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Molecules (Basel, Switzerland) May 2020Ear infection is one of the most commonly occurring inflammation diseases in the world, especially for children. Almost every child encounters at least one episode of... (Review)
Review
Ear infection is one of the most commonly occurring inflammation diseases in the world, especially for children. Almost every child encounters at least one episode of ear infection before he/she reaches the age of seven. The typical treatment currently followed by physicians is visual inspection and antibiotic prescription. In most cases, a lack of improper treatment results in severe bacterial infection. Therefore, it is necessary to design and explore advanced practices for effective diagnosis. In this review paper, we present the various types of ear infection and the related pathogens responsible for middle ear infection. We outline the conventional techniques along with clinical trials using those techniques to detect ear infections. Further, we highlight the need for emerging techniques to reduce ear infection complications. Finally, we emphasize the utility of Raman spectroscopy as a prospective non-invasive technique for the identification of middle ear infection.
Topics: Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Female; Humans; Male; Microscopy, Confocal; Optical Imaging; Otitis Media; Prospective Studies; Sensitivity and Specificity; Spectrum Analysis, Raman
PubMed: 32397569
DOI: 10.3390/molecules25092239 -
Medicina (Kaunas, Lithuania) Dec 2022Otitis media (OM) and its recurring (rAOM), effusive (OME), and chronic forms, represent a frequent clinical challenge. The middle ear, the mandible, and the... (Review)
Review
Otitis media (OM) and its recurring (rAOM), effusive (OME), and chronic forms, represent a frequent clinical challenge. The middle ear, the mandible, and the temporomandibular joint (TMJ) share several embryological and anatomical connections. Despite that, the role of mandibular malposition and TMJ dysfunction is frequently overlooked in the management of otitis media. In this narrative review, we present current evidence supporting the etiopathogenetic role of a dysfunctional stomatognathic system in the onset of OM and the effectiveness of orthognathic treatment in preventing rAOM and OME. In particular, a focus on the influence of TMJ on Eustachian tube function is provided.
Topics: Humans; Otitis Media; Temporomandibular Joint; Recurrence; Mandible
PubMed: 36557008
DOI: 10.3390/medicina58121806 -
Ear, Nose, & Throat Journal Nov 2020To review current pragmatic issues and controversies related to tympanostomy tubes in children, in the context of current best research evidence plus expert opinion to... (Review)
Review
OBJECTIVE
To review current pragmatic issues and controversies related to tympanostomy tubes in children, in the context of current best research evidence plus expert opinion to provide nuance, address uncertainties, and fill evidence gaps.
METHODS
Each issue or controversy is followed by the relevant current best evidence, expert insight and opinion, and recommendations for action. The role of expert opinion and experience in forming conclusions is inversely related to the quality, consistency, and adequacy of published evidence. Conclusions are combined with opportunities for shared decision-making with caregivers to recommend pragmatic actions for clinicians in everyday settings.
RESULTS
The issues and controversies discussed include (1) appropriate tube indications, (2) rationale for not recommending tubes for recurrent acute otitis media persistent middle ear effusion, (3) role of tubes in at-risk children with otitis media with effusion, (4) role of new, automated tube insertion devices, (5) appropriateness and feasibility of in-office tube insertion in awake children, (6) managing methicillin-resistant acute tube otorrhea, and (7) managing recurrent or persistent tube otorrhea.
CONCLUSIONS
Despite a substantial, and constantly growing, volume of high-level evidence on managing children with tympanostomy tubes, there will always be gaps, uncertainties, and controversies that benefit from clinician experience and expert opinion. In that regard, the issues discussed in this review article will hopefully aid clinicians in everyday, pragmatic management decisions.
Topics: Child; Child, Preschool; Clinical Decision-Making; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Ear Ventilation; Otitis; Otitis Media; Otitis Media with Effusion; Patient Selection; Recurrence; Staphylococcal Infections; Treatment Outcome
PubMed: 32283979
DOI: 10.1177/0145561320919656 -
European Review For Medical and... Jun 2023The aim of this study was to investigate the correlation between obstructive sleep apnea (OSA) and otitis media with effusion (OME) in Chinese children and identify risk...
OBJECTIVE
The aim of this study was to investigate the correlation between obstructive sleep apnea (OSA) and otitis media with effusion (OME) in Chinese children and identify risk factors for OME to support the development of standardized diagnostic and treatment methods.
PATIENTS AND METHODS
Clinical data of 1,021 children with OSA admitted to our hospital between January 2019 and December 2020 were collected. The prevalence of OME was assessed based on age groups and different grades of adenoid hypertrophy (AH). Multivariate logistic regression was performed to determine risk factors for OME in this population.
RESULTS
Among the patients, only 73 (6.15%) reported hearing loss as the main complaint, while 178 (17.43%) were diagnosed with OME after the examination. Acoustic immittance showed higher detection rates for OME compared to those of otoscopy and pure tone audiometry. In addition, the incidence of OME did not increase with AH grade but was higher in children with OSA with AH grade IV. Multivariate regression analysis showed that the younger age group (2-5 years), AH grade IV, nasal inflammatory disease, and passive smoking were significant risk factors for OSA and OME. However, sex, age of 6-12 years, and presence of chronic tonsillitis/tonsillar hypertrophy had no significant impact on the prevalence of OME.
CONCLUSIONS
OME is highly prevalent in children with OSA. Clinicians should be vigilant in diagnosing OME, should conduct routine audiological examinations, and actively screen for middle ear fluid in all children with OSA, especially in younger children (2-5 years) with nasal mucosa inflammation and a history of passive smoking. This will help improve the detection rate of OME, as early intervention is paramount for preventing complications.
Topics: Humans; Child; Child, Preschool; Otitis Media with Effusion; Prevalence; Tobacco Smoke Pollution; Risk Factors; Sleep Apnea, Obstructive; Hypertrophy; Otitis Media
PubMed: 37401280
DOI: 10.26355/eurrev_202306_32780 -
Veterinary Medicine and Science Sep 2022
Topics: Animals; Cat Diseases; Cats; Otitis Media
PubMed: 35689834
DOI: 10.1002/vms3.850 -
Frontiers in Cellular and Infection... 2021Otitis media (OM) encompasses a spectrum of clinical presentations ranging from the readily identifiable Acute OM (AOM), which is characterised by otalgia and fever, to... (Review)
Review
Otitis media (OM) encompasses a spectrum of clinical presentations ranging from the readily identifiable Acute OM (AOM), which is characterised by otalgia and fever, to chronic otitis media with effusion (COME) where impaired hearing due to middle ear effusion may be the only clinical symptom. Chronic suppurative OM (CSOM) presents as a more severe form of OM, involving perforation of the tympanic membrane. The pathogenesis of OM in these varied clinical presentations is unclear but activation of the innate inflammatory responses to viral and/or bacterial infection of the upper respiratory tract performs an integral role. This localised inflammatory response can persist even after pathogens are cleared from the middle ear, eustachian tubes and, in the case of respiratory viruses, even the nasal compartment. Children prone to OM may experience an over exuberant inflammatory response that underlies the development of chronic forms of OM and their sequelae, including hearing impairment. Treatments for chronic effusive forms of OM are limited, with current therapeutic guidelines recommending a "watch and wait" strategy rather than active treatment with antibiotics, corticosteroids or other anti-inflammatory drugs. Overall, there is a clear need for more targeted and effective treatments that either prevent or reduce the hyper-inflammatory response associated with chronic forms of OM. Improved treatment options rely upon an in-depth understanding of OM pathogenesis, particularly the role of the host innate immune response during acute OM. In this paper, we review the current literature regarding the innate immune response within the middle ear to bacterial and viral otopathogens alone, and as co-infections. This is an important consideration, as the role of respiratory viruses as primary pathogens in OM is not yet fully understood. Furthermore, increased reporting from PCR-based diagnostics, indicates that viral/bacterial co-infections in the middle ear are more common than bacterial infections alone. Increasingly, the mechanisms by which viral/bacterial co-infections may drive or maintain complex innate immune responses and inflammation during OM as a chronic response require investigation. Improved understanding of the pathogenesis of chronic OM, including host innate immune response within the middle ear is vital for development of improved diagnostic and treatment options for our children.
Topics: Child; Ear, Middle; Humans; Immunity, Innate; Mucous Membrane; Otitis Media; Otitis Media with Effusion
PubMed: 34778109
DOI: 10.3389/fcimb.2021.764772 -
Medical Image Analysis Jul 2021In this study, we propose an automatic diagnostic algorithm for detecting otitis media based on otoscopy images of the tympanic membrane. A total of 1336 images were...
In this study, we propose an automatic diagnostic algorithm for detecting otitis media based on otoscopy images of the tympanic membrane. A total of 1336 images were assessed by a medical specialist into three diagnostic groups: acute otitis media, otitis media with effusion, and no effusion. To provide proper treatment and care and limit the use of unnecessary antibiotics, it is crucial to correctly detect tympanic membrane abnormalities, and to distinguish between acute otitis media and otitis media with effusion. The proposed approach for this classification task is based on deep metric learning, and this study compares the performance of different distance-based metric loss functions. Contrastive loss, triplet loss and multi-class N-pair loss are employed, and compared with the performance of standard cross-entropy and class-weighted cross-entropy classification networks. Triplet loss achieves high precision on a highly imbalanced data set, and the deep metric methods provide useful insight into the decision making of a neural network. The results are comparable to the best clinical experts and paves the way for more accurate and operator-independent diagnosis of otitis media.
Topics: Humans; Neural Networks, Computer; Otitis Media; Otitis Media with Effusion; Otoscopy; Tympanic Membrane
PubMed: 33848961
DOI: 10.1016/j.media.2021.102034 -
Anales de Pediatria May 2023Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and...
Update of the consensus on acute otitis media (AOM) (2012) and sinusitis (2013) following the introduction of pneumococcal vaccines in the immunization schedule, and related changes, such as epidemiological variation, colonization by of nonvaccine serotypes and emerging antimicrobial resistances. A majority of studies show that the introduction of the pneumococcal 13-valent conjugate vaccine has been followed by a reduction in the nasopharyngeal carriage of pneumococcus, with an increase in the proportion of drug-resistant nonvaccine serotypes. The diagnosis of AOM is still clinical, although more stringent criteria are proposed, which are based on the visualization of abnormalities in the tympanic membrane and the findings of pneumatic otoscopy performed by trained clinicians. The routine diagnosis of sinusitis is also clinical, and the use of imaging is restricted to the assessment of complications. Analgesia with acetaminophen or ibuprofen is the cornerstone of AOM management; watchful waiting or delayed antibiotic prescription may be suitable strategies in select patients. The first-line antibiotic drug in children with AOM and sinusitis and moderate to severe disease is still high-dose amoxicillin, or amoxicillin-clavulanic acid in select cases. Short-course regimens lasting 5-7 days are recommended for patients with uncomplicated disease, no risk factors and a mild presentation. In allergic patients, the selection of the antibiotic agent must be individualized based on severity and whether or not the allergy is IgE-mediated. In recurrent AOM, the choice between watchful waiting, antibiotic prophylaxis or surgery must be individualized based on the clinical characteristics of the patient.
Topics: Child; Humans; Consensus; Otitis Media; Amoxicillin; Anti-Bacterial Agents; Sinusitis
PubMed: 37127475
DOI: 10.1016/j.anpede.2023.03.006 -
Upsala Journal of Medical Sciences Nov 2019Clinical trial results of phage treatment of bacterial infections show a low to moderate efficacy, and the variation in infection clearance between subjects within... (Review)
Review
Clinical trial results of phage treatment of bacterial infections show a low to moderate efficacy, and the variation in infection clearance between subjects within studies is often large. Phage therapy is complicated and introduces many additional components of variance as compared to antibiotic treatment. A large part of the variation is due to pharmacokinetics and pharmacodynamics being virtually unknown, but also to a lack of standardisation. This is a consequence of the great variation of phages, bacteria, and infections, which results in different experiments or trials being impossible to compare, and difficulties in estimating important parameter values in a quantitative and reproducible way. The limitations of phage therapy will have to be recognised and future research focussed on optimising infection clearance rates by e.g. selecting phages, bacteria, and target bacterial infections where the prospects of high efficacy can be anticipated, and by combining information from new mathematical modelling of pharmacokinetic and pharmacodynamic processes and quantitatively assessed experiments.
Topics: Animals; Anti-Bacterial Agents; Bacterial Infections; Bacteriophages; Humans; In Vitro Techniques; Models, Theoretical; Otitis Media; Phage Therapy; Pharmacokinetics; Pseudomonas aeruginosa; Randomized Controlled Trials as Topic
PubMed: 31724901
DOI: 10.1080/03009734.2019.1688433 -
International Journal of Molecular... Apr 2023The aim of this comprehensive review was to present the current knowledge on the role of microRNAs (miRNAs) in acute, recurrent, and chronic forms of otitis media.... (Review)
Review
The aim of this comprehensive review was to present the current knowledge on the role of microRNAs (miRNAs) in acute, recurrent, and chronic forms of otitis media. Special attention was focused on cholesteatoma of the middle ear. MicroRNAs modulate gene expression, which, in turn, influences the development and likelihood of the recurrence of acute and aggressive chronic middle ear inflammatory processes. Moreover, this study discusses the modulating role of a specific subgroup of noncoding RNA, circular RNA (circRNA). Recognizing the precise potential pathways and the mechanisms of their function may contribute to a better understanding of the molecular bases of middle ear diseases and identifying novel methods for treating this demanding pathology. Articles published between 2009 and 2022 were used in this analysis. In this review, we provide a complete overview of the latest progress in identifying the role and mechanisms of particular miRNAs and circRNAs in acute, recurrent and chronic forms of otitis media.
Topics: Humans; MicroRNAs; RNA, Circular; Otitis Media; Ear, Middle
PubMed: 37047725
DOI: 10.3390/ijms24076752