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Otolaryngology--head and Neck Surgery :... Apr 2017Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy... (Review)
Review
Objective We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention.
Topics: Adenoidectomy; Anti-Bacterial Agents; Combined Modality Therapy; Congresses as Topic; Humans; Middle Ear Ventilation; Otitis Media; Recurrence; Tympanic Membrane Perforation
PubMed: 28372534
DOI: 10.1177/0194599816633697 -
Recent Patents on Inflammation &... 2017Acute otitis media is a common childhood infection. Prompt diagnosis and appropriate treatment are very important. (Review)
Review
BACKGROUND
Acute otitis media is a common childhood infection. Prompt diagnosis and appropriate treatment are very important.
OBJECTIVE
To review in depth the epidemiology, pathophysiology, clinical manifestations, diagnosis, complications and particularly treatment of acute otitis media in children.
METHODS
A PubMed search was completed in Clinical Queries using the key term "acute otitis media". Patents were searched using the key term "acute otitis media" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com.
RESULTS
Acute otitis media affects over 80% of children before their third birthday and 30 to 45% of these children have suffered two or more episodes. Streptococcus pneumoniae, nontypable Haemophilus influenzae, and Moraxella catarrhalis are the most frequently isolated middle-ear pathogens. The diagnosis is based on acute onset of symptoms such as otalgia and fever, middle ear inflammation such as erythema of the tympanic membrane, and middle ear effusion. The choice of treatment method depends on the age of the child, laterality, and the severity of the disease. Recent patents related to the management of acute otitis media are also retrieved and discussed.
CONCLUSION
Antimicrobial treatment is recommended for all children less than two years of age, as well as in children ≥ two years of age who have a temperature ≥ 39oC; are toxic looking; have otalgia > 48 hours; have bilateral otitis media or otorrhea; have craniofacial abnormalities; are immunocompromised; or have uncertain access to follow-up. Amoxicillin is the drug of choice. Observation without antibiotic is an option in immunocompetent children ≥ two years of age who have an acute uncomplicated otitis media and non-severe illness if appropriate follow-up can be arranged.
Topics: Acute Disease; Age Factors; Anti-Bacterial Agents; Child; Child, Preschool; Fever; Humans; Otitis Media; Otitis Media with Effusion; Patents as Topic; Severity of Illness Index
PubMed: 28707578
DOI: 10.2174/1874609810666170712145332 -
Postgraduate Medicine May 2015Chronic otitis media (COM) is a common problem facing general practitioners, pediatricians and otolaryngologists. This article reviews the aetiopathogenesis,... (Review)
Review
Chronic otitis media (COM) is a common problem facing general practitioners, pediatricians and otolaryngologists. This article reviews the aetiopathogenesis, epidemiology, presentation, natural history, complications and management of COM. The literature was reviewed by using the PubMed search engine and entering a combination of terms including "COM", "diagnosis", "incidence", "complications" and "management". Relevant articles were identified and examined for content. What is the "take-home" message for the clinician? COM is a common problem with various sub-categories according to the disease state. It most commonly presents with painless otorrhoea and hearing loss. Treatment options vary according to the activity and type of disease encountered. COM carries significant patient morbidity.
Topics: Chronic Disease; Humans; Otitis Media
PubMed: 25913599
DOI: 10.1080/00325481.2015.1027133 -
American Family Physician Sep 2019Acute otitis media (AOM) is the most common diagnosis in childhood acute sick visits. By three years of age, 50% to 85% of children will have at least one episode of... (Review)
Review
Acute otitis media (AOM) is the most common diagnosis in childhood acute sick visits. By three years of age, 50% to 85% of children will have at least one episode of AOM. Symptoms may include ear pain (rubbing, tugging, or holding the ear may be a sign of pain), fever, irritability, otorrhea, anorexia, and sometimes vomiting or lethargy. AOM is diagnosed in symptomatic children with moderate to severe bulging of the tympanic membrane or new-onset otorrhea not caused by acute otitis externa, and in children with mild bulging and either recent-onset ear pain (less than 48 hours) or intense erythema of the tympanic membrane. Treatment includes pain management plus observation or antibiotics, depending on the patient's age, severity of symptoms, and whether the AOM is unilateral or bilateral. When antibiotics are used, high-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) is first-line therapy unless the patient has taken amoxicillin for AOM in the previous 30 days or has concomitant purulent conjunctivitis; amoxicillin/clavulanate is typically used in this case. Cefdinir or azithromycin should be the first-line antibiotic in those with penicillin allergy based on risk of cephalosporin allergy. Tympanostomy tubes should be considered in children with three or more episodes of AOM within six months or four episodes within one year with one episode in the preceding six months. Pneumococcal and influenza vaccines and exclusive breastfeeding until at least six months of age can reduce the risk of AOM.
Topics: Acute Disease; Adult; Amoxicillin; Anti-Bacterial Agents; Child; Child, Preschool; Evidence-Based Medicine; Family Practice; Female; Humans; Infant; Male; Middle Ear Ventilation; Otitis Media; Pain Management; Severity of Illness Index
PubMed: 31524361
DOI: No ID Found -
Current Opinion in Otolaryngology &... Dec 2019To review the latest literature on otitis media diagnosis, guidelines, treatment, and pathophysiology. (Review)
Review
PURPOSE OF REVIEW
To review the latest literature on otitis media diagnosis, guidelines, treatment, and pathophysiology.
RECENT FINDINGS
Although otitis media remains one of the most common reasons for outpatient visits, antibiotic prescriptions, and surgery in the United States, little progress has been made in terms of developing novel treatments for the prevention and resolution of this condition, indicating the urgent need to continue investigations into the pathophysiology of this disorder. The recent past has seen the publication of new guidelines for the management of both acute otitis media, chronic otitis media and tympanostomy tube placement. Exciting technologies are being investigated into novel means to improve the diagnosis of otitis media, reviewed herein. Advancements in mucosal immunology and genetics have offered clues as to the underlying pathophysiology influencing otitis media propensity. Future research into modifying these pathophysiologic underpinnings, potentially through the usage of transtympanic drug delivery systems, should greatly influence the management of this condition.
SUMMARY
Research into novel methods for otitis media pathophysiology, diagnosis and treatment has seen great strides in the recent past. Avenues towards markedly altering the evaluation and management of the condition are likely to be adopted into clinical practice over the coming years.
Topics: Humans; Otitis Media
PubMed: 31592792
DOI: 10.1097/MOO.0000000000000591 -
Laryngo- Rhino- Otologie Jul 2018A number of diseases of the middle ear are summed up under the term otitis media: acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic...
A number of diseases of the middle ear are summed up under the term otitis media: acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media and chronic otitis media epitympanalis (= cholesteatoma). Acute otitis media belongs to the most common pediatric diseases and is often caused by bacterial infection. Since the advent of pneumococcal vaccines the quantity of AOM caused by pneumococci has declined; vaccination against NTHi and Moraxella catarrhalis are being developed. Main pillar of conservative treatment of AOM is symptomatic therapy of otalgia and fever as well as restoring the Eustachian tubal function. When indicated, amoxicillin represents antibiotic medication of choice. Acute mastoiditis, facial nerve paresis, labyrinthitis, Gradenigo syndrome, sinus vein thrombosis, meningitis and brain abscess belong to the complications of AOM among others. Both innate and adaptive immune system are involved in recovery of OM with innate immunity playing a critical role. Dysfunction of the Eustachian tube often underlies OM. Manometric measurement of Eustachian tube function may be useful for indication of balloon Eustachian tuboplasty. Several theories explain pathogenesis of cholesteatoma and multiple pro-inflammatory processes promote its progress in the course of the disease.
Topics: Acute Disease; Bacterial Infections; Child; Eustachian Tube; Humans; Mastoiditis; Otitis Media; Otitis Media with Effusion
PubMed: 29986368
DOI: 10.1055/s-0044-101327 -
Expert Review of Anti-infective Therapy May 2023Acute otitis media (AOM) affects most (80%) children by 5 years of age and is the most common reason children are prescribed antibiotics. The epidemiology of AOM has... (Review)
Review
INTRODUCTION
Acute otitis media (AOM) affects most (80%) children by 5 years of age and is the most common reason children are prescribed antibiotics. The epidemiology of AOM has changed considerably since the widespread use of pneumococcal conjugate vaccines, which has broad-reaching implications for management.
AREAS COVERED
In this narrative review, we cover the epidemiology of AOM, best practices for diagnosis and management, new diagnostic technology, effective stewardship interventions, and future directions of the field. Literature review was performed using PubMed and ClinicalTrials.gov.
EXPERT OPINION
Inaccurate diagnoses, unnecessary antibiotic use, and increasing antimicrobial resistance remain major challenges in AOM management. Fortunately, effective tools and interventions to improve diagnostic accuracy, de-implement unnecessary antibiotic use, and individualize care are on the horizon. Successful scaling of these tools and interventions will be critical to improving overall care for children.
Topics: Child; Humans; Infant; Acute Disease; Otitis Media; Anti-Bacterial Agents; Pneumococcal Vaccines
PubMed: 37097281
DOI: 10.1080/14787210.2023.2206565 -
JAMA Pediatrics Mar 2020
Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Otitis Media; Pain Management
PubMed: 31985755
DOI: 10.1001/jamapediatrics.2019.5664 -
The New England Journal of Medicine May 2021Official recommendations differ regarding tympanostomy-tube placement for children with recurrent acute otitis media. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Official recommendations differ regarding tympanostomy-tube placement for children with recurrent acute otitis media.
METHODS
We randomly assigned children 6 to 35 months of age who had had at least three episodes of acute otitis media within 6 months, or at least four episodes within 12 months with at least one episode within the preceding 6 months, to either undergo tympanostomy-tube placement or receive medical management involving episodic antimicrobial treatment. The primary outcome was the mean number of episodes of acute otitis media per child-year (rate) during a 2-year period.
RESULTS
In our main, intention-to-treat analysis, the rate (±SE) of episodes of acute otitis media per child-year during a 2-year period was 1.48±0.08 in the tympanostomy-tube group and 1.56±0.08 in the medical-management group (P = 0.66). Because 10% of the children in the tympanostomy-tube group did not undergo tympanostomy-tube placement and 16% of the children in the medical-management group underwent tympanostomy-tube placement at parental request, we conducted a per-protocol analysis, which gave corresponding episode rates of 1.47±0.08 and 1.72±0.11, respectively. Among secondary outcomes in the main analysis, results were mixed. Favoring tympanostomy-tube placement were the time to a first episode of acute otitis media, various episode-related clinical findings, and the percentage of children meeting specified criteria for treatment failure. Favoring medical management was children's cumulative number of days with otorrhea. Outcomes that did not show substantial differences included the frequency distribution of episodes of acute otitis media, the percentage of episodes considered to be severe, and antimicrobial resistance among respiratory isolates. Trial-related adverse events were limited to those included among the secondary outcomes of the trial.
CONCLUSIONS
Among children 6 to 35 months of age with recurrent acute otitis media, the rate of episodes of acute otitis media during a 2-year period was not significantly lower with tympanostomy-tube placement than with medical management. (Funded by the National Institute on Deafness and Other Communication Disorders and others; ClinicalTrials.gov number, NCT02567825.).
Topics: Acute Disease; Anti-Bacterial Agents; Child, Preschool; Drug Resistance, Bacterial; Female; Humans; Infant; Intention to Treat Analysis; Kaplan-Meier Estimate; Male; Middle Ear Ventilation; Otitis Media; Otitis Media with Effusion; Quality of Life; Recurrence
PubMed: 33979487
DOI: 10.1056/NEJMoa2027278 -
American Family Physician Jan 2017
Review
Topics: Acute Disease; Anti-Bacterial Agents; Child; Humans; Otitis Media; Otitis Media with Effusion; Prognosis
PubMed: 28084706
DOI: No ID Found