective cohort study. Data on AOM and determinants were collected by repeated parental questionnaires. Distinct AOM trajectories within the population were identified with latent‐class analyses. Next, using multivariate analysis we checked whether specific determinants were associated with specific trajectories. Results Three distinct trajectories were identified; that is, non–otitis prone, early AOM—that is children who suffered AOM episodes until 3 years of age but not beyond, and persistent AOM—that is children who remained otitis‐prone. Male gender (OR: 1.26, CI: 1.11‐1.43) and day‐care attendance (OR: 1.31, CI: 1.06‐1.60) were associated with increased odds of early AOM. Breastfeeding was beneficial for children in both the early‐AOM and persistent‐AOM trajectories (OR: 0.78 and 0.77, respectively). Birth in the summer or autumn as compared with birth in the spring decreased odds of AOM only in the persistent‐AOM trajectory. Half of all AOM‐prone children recovered after the age of 3 years. Conclusion Specific determinants are associated with different AOM trajectories. Future research is needed to better predict which child will remain otitis‐prone and which recovers after the age of 3 years to better tailor treatment towards the needs of the individual child.
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Affiliation(s)
- Gijs van Ingen
- Department of Otolaryngology-Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
| | - Carlijn M P le Clercq
- Department of Otolaryngology-Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A Moll
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Marc P van der Schroeff
- Department of Otolaryngology-Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
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6
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Wijayanti SPM, Wahyono DJ, Rejeki DSS, Octaviana D, Mumpuni A, Darmawan AB, Kusdaryanto WD, Nawangtantri G, Safari D. Risk factors for acute otitis media in primary school children: a case-control study in Central Java, Indonesia. J Public Health Res 2021; 10:1909. [PMID: 33489992 PMCID: PMC7816044 DOI: 10.4081/jphr.2021.1909] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/16/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Acute otitis media (AOM) is the most common disease in young children requiring antibiotic treatment. Information on AOM-related determinant risk factors in primary school children is still limited, particularly in Indonesia. This study aims to identify risk factors related to AOM in primary school children in Banyumas Regency, Central Java, Indonesia. Design and Methods: This is an analytical study with a casecontrol design in Banyumas Regency, Indonesia. 3574 children from 6 regions of the Banyumas Regency were recruited for the screening of AOM detection, and confirmation of AOM diagnosis was determined by Otolaryngologist. One hundred and twentyfive cases and 125 control were involved in this study. Data collection was carried out using a structured questionnaire focusing on several variables such as household cooking fuel, house environment, smoking exposure, knowledge of parents, and nutrition status. Univariate, bivariate using chi-square and multivariate with regression logistic was conducted for data analysis. Results: This study highlights the risk of household firewood use (p=0.003), poor nutritional status (p=0.009), and a family history of ear infections (p=0.015) with an increased risk of otitis media. Conclusions: Household firewood use, poor nutritional status and family history of ear infection are factors associated with the occurrence of acute otitis media. It is necessary to provide public health education to prevent exposure to fuel at risk for children and to improve their nutritional status. Significance for public health This study has important public health benefits because it offers valuable information about Acute Otitis Media (AOM) that is still limited in previous studies, particularly in Indonesia. This study confirms that problems related to AOM are still important because cases are still present in the community, particularly among primary school children. The basic advantage of this paper is the information that household firewood use, poor nutritional status and family history of ear infection are factors associated with acute otitis media in primary school children. This critical knowledge should be followed up by related parties to prevent the incidence of AOM cases in the community.
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Affiliation(s)
| | | | - Dwi Sarwani Sri Rejeki
- Department of Public Health, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto
| | - Devi Octaviana
- Department of Public Health, Faculty of Health Sciences, Jenderal Soedirman University, Purwokerto
| | - Aris Mumpuni
- Faculty of Biology, Jenderal Soedirman University, Purwokerto
| | - Anton Budhi Darmawan
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Jenderal Soedirman University, Purwokerto
| | - Wahyu Dwi Kusdaryanto
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Jenderal Soedirman University, Purwokerto
| | | | - Dodi Safari
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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7
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Clamp PJ, De-Loyde K, Maw AR, Gregory S, Golding J, Hall A. Factors associated with the development of paediatric chronic otitis media by age nine: a prospective longitudinal cohort study of 6560 children. J Laryngol Otol 2020; 134:1-12. [PMID: 33208197 DOI: 10.1017/s0022215120002182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to analyse social, health and environmental factors associated with the development of chronic otitis media by age nine. METHOD This was a prospective, longitudinal, birth cohort study of 6560 children, reviewed at age nine. Chronic otitis media defined as previous surgical history or video-otoscopic changes of tympanic membrane retraction, perforation or cholesteatoma. Non-affected children were used as the control group. RESULTS Univariate analysis demonstrated an association between chronic otitis media and otorrhoea, snoring, grommet insertion, adenoidectomy, tonsillectomy, hearing loss, abnormal tympanograms and preterm birth. Multivariate analysis suggests many of these factors may be interrelated. CONCLUSION The association between chronic otitis media and otorrhoea, abnormal tympanograms and grommets supports the role of the Eustachian tube and otitis media (with effusion or acute) in the pathogenesis of chronic otitis media. The role of snoring, adenoidectomy and tonsillectomy is unclear. Associations suggested by previous studies (sex, socioeconomic group, parental smoking, maternal education, childcare, crowding and siblings) were not found to be significant predictors in this analysis.
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Affiliation(s)
- P J Clamp
- Department of ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, UK
| | - K De-Loyde
- School of Social and Community Medicine, University of Bristol, UK
| | - A R Maw
- School of Social and Community Medicine, University of Bristol, UK
| | - S Gregory
- School of Social and Community Medicine, University of Bristol, UK
| | - J Golding
- School of Social and Community Medicine, University of Bristol, UK
| | - A Hall
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Life and Health Sciences, Aston University, Birmingham, UK
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8
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Christensen N, Bruun S, Søndergaard J, Christesen HT, Fisker N, Zachariassen G, Sangild PT, Husby S. Breastfeeding and Infections in Early Childhood: A Cohort Study. Pediatrics 2020; 146:peds.2019-1892. [PMID: 33097658 DOI: 10.1542/peds.2019-1892] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies on the association between breastfeeding and infections in children beyond the first year of life reveal conflicting results. In a population-based birth cohort, we investigated whether the duration of breastfeeding was associated with the number of hospitalizations due to infection and symptoms of infection at home. METHODS In the Odense Child Cohort, text message questionnaires were used to register information on breastfeeding (weekly until end of weaning) and symptoms of infection (biweekly; 12-36 months of age). Hospitalization data were obtained from the Danish National Patient Registry. RESULTS Of the 1087 invited, 815 mother-infant pairs were included. The median duration of any breastfeeding was 7.6 (interquartile range: 3.5-10.4) months and of exclusive breastfeeding was 2.1 (interquartile range: 0.7-4.4) months. Hospitalization due to infection was seen in 207 (25.4%) infants during the first 3 years of life. The adjusted incidence rate ratio (IRR) for hospitalization due to any infection decreased with a longer duration of any breastfeeding (adjusted IRR: 0.96; 95% confidence interval 0.93-0.99; P < .001). The strongest associations between the duration of any breastfeeding and hospitalizations due to infection were found within the first year of life, for lower respiratory tract infections, and other infections (P ≤ .05). For infants exclusively breastfed, the adjusted IRR for hospitalization was 0.88 (95% confidence interval: 0.80-0.96; P = .006). No protective associations were present between breastfeeding and infection symptoms registered at home from ages 12 to 36 months. CONCLUSIONS The results suggest that increased duration of breastfeeding, especially exclusive breastfeeding, protects against infections requiring hospitalization in the first year of life but not hospitalizations or symptoms of infection at home beyond the first year.
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Affiliation(s)
- Nikolas Christensen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Signe Bruun
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and.,Strategic Business Unit Pediatric, Arla Foods Ingredients Group P/S, Viby, Denmark; and
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Niels Fisker
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences and
| | - Per Torp Sangild
- Department of Clinical Research, Faculty of Health Sciences and.,Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Husby
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; .,Department of Clinical Research, Faculty of Health Sciences and
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9
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Hartley M, Woolcott CG, Langley JM, Brown MM, Ashley-Martin J, Kuhle S. Birth by Caesarean section and otitis media in childhood: a retrospective cohort study. Sci Rep 2020; 10:5219. [PMID: 32251348 PMCID: PMC7090017 DOI: 10.1038/s41598-020-62229-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/06/2020] [Indexed: 11/09/2022] Open
Abstract
The objective of the present study was to examine the association between birth by Caesarean section (CS) and otitis media (OM) in childhood. We assembled a retrospective cohort of children born between 2003 and 2007 in Nova Scotia and followed them through to 2014. The cohort was derived through a linkage of the Nova Scotia Atlee Perinatal Database with provincial administrative health data. Cox proportional hazards, negative binomial regression and logistic regression were used to examine the association between CS and OM. Among the 36,318 children, 27% were born by CS, and 78% had at least one OM episode (median 2 episodes). Children born by CS were at a slightly higher risk of OM (hazard ratio 1.06, 95% confidence interval (CI) 1.03, 1.09), had more OM episodes in the first 7 years of life (incidence rate ratio 1.04, 95% CI 1.01, 1.07), and were more likely to be above the 95th percentile for OM episodes than children born vaginally (odds ratio 1.10, 95% CI 0.99, 1.23). Our study shows that birth by CS is weakly associated with OM in childhood, but the clinical and public health impact of these findings is small.
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Affiliation(s)
- Maria Hartley
- Perinatal Epidemiology Research Unit, Depts of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Christy G Woolcott
- Perinatal Epidemiology Research Unit, Depts of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Joanne M Langley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mary M Brown
- Perinatal Epidemiology Research Unit, Depts of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jillian Ashley-Martin
- Perinatal Epidemiology Research Unit, Depts of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Stefan Kuhle
- Perinatal Epidemiology Research Unit, Depts of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada.
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10
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van Ingen G, le Clercq CMP, Touw CE, Duijts L, Moll HA, Jaddoe VWV, Raat H, Baatenburg de Jong RJ, van der Schroeff MP. Environmental determinants associated with acute otitis media in children: a longitudinal study. Pediatr Res 2020; 87:163-168. [PMID: 31421634 DOI: 10.1038/s41390-019-0540-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is a common pediatric disease and frequent reason for antibiotic treatment. We aimed to identify environmental and host factors associated with AOM and assess which determinants were associated with AOM at specific ages. METHODS This study among 7863 children was embedded in the Generation R Study: a population-based prospective cohort study from fetal life onwards. Data on outcome and possible determinants were collected using questionnaires until 6 years. We used generalized estimating equation models to examine associations with AOM with longitudinal odds at different ages, considering correlations between repeated measurements. RESULTS Male gender increased odds of AOM in children at 2, 3, and 4 years but not at other ages. Postnatal household smoking, presence of siblings, and pet birds increased odds of AOM. Breastfeeding decreased AOM odds, most notably in the first 2 months of life. No association was found for season of birth, maternal age, ethnicity, aberrant birth weight for gestational age, prenatal smoking, furry pets, and daycare attendance. CONCLUSIONS Risk of childhood AOM varies with age. Significant association with AOM was found for gender and breastfeeding at specific ages and for household smoking, presence of siblings, and pet birds at all the studied ages.
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Affiliation(s)
- Gijs van Ingen
- Department of Otolaryngology - Head and Neck Surgery, Erasmus MC, Rotterdam, Netherlands. .,The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands.
| | - Carlijn M P le Clercq
- Department of Otolaryngology - Head and Neck Surgery, Erasmus MC, Rotterdam, Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands
| | - Carolina E Touw
- Department of Otolaryngology - Head and Neck Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Liebeth Duijts
- The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, Rotterdam, Netherlands
| | - Henriette A Moll
- The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands
| | - Hein Raat
- The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | | | - Marc P van der Schroeff
- Department of Otolaryngology - Head and Neck Surgery, Erasmus MC, Rotterdam, Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, Netherlands
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11
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Chen KWK, Huang DTN, Chou LT, Nieh HP, Fu RH, Chang CJ. Childhood otitis media: Relationship with daycare attendance, harsh parenting, and maternal mental health. PLoS One 2019; 14:e0219684. [PMID: 31310620 PMCID: PMC6634415 DOI: 10.1371/journal.pone.0219684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/30/2019] [Indexed: 02/05/2023] Open
Abstract
Psychological stress has been linked to developmental problems and poor health in children, but it is unclear whether it is also related to otitis media (OM). As part of a long-term study surveying the characteristics of childcare and development in Taiwan, we analyzed the relationship between OM and sources of psychological stress in children, such as poor maternal mental health and harsh parental discipline. We analyzed the data of 1998 children from the "Kids in Taiwan: National Longitudinal Study of Child Development & Care (KIT) Project" at the age of 3 years. Using bivariate and multivariate logistic regression models, we tested several risk factors as potential independent predictors of two outcomes: parent-reported incidence of OM and child health. The proportion of children who had developed OM in the first 3 years of their life was 12.5%. Daycare attendance (odds ratio [OR]: 1.475; 95% confidence interval [CI]: 1.063-2.046), poor maternal mental health (OR: 1.913; 95% CI: 1.315-2.784), and harsh parental discipline (OR: 1.091; 95% CI: 1.025-1.161) correlated with parent-reported occurrence of OM. These findings suggest that providing psychosocial support to both parents and children might be a novel strategy for preventing OM.
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Affiliation(s)
- Kai-Wei Kevin Chen
- Division of Infectious Diseases, Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan, R.O.C
| | - Daniel Tsung-Ning Huang
- Division of Infectious Diseases, Department of Pediatrics, MacKay Children's Hospital, Taipei City, Taiwan, R.O.C
- Department of Medicine, MacKay Medical College, Sanzhi District, New Taipei City, Taiwan, R.O.C
| | - Li-Tuan Chou
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei City, Taiwan, R.O.C
| | - Hsi-Ping Nieh
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei City, Taiwan, R.O.C
| | - Ren-Huei Fu
- Chang Gung Medical Education Research Center, Division of Neonatology, Department of Pediatric, Chang Gung Memorial Hospital Linkou Branch, Guishan District, Taoyuan City, Taiwan, R.O.C
| | - Chien-Ju Chang
- Department of Human Development and Family Studies, National Taiwan Normal University, Taipei City, Taiwan, R.O.C
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12
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Wimberley T, Agerbo E, Pedersen CB, Dalsgaard S, Horsdal HT, Mortensen PB, Thompson WK, Köhler-Forsberg O, Yolken RH. Otitis media, antibiotics, and risk of autism spectrum disorder. Autism Res 2018; 11:1432-1440. [PMID: 30284386 DOI: 10.1002/aur.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/06/2018] [Accepted: 07/23/2018] [Indexed: 12/15/2022]
Abstract
Otitis media infections and antibiotic treatment have been linked to the risk of developing autism spectrum disorder. Broad-spectrum antibiotics may alter the composition of the gut flora microbiota, which is hypothesized to be involved in the regulation of the immune system. This study examines the interplay among otitis media, antibiotics, and the subsequent risk of developing autism. Based on the entire Danish population, 780,547 children were followed from birth (January 1, 1997 to December 31, 2008) until December 31, 2012. We calculated adjusted hazard ratios and absolute risks of autism with 95% confidence intervals (CIs) related to previous otitis media diagnoses and antibiotic prescriptions redeemed at Danish pharmacies. The absolute risk of autism before age 10 was increased among children with otitis media (1.2% for females and 3.3% for males) and in children who had redeemed an antibiotic prescription (0.6% and 2.7% for females and males) compared to children without a history of otitis media and antibiotics usage (0.4% for females and 1.9% for males). Similarly, we found an increased hazard ratio of autism associated with otitis media (1.83 95% CI 1.71-1.95) and antibiotics usage (1.29 95% CI 1.17-1.43). A history of both otitis media and antibiotic treatment did not further increase the risk of autism. Although the risk of autism was associated with otitis media and treatment with antibiotics, we found little evidence of a synergistic effect between otitis media infections and treatment with antibiotics. Autism Res 2018, 11: 1432-1440. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We investigated whether otitis media ear infections and antibiotic treatment were associated with autism spectrum disorder. Autism was more common in children who had had an otitis media infection or who had been treated with antibiotics. Given the observational nature of our data, our study cannot be used to conclude that otitis media or use of antibiotics cause autism, as our findings may be subject to unobserved confounding.
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Affiliation(s)
- Theresa Wimberley
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,NCRR-The National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,NCRR-The National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B Pedersen
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,NCRR-The National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Søren Dalsgaard
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,NCRR-The National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Department for Child and Adolescent Psychiatry, Hospital of Telemark, Kragerø, Norway
| | - Henriette Thisted Horsdal
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,NCRR-The National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Preben B Mortensen
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,NCRR-The National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark.,CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Wesley K Thompson
- iPSYCH-The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus and Copenhagen, Aarhus University, Denmark.,Mental Health Center Sct. Hans, Institute of Biological Psychiatry, Denmark.,University of California, San Diego, La Jolla, California
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark.,Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert H Yolken
- Stanley Division of Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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13
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Laursen RP, Larnkjær A, Ritz C, Hojsak I, Michaelsen K, Mølgaard C. Risks for upper respiratory infections in infants during their first months in day care included environmental and child-related factors. Acta Paediatr 2018; 107:1616-1623. [PMID: 29542189 DOI: 10.1111/apa.14320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/01/2018] [Accepted: 03/09/2018] [Indexed: 01/03/2023]
Abstract
AIM We examined the frequency and potential risk factors for respiratory infections, diarrhoea and absences in infants during their first months in day care. METHODS This prospective cohort study comprised 269 Danish infants aged eight months to 14 months and was part of a study that examined how probiotics affected absences from day care due to respiratory and gastrointestinal infections. The risk factors examined were the household, child characteristics and type of day care facility. Parents registered upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), diarrhoea and day care absences on web-based questionnaires. RESULTS Over a mean of 5.6 months in day care, 36% and 20% of the infants had at least one URTI or LRTI, and 60% had diarrhoeal episodes. The risk of at least one URTI was increased by previous respiratory infections, with an odds ratio (OR) of 2.65, but was inversely associated with having a pet (OR: 0.43), being cared for by registered child minders compared to day care centres (OR: 0.36), birthweight (OR 0.40) and age at day care enrolment (OR: 0.64). No significant risk factors for LRTIs and diarrhoea were found. CONCLUSION Infection risks were associated with environmental factors and factors related to the child.
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Affiliation(s)
- Rikke Pilmann Laursen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Anni Larnkjær
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Iva Hojsak
- School of Medicine, Children's Hospital Zagreb, University of Zagreb, Zagreb, Croatia
- School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - Kim Michaelsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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14
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Risk of childhood otitis media with focus on potentially modifiable factors: A Danish follow-up cohort study. Int J Pediatr Otorhinolaryngol 2018; 106:1-9. [PMID: 29447878 DOI: 10.1016/j.ijporl.2017.12.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/26/2017] [Accepted: 12/26/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Otitis media is the primary cause of antibiotic prescription in children. Two-thirds of all children experience at least one episode of otitis media before the age of 7 years. The aim of this study was to characterise the attributable effect of several modifiable risk exposures on the risk of >3 episodes of otitis media at age 18 months and 7 years within a large prospective national birth cohort. METHODS The study used the Danish National Birth Cohort comprising information about otitis media and risk exposures from more than 50,000 mother-child pairs from the period 1996-2002. Logistic regression models were used to estimate odds ratios for the risk factors and to calculate the population attributable fraction. RESULTS Short time with breastfeeding, early introduction to daycare, cesarean section, and low compliance to the national vaccination program were all associated with an increased risk of >3 episodes of otitis media at 18 months of age and at 7 years of age. The fraction of children with otitis media attributed from breastfeeding lasting for less than 6 months was 10%. Introduction to daycare before the age of 12 months attributed with 20% of the cases of >3 episodes of otitis media. CONCLUSIONS Short duration of breastfeeding, early introduction into daycare, cesarean section, and low compliance with the national vaccination program increased the risk of experiencing >3 episodes of otitis media at 18 months, and at 7 years of age. These are factors that all can be modulated.
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15
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Acute Otitis Media and Acute Coalescent Mastoiditis. MIDDLE EAR DISEASES 2018. [PMCID: PMC7122426 DOI: 10.1007/978-3-319-72962-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute otitis media is a frequent manifestation of otitis media, mainly during the early childhood. The multifactorial pathogenesis and risk factors are exposed along with its most microbiological agents. The clinical manifestations and their differential diagnoses are presented. General concepts and different actual guidelines of the treatment are described, also the efficient preventive measures are proposed. The second main issue of this chapter is to deal with the complications of acute otitis media, especially the acute coalescent mastoiditis, that is the most common suppurative complication of AOM. The pathogenesis of coalescent acute mastoiditis, its epidemiology, risk factors and the microbiological agents are presented. The clinical features and differential diagnosis are described, as the specific imaging findings. Complications of acute coalescent mastoiditis are typically the subperiosteal abscess, due to the cortical bony necrosis of the mastoid and its septa, or the intracranial spread of the infection (meningitis, intracranial abscesses and venous sinus thrombosis). The general concept of management is exposed, with emphasis on the antimicrobial treatment and the different surgical options.
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16
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the literature regarding the association between breastfeeding and childhood otitis media (OM), with focus on the literature published within the past 5 years. The review comprises original articles and recent reviews. RECENT FINDINGS The effect of a protective effect of breastfeeding on the risk of OM is still being discussed. Within the past 5 years, 6 reviews and 15 original articles have been published. No randomized controlled trials have been published, and the diversity of exposure and outcome measures in the studies was significant. Also, we provide a summary of the recent literature on cost-benefit of breastfeeding and believed mechanism of protection against OM. Breastfeeding for more than 6 months seems to protect against OM during the first 6 years of life. Exclusive breastfeeding may have a more protective effect than non-exclusive breastfeeding. Introduction of formula feeding before the age of 6 months increased the risk of OM.
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17
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Marom T, Israel O, Gavriel H, Pitaro J, Baker AA, Eviatar E. Comparison of first year of life acute otitis media admissions before and after the 13-valent pneumococcal conjugate vaccine. Int J Pediatr Otorhinolaryngol 2017; 97:251-256. [PMID: 28483246 DOI: 10.1016/j.ijporl.2017.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood infection, which is usually managed in the outpatient setting. Yet, the more severe cases are referred for inpatient treatment. We hypothesized that pneumococcal conjugate vaccines (PCVs), administered during the first year of life, would decrease AOM admissions rate in this age group. We studied the characteristics of infants admitted with AOM and acute mastoiditis (AM) in the PCV13 era, routinely given from November 2010 to all infants. METHODS Charts of infants ≤1 year that were hospitalized during 1/1/2010-31/12/2015 with AOM, with or without AM, were retrieved using hospitalization codes. We compared 2010-11 (transition years, from PCV7 to PCV13) to 2012-15 (post-PCV13 marketing years). RESULTS AOM was the primary/secondary discharge diagnosis in ∼4% of all admitted infants ≤1 year. Boys had more admissions than girls (62% vs 38%). Accuracy of AOM diagnoses substantially increased in the post-marketing years. The average hospitalization duration slightly shortened, from 3.21 (2010-11) to 2.99 days (2012-15) (p = 0.52). Despite considerably modest pre-admission antibiotic treatment rate (<30%), AM was infrequent (∼3.4% of AOM admissions). Amoxicillin was the most common antibiotic therapy given before admission and during hospitalization. The number of myringotomies, usually reserved for treatment failure cases, significantly declined, and there were almost no cases of resistant bacteria. Respiratory syncytial virus was detected in ∼20% of collected respiratory samples, and influenza A/B viruses in ∼8%. CONCLUSIONS AOM is still a major cause for hospitalization of infants in the PCV13 era. Yet, complications are infrequent, and AM rate is low.
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Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel.
| | - Ofer Israel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| | - Haim Gavriel
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| | - Jacob Pitaro
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
| | - Ali Abo Baker
- Faculty of Medicine, Tel Aviv University Sackler School of Medicine, 69978 Tel Aviv, Israel
| | - Ephraim Eviatar
- Department of Otolaryngology-Head and Neck Surgery, Assaf Harofeh Medical Center, Tel Aviv University Sackler School of Medicine, 70300 Zerifin, Israel
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18
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Granath A. Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention? CURRENT OTORHINOLARYNGOLOGY REPORTS 2017; 5:93-100. [PMID: 28616364 PMCID: PMC5446546 DOI: 10.1007/s40136-017-0151-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review To survey current strategies for treatment and prevention of recurrent acute otitis media (rAOM). Recent Findings Treatment with systemic antibiotics is required in recurrent episodes of acute otitis media. A cautious attitude is recommended due to antibiotic resistance. Antibiotics also provide effective prophylaxis for rAOM. Topical treatment with ear drops is recommended in rAOM with otorrhea from tympanostomy tubes. Pneumococcal conjugated vaccines seem to have a moderate reductive effect on overall otitis media. The effect on rAOM is still unclear. Different administrations of immunoglobulins have not been effective against rAOM. Breastfeeding had a protective effect against rAOM. A recommendation against cigarette smoke exposure as a measure to prevent otitis seems warranted. An effect for adenoidectomy in children <2 years old with rAOM has been suggested. There is a strong genetic connection with rAOM. Probiotics and nasal spray with Streptococci might offer future opportunities as prophylaxis. Too little is known about complimentary treatments to give any recommendations. Summary Systemic antibiotics are still needed as treatment against episodes of AOM in rAOM children. There are several preventive measures that can be taken to reduce the burden of AOM but they all have a small-moderate effect. Systemic antibiotics provide effective prophylaxis in rAOM, but must be used with extreme caution due to the emerging antibiotic resistance.
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Affiliation(s)
- Anna Granath
- ENT-Department Karolinska University Hospital and Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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19
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Correction: Risk Factors of Early Otitis Media in the Danish National Birth Cohort. PLoS One 2017; 12:e0171901. [PMID: 28166304 PMCID: PMC5293255 DOI: 10.1371/journal.pone.0171901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0166465.].
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