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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 -
Nature Reviews. Disease Primers Sep 2016Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic... (Review)
Review
Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.
Topics: Hearing Loss; Humans; Middle Ear Ventilation; Otitis Media; Otoscopy; Pain; Quinolones; Risk Factors; Tympanic Membrane
PubMed: 27604644
DOI: 10.1038/nrdp.2016.63 -
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 -
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 -
Auris, Nasus, Larynx Aug 2020"Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children-2018 update (2018 Guidelines)" aim to provide appropriate...
OBJECTIVE
"Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media in Children-2018 update (2018 Guidelines)" aim to provide appropriate recommendations about the diagnosis and management of children with acute otitis media (AOM), including recurrent acute otitis media (recurrent AOM), in children under 15 years of age. These evidence-based recommendations were created with the consensus of the subcommittee members, taking into consideration unique characteristics of bacteriology and antimicrobial susceptibilities of AOM pathogens in Japan, as well as global advances in vaccines.
METHODS
The subcommittee re-evaluated key clinical issues based on SCOPE (a master plan of the guidelines) and created clinical questions (CQ) about the diagnosis and management of AOM patients. A literature search of the publications from 2013 to 2016 were added to the Guidelines 2013, not only to assess the evidence on the effectiveness of vaccines, but also to provide up to date information of the bacteriology and antimicrobial susceptibilities of AOM causative pathogens in Japan.
RESULTS
We have proposed guidelines for disease severity-based management of AOM patients, after classifying AOM severity into mild, moderate, and severe, based on age, clinical manifestations, and otoscopic findings.
CONCLUSIONS
Precise otoscopic findings are essential for judging AOM severity, which can lead to appropriate management of AOM patients.
Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Disease Management; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Japan; Otitis Media; Otoscopy; Practice Guidelines as Topic; Recurrence; Severity of Illness Index; Watchful Waiting
PubMed: 32576390
DOI: 10.1016/j.anl.2020.05.019 -
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 -
Danish Medical Journal Oct 2020Although acute otitis media (AOM) is a very frequent illness in children, it remains unclear to what extent children with AOM benefit from antibiotics (ABX). This...
INTRODUCTION
Although acute otitis media (AOM) is a very frequent illness in children, it remains unclear to what extent children with AOM benefit from antibiotics (ABX). This systematic review aimed to clarify this subject by including randomised clinical trials (RCTs) from the pneumococcal vaccine era only.
METHODS
We performed a systematic literature search in four databases from 1 January 2000 to 1 January 2019 for RCTs comparing ABX to placebo in patients with AOM. Pain was registered as the main outcome. Adverse events (AE), development of contralateral otitis media, tympanic membrane perforation, late AOM recurrence, abnormal tympanometry and time to resolution of middle ear effusion were registered as secondary outcomes.
RESULTS
Six publications based on five RCTs with 1,862 patients were included. The number needed to treat (NNT) to reduce pain varied from seven (pain at day 7-10) to 28 (pain at day 2-3). The NNT for preventing contralateral otitis was ten. AE were seen in every 13th patient treated with ABX.
CONCLUSIONS
ABX appears to have a limited effect on both primary and secondary outcomes compared with placebo. A substantial number of patients experienced AE. New RCTs are needed to further clarify the effect. Ideally, RCTs could be conducted in Danish general practices in collaboration with practicing ear, nose and throat specialists to obtain large unselected populations with high rates of vaccine coverage. Until more evidence is provided, ABX should be considered among children younger than two years of age with severe symptoms of AOM, i.e. fewer and affected well-being.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Humans; Infant; Neoplasm Recurrence, Local; Otitis Media; Tympanic Membrane Perforation
PubMed: 33215607
DOI: No ID Found -
The Journal of International Advanced... Dec 2016To evaluate and compare clinical and microbiological findings in adults hospitalized for acute otitis media (AOM) or mastoid infections (acute or latent).
OBJECTIVE
To evaluate and compare clinical and microbiological findings in adults hospitalized for acute otitis media (AOM) or mastoid infections (acute or latent).
MATERIALS AND METHODS
We retrospectively reviewed the medical records of all adults (≥17 years old) hospitalized (between 2003 and 2012) at a tertiary referral center for acute mastoid infections or AOM not responding to outpatient medical treatment.
RESULTS
Of the 160 patients in the study sample, 19% had an infection caused by S. pyogenes, 14% by S. pneumoniae, and 11% by P. aeruginosa. AOM was the most common infection (38%), whereas 33% had acute mastoiditis (AM), 18% had latent mastoiditis (LM), and 13% AM of a chronically infected ear (AMc). In contrast to the other infections, P. aeruginosa (30%) and S. aureus (25%) were most common in AMc. Otorrhea (83%), tympanic membrane perforation (57%), and hearing problems (83%) were common in S. pyogenes infections. Patients with S. pneumoniae had longer lengths of hospitalization than those with other bacterial infections (7 vs. 4 days). Otorrhea (94%) and retroauricular symptoms were more common in P. aeruginosa infections. Hearing symptoms were common (67%) but fever (32%) and retroauricular symptoms were uncommon in AOM. Fever (44%) and mastoid tenderness (65%) were common in AM. Patients with LM underwent the most mastoidectomies (54%). Prior medical conditions, retroauricular symptoms, otorrhea (90%), and post-infection problems were common in AMc.
CONCLUSION
The bacteriological etiology of hospitalized AOM more closely resembled those of LM and AM than that of AMc. Adults hospitalized for AOM or AM required fewer mastoidectomies than those hospitalized for LM or AMc.
Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Female; Hospitalization; Humans; Male; Mastoiditis; Middle Aged; Otitis Media; Pseudomonas aeruginosa; Retrospective Studies; Streptococcus; Young Adult
PubMed: 27895000
DOI: 10.5152/iao.2016.2620 -
European Annals of Otorhinolaryngology,... Feb 2018Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection....
Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection. Children can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) thus requiring treatment. Although many meta-analyses and national guidelines have been issued, management remains difficult to standardize, and use of surgical and medical treatments continue to vary. We convened an international consensus conference as part of the 2017 International Federation of Oto-rhino-laryngological Societies Congress, to identify best practices in OME management. Overall, regional differences were minor and consensual management was obtained on several important issues. At initial assessment, although a thorough medical examination is necessary to seek reflux, allergy or nasal obstruction symptoms; an age-appropriate auditory test is the only assessment required in children without abnormal history. Non-surgical treatments poorly address the underlying problem of an age-dependent dysfunctional Eustachian tube; auto-inflation seems to be the only beneficial, low-risk and low-cost non-surgical therapy. There was a clear international recommendation against using steroids, antibiotics, decongestants or antihistamines to treat OME, because of side-effects, cost issues and no convincing evidence of long-term effectiveness. Decisions to insert tympanostomy ventilation tubes should be based on an auditory test but also take into account the child's context and overall hearing difficulties. Tubes significantly improve hearing and reduce the number of recurrent AOM with effusion while in place. Adjuvant adenoidectomy should be considered in children over four years of age, and in those with significant nasal obstruction or infection.
Topics: Child; Humans; Internationality; Middle Ear Ventilation; Otitis Media with Effusion; Practice Guidelines as Topic
PubMed: 29398506
DOI: 10.1016/j.anorl.2017.11.009