Secretory otitis media--infectious background and its implications for treatment

[The main steps in treatment of the children with otitis media with effusion]

MATERIAL AND METHODS

361 children at age from 11 months to 18 years with otitis media with effusion (OME) were inspected after tympanostomy during 2013-2018 years. Treatment was carried out in accordance with the stages of OME: secretory, mucous, fibrous. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, computed tomography. Surgical treatment may be required already at the secretory stage of the disease, as well as in all cases with mucous and fibrous stages of OME.

RESULTS

In children with recurrences of OME and in patients with congenital cleft lip and palate, it is preferable to use long-wearing ventilation tubes and balloning of the auditory tubes. The effectiveness of surgical treatment of OME was 97.6%.

CONCLUSION

The authors recommend dispensary observation of patients with OME for 12-24 months.

[The main steps in treatment of the children with otitis media with effusion]

THE AIM

Of the investigation was to establish the standard and improve the treatment of otitis media with effusion (OME) in children. 361 children at age from 11 months to 18 years were inspected after tympanostomy during 2013-2018 years. The main diagnostic methods were: otoscopy, tympanometry, endoscopy, CT.

MATERIAL AND METHODS

Treatment takes into consideration the reveal of OME: surgical initially. The tympanostomy preferable place is anterior-inferior quadrant.

RESULTS

In cases with cleft palate or reccurence OME long-term tubes and balloonisation of ET are preferable.

CONCLUSION

Authors received normalization of the hearing thresholds in 97.6% cases, but after surgery the patients have to be followed-up during 12-24 months.

Double-blind randomised trial of co-amoxiclav versus placebo for persistent otitis media with effusion in general practice

BACKGROUND

The treatment of persistent otitis media with effusion (OME) remains controversial, but this condition is the commonest reason for children to require ear, nose, and throat (ENT) surgery. Trials of antibiotics are inconclusive, are often weak methodologically, and have not been done in general practice. Our aim was a trial of an antibiotic for OME in such a population.

METHODS

433 children, aged 6 months to 6 years, with OME from 57 general practices entered a 3-month watchful waiting period. Of 223 (52%) with persistent bilateral OME, 162 were randomised double-blind to receive co-amoxiclav suspension (20 mg/kg amoxicillin, 5 mg/kg clavulanate potassium) or matching placebo, orally three times a day for 14 days. All cases also received xylometazoline 0.25% decongestant nosedrops thrice daily. Of the 61 not randomised, 13 children were referred to an ENT surgeon and parents refused consent in 48 cases. The main outcome measures were persistent OME in both ears and in one or both ears, as assessed clinically and by tympanometry. Analysis was by intention-to-treat.

FINDINGS

79 children in the treatment group and 70 in the placebo group were analysed for efficacy. 3 withdrew in the co-amoxiclav group (2 lost to follow-up, 1 due to side-effects); 6 withdrew in the placebo group (5 and 1, respectively). In addition, 4 tympanograms were uninterpretable in the controls. Compliance was over 90% in both groups. Persistent OME in both ears and in one or both ears were found at significantly lower rates in the co-amoxiclav group than in the controls at the 2-week follow-up: 53 vs 84% and 77 vs 93%, respectively. Odds ratios adjusted for sex, history of adenoidectomy, and upper respiratory tract infection at follow-up were 0.25 (95% CI 0.11, 0.58, p = 0.001) and 0.30 (0.10, 0.89, p = 0.03), respectively. Parents of children in the co-amoxiclav group reported significantly more side-effects than those of control children (44 vs 22%, p = 0.03). Side-effects were mostly gastrointestinal and mild.

INTERPRETATION

Our study in a general-practice setting confirmed the positive short-term effect of antibiotic treatment for persistent middle-ear infection. Before referral to an ENT surgeon, children with persistent OME presenting to general practitioners could be considered for such treatment, depending on the individual child and possible adverse sequelae.

Interferon production by leukocytes in children with otitis media with effusion

We have previously shown that leukocyte cultures of children suffering from recurrent respiratory tract infections produce less interferon (IFN) than those of healthy children. In the present study this tentative marker of recurrent infections was used to study the pathogenetic background of otitis media with effusion (OME). Altogether 57 consecutive children, aged 2-11 years, who came for tympanostomy and/or adenoidectomy were divided into three subgroups: 25 of them had OME and a history of recurrent acute otitis media (rAOM/OME+), 20 had OME without an infectious background (inf-/OME+), and 12 had a history of recurrent upper respiratory infections (inf +/OME-) without OME. All the children were free of acute illness at the time of sampling. Differences between the groups were seen in IFN yields when leukocyte cultures were stimulated with adeno-, rhino-, corona-, respiratory syncytial or influenza A viruses. Leukocytes from inf-/OME+ children produced more IFN than those of the other two groups. Though no sex differences in the IFN responses were seen among rAOM/OME+ and inf +/OME- children, leukocytes from inf-/OME+ girls produced significantly higher amounts of IFN than those of inf-/OME+ boys, or rAOM/OME+ and inf +/OME- children. These differences between clinically different groups of children support the view that the etiology of OME can be heterogeneous.