-
American Family Physician Mar 2015Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and... (Review)
Review
Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. TMD is classified as intra-articular or extra-articular. Common symptoms include jaw pain or dysfunction, earache, headache, and facial pain. The etiology of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive triggers. Diagnosis is most often based on history and physical examination. Diagnostic imaging may be beneficial when malocclusion or intra-articular abnormalities are suspected. Most patients improve with a combination of noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices. Nonsteroidal anti-inflammatory drugs and muscle relaxants are recommended initially, and benzodiazepines or antidepressants may be added for chronic cases. Referral to an oral and maxillofacial surgeon is indicated for refractory cases.
Topics: Adult; Disease Management; Humans; Medical History Taking; Physical Examination; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 25822556
DOI: No ID Found -
The Pan African Medical Journal 2019
Topics: Administration, Oral; Antiviral Agents; Drug Therapy, Combination; Earache; Facial Paralysis; Glucocorticoids; Herpes Zoster Oticus; Herpesvirus 3, Human; Humans; Hypesthesia; Male; Middle Aged; Prednisolone; Skin Diseases, Vesiculobullous; Trigeminal Nerve; Valacyclovir; Varicella Zoster Virus Infection
PubMed: 32180875
DOI: 10.11604/pamj.2019.34.201.19207 -
The Cochrane Database of Systematic... Jun 2015Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA, Canada and Australia. This is an update of a Cochrane review first published in The Cochrane Library in Issue 1, 1997 and previously updated in 1999, 2005, 2009 and 2013.
OBJECTIVES
To assess the effects of antibiotics for children with AOM.
SEARCH METHODS
We searched CENTRAL (2015, Issue 3), MEDLINE (1966 to April week 3, 2015), OLDMEDLINE (1958 to 1965), EMBASE (January 1990 to April 2015), Current Contents (1966 to April 2015), CINAHL (2008 to April 2015) and LILACS (2008 to April 2015).
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing 1) antimicrobial drugs with placebo and 2) immediate antibiotic treatment with expectant observation (including delayed antibiotic prescribing) in children with AOM.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data.
MAIN RESULTS
For the review of antibiotics against placebo, 13 RCTs (3401 children and 3938 AOM episodes) from high-income countries were eligible and had generally low risk of bias. The combined results of the trials revealed that by 24 hours from the start of treatment, 60% of the children had recovered whether or not they had placebo or antibiotics. Pain was not reduced by antibiotics at 24 hours (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.78 to 1.01) but almost a third fewer had residual pain at two to three days (RR 0.70, 95% CI 0.57 to 0.86; number needed to treat for an additional beneficial outcome (NNTB) 20). A quarter fewer had pain at four to seven days (RR 0.76, 95% CI 0.63 to 0.91; NNTB 16) and two-thirds fewer had pain at 10 to 12 days (RR 0.33, 95% CI 0.17 to 0.66; NNTB 7) compared with placebo. Antibiotics did reduce the number of children with abnormal tympanometry findings at two to four weeks (RR 0.82, 95% CI 0.74 to 0.90; NNTB 11), at six to eight weeks (RR 0.88, 95% CI 0.78 to 1.00; NNTB 16) and the number of children with tympanic membrane perforations (RR 0.37, 95% CI 0.18 to 0.76; NNTB 33) and halved contralateral otitis episodes (RR 0.49, 95% CI 0.25 to 0.95; NNTB 11) compared with placebo. However, antibiotics neither reduced the number of children with abnormal tympanometry findings at three months (RR 0.97, 95% CI 0.76 to 1.24) nor the number of children with late AOM recurrences (RR 0.93, 95% CI 0.78 to 1.10) when compared with placebo. Severe complications were rare and did not differ between children treated with antibiotics and those treated with placebo. Adverse events (such as vomiting, diarrhoea or rash) occurred more often in children taking antibiotics (RR 1.38, 95% CI 1.19 to 1.59; number needed to treat for an additional harmful outcome (NNTH) 14). Funnel plots do not suggest publication bias. Individual patient data meta-analysis of a subset of included trials found antibiotics to be most beneficial in children aged less than two years with bilateral AOM, or with both AOM and otorrhoea.For the review of immediate antibiotics against expectant observation, five trials (1149 children) from high-income countries were eligible and had low to moderate risk of bias. Four trials (1007 children) reported outcome data that could be used for this review. From these trials, data from 959 children could be extracted for the meta-analysis of pain at three to seven days. No difference in pain was detectable at three to seven days (RR 0.75, 95% CI 0.50 to 1.12). One trial (247 children) reported data on pain at 11 to 14 days. Immediate antibiotics were not associated with a reduction in the number of children with pain (RR 0.91, 95% CI 0.75 to 1.10) compared with expectant observation. Additionally, no differences in the number of children with abnormal tympanometry findings at four weeks, tympanic membrane perforations and AOM recurrence were observed between groups. No serious complications occurred in either the antibiotic or the expectant observation group. Immediate antibiotics were associated with a substantial increased risk of vomiting, diarrhoea or rash compared with expectant observation (RR 1.71, 95% CI 1.24 to 2.36; NNTH 9).Results from an individual patient data meta-analysis including data from six high-quality trials (1643 children) that were also included as individual trials in our review showed that antibiotics seem to be most beneficial in children younger than two years of age with bilateral AOM (NNTB 4) and in children with both AOM and otorrhoea (NNTB 3).
AUTHORS' CONCLUSIONS
This review reveals that antibiotics have no early effect on pain, a slight effect on pain in the days following and only a modest effect on the number of children with tympanic perforations, contralateral otitis episodes and abnormal tympanometry findings at two to four weeks and at six to eight weeks compared with placebo in children with AOM. In high-income countries, most cases of AOM spontaneously remit without complications. The benefits of antibiotics must be weighed against the possible harms: for every 14 children treated with antibiotics one child experienced an adverse event (such as vomiting, diarrhoea or rash) that would not have occurred if antibiotics were withheld. Therefore clinical management should emphasise advice about adequate analgesia and the limited role for antibiotics. Antibiotics are most useful in children under two years of age with bilateral AOM, or with both AOM and otorrhoea. For most other children with mild disease in high-income countries, an expectant observational approach seems justified.
Topics: Acute Disease; Adolescent; Age Factors; Anti-Bacterial Agents; Child; Child, Preschool; Earache; Humans; Infant; Otitis Media; Pain; Randomized Controlled Trials as Topic; Secondary Prevention; Tympanic Membrane Perforation
PubMed: 26099233
DOI: 10.1002/14651858.CD000219.pub4 -
Italian Journal of Pediatrics Mar 2023Acute pain is a common symptom in children of all ages, and is associated with a variety of conditions. Despite the availability of guidelines, pain often remains...
BACKGROUND
Acute pain is a common symptom in children of all ages, and is associated with a variety of conditions. Despite the availability of guidelines, pain often remains underestimated and undertreated. Paracetamol and ibuprofen are the most commonly used drugs for analgesia in Pediatrics. Multimodal pain management by using a combination of paracetamol and ibuprofen results in greater analgesia.
METHODS
An investigation using the Nominal Group Technique was carried out between May and August 2022. Two open (non-anonymous) questionnaires were consecutively sent to a Board of ten clinicians to understand their opinions on the use of the oral paracetamol and ibuprofen association. Answers were examined in a final meeting where conclusions were drawn.
RESULTS
The board achieved a final consensus on a better analgesic power of paracetamol and ibuprofen in fixed-dose combination as compared to monotherapy, without compromising safety. Strong consensus was reached on the opinion that the fixed-dose combination of paracetamol and ibuprofen may be a useful option in case of inefficacy of one or other drug as monotherapy, especially in case of headaches, odontalgia, earache, and musculoskeletal pain. The use of the fixed combination may be also considered suitable for postoperative pain management.
CONCLUSIONS
The use of the fixed-dose combination may represent advantage in terms of efficacy and safety, allowing a better control of the dose of both paracetamol and ibuprofen as monotherapy, thus minimizing the risk of incorrect dosage. However, the limited evidence available highlights the need for future well designed studies to better define the advantages of this formulation in the various therapeutic areas.
Topics: Child; Humans; Acetaminophen; Acute Pain; Analgesics, Non-Narcotic; Consensus; Drug Combinations; Ibuprofen; Pain, Postoperative; Pain Management; Health Care Surveys; Administration, Oral
PubMed: 36945023
DOI: 10.1186/s13052-023-01445-4 -
Australian Family Physician Jul 2016Otalgia is frequently seen in general practice. It can be broadly divided into primary otalgia, which includes the diseases occurring largely within the ear, or...
BACKGROUND
Otalgia is frequently seen in general practice. It can be broadly divided into primary otalgia, which includes the diseases occurring largely within the ear, or secondary otalgia, which is pain referred to the ear by travelling along cranial nerves that supply both the ear and referred region. The causes of secondary otalgia may require more extensive examination and investigation to define the aetiology.
OBJECTIVE
The aims of this article are to outline the most common causes of otalgia seen in general practice, and provide a pragmatic approach to initial assessment and deciding when to refer for specialist review.
DISCUSSION
The most common cause of primary otalgia is infection. Other causes require a greater index of suspicion. Specialist referral could be made if there are complications of primary otalgia or if a secondary cause needs to be excluded in a patient with a normal otology examination.
Topics: Disease Management; Earache; Female; Humans; Young Adult
PubMed: 27610432
DOI: No ID Found -
The Journal of International Advanced... Jul 2022Congenital cholesteatomas account for just up to 5% of all cholesteatomas and most commonly arise in the petrous apex and middle ear. Congenital cholesteatomas arising...
BACKGROUND
Congenital cholesteatomas account for just up to 5% of all cholesteatomas and most commonly arise in the petrous apex and middle ear. Congenital cholesteatomas arising in the mastoid are rare and typically present late.
METHODS
In this study, we report a case series of 3 cases managed in our department between 2006 and 2021 and present a summary of the current literature.
RESULTS
Congenital cholesteatomas arising in the mastoid is a rare finding and even among reported cases, not all are clearly mastoid in origin. Their location allows for considerable growth before symptoms develop. Pain and localized swelling in the temporal area are the most common presenting symptoms which can lead to diagnostic challenges. Our cases show that although surgery is often appropriate, conservative manage- ment may be suitable in certain situations.
CONCLUSION
Congenital cholesteatoma of mastoid origin is rare and can present a diagnostic challenge. Greater awareness is important to facilitate early detection. A high index of suspicion is needed in those presenting with retro-auricular pain and swelling in the context of a normal ontological examination.
Topics: Bone Diseases; Cholesteatoma; Cholesteatoma, Middle Ear; Ear, Middle; Earache; Humans; Mastoid
PubMed: 35072629
DOI: 10.5152/iao.2022.21450 -
Cureus Oct 2022Otitis media is a disorder of the middle ear, which can occur at any age but is more common among infants and children. The patient usually presents with earaches,... (Review)
Review
Otitis media is a disorder of the middle ear, which can occur at any age but is more common among infants and children. The patient usually presents with earaches, impaired hearing, and fever. If antibiotics and decongestants do not suit the patient, a myringotomy can be performed to achieve middle ear aeration. In myringotomy, a slit is created in the tympanic membrane, and fluid is removed with suction. In cases where myringotomy, aspiration, and medical care don't help and the fluid recurs, a tympanostomy tube is inserted to create continuous aeration of the middle ear. A tympanostomy tube is a small tube inserted in the tympanic membrane which helps in the prevention of fluid accumulation in the middle ear. These tubes are temporary and often fall off after the ear heals. Other names for tympanostomy tubes are grommet, myringotomy tube, or pressure equalizing tube. Initially, tympanostomy tubes were made of metal but now fluoroplastic or silicone elastomers are used to make them. The two basic designs of a tympanostomy tube are short-term tube and long-term tube. The choice of a tympanostomy tube depends on factors like age, the period needed for ventilation, socioeconomic status, and the extent of the retracted eardrum. The incidence of occlusion, infection, functional duration, and persistent perforation following extrusion varies between the designs and materials. Every year, many children are affected by recurrent otitis media, which can negatively influence their quality of life and their ability to hear and communicate. With so many children requiring tympanostomy tubes, choosing the appropriate tube is vital to provide optimal treatment and limit complications.
PubMed: 36397911
DOI: 10.7759/cureus.30166 -
Life (Basel, Switzerland) Jul 2022In Mediterranean cuisine and culture, olive oil and olive fruits play a significant role. Many people believe that those who consume olive oil and its fruit live longer... (Review)
Review
In Mediterranean cuisine and culture, olive oil and olive fruits play a significant role. Many people believe that those who consume olive oil and its fruit live longer and have a decreased risk of illness. Olive leaves were used to treat a range of diseases in ancient times, including malaria fever and lower earaches. Although it was not understood at the time what key components were responsible for these effects because they had not yet been discovered, Oleuropein is now recognized as one of the primary elements in immature olive fruits and leaves. Later research was carried out to determine the effects of this molecule, and it was determined that it functions as an antioxidant. Oleuropein consumption has aided in cancer treatment over the years, and this was assumed to be owing to its antioxidant properties. Oleuropein's effects on cancer, however, go beyond that; it is now known that Oleuropein functions as both an anti-proliferative and an apoptotic promoter in many cancer cells. The kinetics and dosages of Oleuropein and the mechanisms behind its involvement and effects in cancer are explored in this review. Finally, the effects of Oleuropein in combination with anticancer medicines are investigated.
PubMed: 36013319
DOI: 10.3390/life12081140 -
AJNR. American Journal of Neuroradiology Dec 2020Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for... (Review)
Review
Otalgia is very common, and when the cause of ear pain is not identified on otoscopy and physical examination, cross-sectional imaging is routinely used to evaluate for potential sources of referred ear pain (secondary otalgia). Innervation of the ear structures is complex, involving multiple upper cervical, lower cranial, and peripheral nerves, which transit and innervate a large anatomic territory involving the brain, spine, skull base, aerodigestive tract, salivary glands, paranasal sinuses, face, orbits, deep spaces of the neck, skin, and viscera. Interpreting radiologists must be familiar with these neural pathways and potential sources of secondary otalgia. The purposes of this review are to detail the currently proposed mechanisms of referred ear pain, review the salient neuroanatomy of the complex pathways responsible for secondary otalgia, highlight important benign and malignant etiologies of referred ear pain, and provide a structured search pattern for approaching these challenging cases on cross-sectional imaging.
Topics: Earache; Humans; Neuroimaging; Pain, Referred
PubMed: 33093134
DOI: 10.3174/ajnr.A6808 -
Systematic Reviews Apr 2021Patient-reported outcome measures (PROMs) are valuable tools in assessing the quality of health care from a patient perspective and are increasingly used by otologists.... (Review)
Review
BACKGROUND
Patient-reported outcome measures (PROMs) are valuable tools in assessing the quality of health care from a patient perspective and are increasingly used by otologists. However, selecting the right questionnaire has proven to be a difficult and time-consuming task. To facilitate this process, we will provide a comprehensive overview of existing questionnaires.
METHODS
A systematic literature search has been conducted on August 26, 2019, using the EMBASE and PubMed medical databases. 13,345 unique records were extracted. Questionnaires addressing any otologic complaint (tinnitus, hearing loss, earache, otorrhoea, and ear-related pressure sensation, vertigo, itch, or dysgeusia) were identified. All questionnaires were evaluated for eligibility by two independent researchers. Inclusion criteria were adult population, closed-ended questions, English language of the questionnaire, and the availability of the original article describing the development of the instrument or a validation paper describing the validation process written in English.
OBJECTIVE
Create a comprehensive overview of all validated closed-ended otology questionnaires for adults and demonstrate their basic characteristics.
MAIN OUTCOME MEASURE
The number of questionnaires in English literature for the adult population, subdivided per symptom and target population.
RESULTS
A total of 155 unique questionnaires were selected: 33 tinnitus questionnaires, 23 vertigo questionnaires, 84 hearing loss questionnaires, and 15 multiple complaint questionnaires. A protocol for further questionnaire comparison is presented.
DISCUSSION
Two separate sequential searches were needed to identify unique questionnaires and to identify their development/validation paper. Although many ear diseases create multiple symptoms, the majority of the questionnaires were symptom specific.
CONCLUSION
Many questionnaires concerning ear-related symptoms exist and predominantly concern hearing loss, vertigo, or tinnitus. Only a few questionnaires cover the multiple complaints that ear diseases can create. The presented overview is the most comprehensive overview of otology questionnaires in literature to date. It will serve as a basis for questionnaire selection by professionals and could serve as a protocol for questionnaire selection in other fields.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017058155.
Topics: Adult; Hearing Loss; Humans; Otolaryngology; Patient Reported Outcome Measures; Surveys and Questionnaires; Tinnitus
PubMed: 33879248
DOI: 10.1186/s13643-021-01659-9