International Journal of Pediatric Otorhinolaryngology
Volume 73, Issue 6, June 2009, Pages 803-806
Glenn Isaacsona, aDepartment of Otolaryngology – Head & Neck Surgery, Temple University School of Medicine, USA bDepartment of Pediatrics, Temple University School of Medicine, USA
Abstract
Objective
To evaluate the efficacy of a protocol designed to prevent post-adenotonsillectomy airway obstruction in small children with obstructive sleep apnea.
Design
Computerized retrospective review of single surgeon case series.
Setting
Tertiary children's medical center.
Methods
Children with sleep study proven obstructive sleep apnea or children under the age of 3 years with clinically suspected obstructive sleep apnea were treated according to a protocol that included: (1) rapid bloodless tonsillectomy; (2) repeated release of the tonsillar retractor; (3) avoidance of uvular edema; (4) routine intra-operative intranasal oxymetazoline, and placement of nasal airway; (5) extended recovery room observation. Primary outcome measures were (1) avoidance of unexpected intensive care unit admission; (2) post-extubation pulmonary edema; (3) aspiration pneumonia.
Results
During the period March 2004–August 2007, 864 children underwent adenotonsillectomy by a single surgeon—604 for the indication of obstructive sleep apnea or adenotonsillar hypertrophy with obstruction. Two hundred and ten were under the age of 3 years or had sleep study proven obstructive sleep apnea. There were two unexpected admissions to the pediatric intensive care unit for persistent upper airway obstruction—none required intubation. No child developed post-obstructive pulmonary edema. Three children were treated for infiltrates consistent with aspiration pneumonitis.
Conclusion
Most cases of post-extubation pulmonary edema and pneumonia can be avoided in young children and those with mild-to-moderate obstructive sleep apnea following a protocol that anticipates and avoids precipitating causes of upper airway obstruction.
Thursday, December 31, 2009
Ciprofloxacin 0.3%/Dexamethasone 0.1% Sterile Otic Suspension for the Topical Treatment of Ear Infections: A Review of the Literature
The Pediatric Infectious Disease Journal:
February 2009 - Volume 28 - Issue 2 - pp 141-144
Wall, G Michael PhD; Stroman, David W. PhD; Roland, Peter S. MD; Dohar, Joseph MD
Wall, G Michael PhD; Stroman, David W. PhD; Roland, Peter S. MD; Dohar, Joseph MD
Abstract
The objective of this article is to review the literature related to ciprofloxacin 0.3% and dexamethasone 0.1% sterile otic suspension. A systematic literature search utilizing Medline was conducted to identify peer-reviewed articles related to safety and efficacy. A total of 47 publications were identified and reviewed herein. The literature supports the use of antibiotic/antiiflammatory combination ear drops in the treatment of both acute otitis externa and acute otitis media in pediatric patients with tympanostomy tubes.
Ciprofloxacin/dexamethasone has been demonstrated as safe and effective with regard to clinical cures and microbiological eradication of pathogens in either disease with low treatment failure rates. Additionally, the literature also provides clear evidence for the contribution of dexamethasone when added to ciprofloxacin for the topical treatment of ear infections.
February 2009 - Volume 28 - Issue 2 - pp 141-144
Wall, G Michael PhD; Stroman, David W. PhD; Roland, Peter S. MD; Dohar, Joseph MD
Wall, G Michael PhD; Stroman, David W. PhD; Roland, Peter S. MD; Dohar, Joseph MD
Abstract
The objective of this article is to review the literature related to ciprofloxacin 0.3% and dexamethasone 0.1% sterile otic suspension. A systematic literature search utilizing Medline was conducted to identify peer-reviewed articles related to safety and efficacy. A total of 47 publications were identified and reviewed herein. The literature supports the use of antibiotic/antiiflammatory combination ear drops in the treatment of both acute otitis externa and acute otitis media in pediatric patients with tympanostomy tubes.
Ciprofloxacin/dexamethasone has been demonstrated as safe and effective with regard to clinical cures and microbiological eradication of pathogens in either disease with low treatment failure rates. Additionally, the literature also provides clear evidence for the contribution of dexamethasone when added to ciprofloxacin for the topical treatment of ear infections.
Saturday, December 26, 2009
Analysis of 60 patients after tympanotomy and sealing of the round window membrane after acute unilateral sensorineural hearing loss.
Am J Otolaryngol. 2009 May-Jun;30(3):157-61. Epub 2008 Sep 21.
Gedlicka C, Formanek M, Ehrenberger K.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Vienna, Vienna, Austria. claudia.gedlicka@meduniwien.ac.at
OBJECTIVE: This retrospective study was performed to evaluate the effectiveness of tympanotomy and sealing of the round window membrane after unilateral acute hearing loss.
DESIGN: All patients presenting idiopathic sudden hearing loss, acoustic, or barotrauma were treated with prednisolone and caroverine. Thirty-six patients had a mean pure tone hearing level worse than 70 dB. Recovery was defined as improvement of hearing threshold for 5 frequencies (250, 500, 1000, 2000, and 4000 Hz). If hearing did not improve after conservative treatment, an exploratory tympanotomy and sealing of the round window membrane were suggested. In the last 8 years, 60 patients with idiopathic sudden hearing loss, acoustic, or barotrauma underwent tympanotomy.
RESULTS: In 40 patients, we observed improvement of hearing level up to complete remission. In 20 patients, no change could be detected. In the group of patients with documented barotrauma, 12 patients showed improved hearing levels. Of 37 patients with idiopathic sudden hearing loss, 26 had an improved hearing after surgery. Most patients were operated on within 14 days (range, 1-60 days), but time of surgery had no influence on outcome in patients with idiopathic hearing loss. In contrast, in patients with barotrauma, time of surgery seems to have an influence on outcome.
CONCLUSIONS: Tympanotomy and sealing of the round window membrane can be recommended in cases of acute hearing loss after failure of conservative treatment.
Gedlicka C, Formanek M, Ehrenberger K.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Vienna, Vienna, Austria. claudia.gedlicka@meduniwien.ac.at
OBJECTIVE: This retrospective study was performed to evaluate the effectiveness of tympanotomy and sealing of the round window membrane after unilateral acute hearing loss.
DESIGN: All patients presenting idiopathic sudden hearing loss, acoustic, or barotrauma were treated with prednisolone and caroverine. Thirty-six patients had a mean pure tone hearing level worse than 70 dB. Recovery was defined as improvement of hearing threshold for 5 frequencies (250, 500, 1000, 2000, and 4000 Hz). If hearing did not improve after conservative treatment, an exploratory tympanotomy and sealing of the round window membrane were suggested. In the last 8 years, 60 patients with idiopathic sudden hearing loss, acoustic, or barotrauma underwent tympanotomy.
RESULTS: In 40 patients, we observed improvement of hearing level up to complete remission. In 20 patients, no change could be detected. In the group of patients with documented barotrauma, 12 patients showed improved hearing levels. Of 37 patients with idiopathic sudden hearing loss, 26 had an improved hearing after surgery. Most patients were operated on within 14 days (range, 1-60 days), but time of surgery had no influence on outcome in patients with idiopathic hearing loss. In contrast, in patients with barotrauma, time of surgery seems to have an influence on outcome.
CONCLUSIONS: Tympanotomy and sealing of the round window membrane can be recommended in cases of acute hearing loss after failure of conservative treatment.
An unusual case of cotton wool use to improve hearing.
J Laryngol Otol. 2009 Dec 23:1-3. [Epub ahead of print]
Bergin M, Murray D, Bird P.
*Department of Otolaryngology Head and Neck Surgery, Christchurch Hospital, New Zealand.
Objectives: To report an unusual observation whereby hearing was improved by insertion of cotton wool onto a retracted tympanic membrane, and to explore potential explanations for this.
Case report:We report the case of a 56-year-old woman with a severe mixed hearing loss who was noted to have a significant improvement in her hearing using a technique shown to her many years ago by a Russian physician. Upon application of a moist piece of cotton wool, gains of up to 40 dB were observed. This was associated with a significant subjective improvement in hearing. We discuss potential mechanisms for this effect, including amplification, a baffle effect and phase differences.
Conclusion:The mechanism of the hearing improvement observed in this case is unknown, but is likely to be related to sound amplification from the relatively large surface area of the cotton wool to the smaller oval window.
Bergin M, Murray D, Bird P.
*Department of Otolaryngology Head and Neck Surgery, Christchurch Hospital, New Zealand.
Objectives: To report an unusual observation whereby hearing was improved by insertion of cotton wool onto a retracted tympanic membrane, and to explore potential explanations for this.
Case report:We report the case of a 56-year-old woman with a severe mixed hearing loss who was noted to have a significant improvement in her hearing using a technique shown to her many years ago by a Russian physician. Upon application of a moist piece of cotton wool, gains of up to 40 dB were observed. This was associated with a significant subjective improvement in hearing. We discuss potential mechanisms for this effect, including amplification, a baffle effect and phase differences.
Conclusion:The mechanism of the hearing improvement observed in this case is unknown, but is likely to be related to sound amplification from the relatively large surface area of the cotton wool to the smaller oval window.
Thursday, December 24, 2009
Diagnostic Value of Nasal Allergen Challenge Combined With Radiography and Ultrasonography in Chronic Maxillary Sinus Disease
Arch Otolaryngol Head Neck Surg. 2009;135(12):1246-1255.Zdenek Pelikan, MD, PhD
Objective To investigate the possible role of nasal allergy in chronic disease of the maxillary sinuses (CDMS) by means of nasal provocation test (NPT) with allergen combined with radiography and ultrasonography.
Design Prospective clinical controlled study.
Setting Academic referral center.
Patients Seventy-one patients with CDMS and 16 control subjects with allergic rhinitis but no history of sinus disease.
Interventions In the 71 patients, a total of 135 NPTs and 71 control challenges with phosphate-buffered saline were performed by rhinomanometry combined with radiography and ultrasonography. In the control patients, 16 positive NPTs were repeated and combined with radiography and ultrasonography.
Main Outcome Measures Number, type, and timing of nasal responses with accompanying changes on radiographs and ultrasonograms.
Results Of the 71 patients, 67 developed 104 positive nasal responses of various types (P < .001), 89 of which were accompanied by significant changes on radiographs (P = .008), whereas 83 were also associated with significant changes on ultrasonograms (P = .007). No significant changes on the radiographs or the ultrasonograms were recorded during the 71 phosphate-buffered saline control tests in the patients with CDMS (P = .14 and .06, respectively) or during the 16 NPTs in control subjects (P = .15 and .12, respectively). The radiographic and ultrasonographic findings were significantly correlated (r = 0.81; P < .01).
Conclusions Nasal allergy may be involved in some patients with CDMS, resulting in appearance of a maxillary sinus response. Monitoring this response by means of serial ultrasonography and, if necessary, also by conventional radiography or computed tomography simultaneously with the nasal challenge with allergen seems to be a very useful diagnostic supplement allowing additional therapeutic measures focused on the nasal allergy.
Objective To investigate the possible role of nasal allergy in chronic disease of the maxillary sinuses (CDMS) by means of nasal provocation test (NPT) with allergen combined with radiography and ultrasonography.
Design Prospective clinical controlled study.
Setting Academic referral center.
Patients Seventy-one patients with CDMS and 16 control subjects with allergic rhinitis but no history of sinus disease.
Interventions In the 71 patients, a total of 135 NPTs and 71 control challenges with phosphate-buffered saline were performed by rhinomanometry combined with radiography and ultrasonography. In the control patients, 16 positive NPTs were repeated and combined with radiography and ultrasonography.
Main Outcome Measures Number, type, and timing of nasal responses with accompanying changes on radiographs and ultrasonograms.
Results Of the 71 patients, 67 developed 104 positive nasal responses of various types (P < .001), 89 of which were accompanied by significant changes on radiographs (P = .008), whereas 83 were also associated with significant changes on ultrasonograms (P = .007). No significant changes on the radiographs or the ultrasonograms were recorded during the 71 phosphate-buffered saline control tests in the patients with CDMS (P = .14 and .06, respectively) or during the 16 NPTs in control subjects (P = .15 and .12, respectively). The radiographic and ultrasonographic findings were significantly correlated (r = 0.81; P < .01).
Conclusions Nasal allergy may be involved in some patients with CDMS, resulting in appearance of a maxillary sinus response. Monitoring this response by means of serial ultrasonography and, if necessary, also by conventional radiography or computed tomography simultaneously with the nasal challenge with allergen seems to be a very useful diagnostic supplement allowing additional therapeutic measures focused on the nasal allergy.
The Histologic Relationship of Preauricular Sinuses to Auricular Cartilage
Arch Otolaryngol Head Neck Surg. 2009;135(12):1262-1265.
Brian Dunham, MD; Martha Guttenberg, MD; Wynne Morrison, MD; Lawrence Tom, MD
Objective To determine the histologic relationship and distance between excised preauricular epithelial sinus tract and the adjacent auricular cartilage (sinocartilaginous distance) in a series of patients. The excision of preauricular sinuses is a common surgical procedure. Recurrences are frequent and can be technically challenging. While advocated by several authors, the surgical removal of adjacent auricular cartilage is not universally performed.
Design Retrospective case series.
Setting Children's Hospital of Philadelphia.
Patients Fifty-two pediatric patients who underwent surgical excision of preauricular sinus tracts and adjacent auricular cartilage.
Interventions Between September 1, 2005, and July 31, 2007, the preauricular sinus tracts and adjacent auricular cartilage were excised from 52 pediatric patients. A pathologist reviewed a total of 58 specimens to determine the relationship between epithelial tract and cartilage.
Main Outcome Measure The sinocartilaginous distance in microns.
Results Patient ages ranged from 8 months to 17 years (mean age, 4 years). In all but 1 case, the tracts were in close proximity to the cartilage. The average sinocartilaginous distance was 472 µm (median distance, 400 µm); the 25th percentile was 250 µm. In over 50% of the specimens, the sinocartilaginous distance was less than 0.5 mm, and in nearly all of the these, the epithelial tract was in continuity with stromal tissue histologically indistinguishable from perichondrium.
Conclusions The observed sinocartilaginous distances suggest that it may be difficult to dissect most sinus tracts from the cartilage. The routine removal of a small portion of auricular cartilage along with the sinus tract may yield a more thorough excision and help to prevent recurrence.
Brian Dunham, MD; Martha Guttenberg, MD; Wynne Morrison, MD; Lawrence Tom, MD
Objective To determine the histologic relationship and distance between excised preauricular epithelial sinus tract and the adjacent auricular cartilage (sinocartilaginous distance) in a series of patients. The excision of preauricular sinuses is a common surgical procedure. Recurrences are frequent and can be technically challenging. While advocated by several authors, the surgical removal of adjacent auricular cartilage is not universally performed.
Design Retrospective case series.
Setting Children's Hospital of Philadelphia.
Patients Fifty-two pediatric patients who underwent surgical excision of preauricular sinus tracts and adjacent auricular cartilage.
Interventions Between September 1, 2005, and July 31, 2007, the preauricular sinus tracts and adjacent auricular cartilage were excised from 52 pediatric patients. A pathologist reviewed a total of 58 specimens to determine the relationship between epithelial tract and cartilage.
Main Outcome Measure The sinocartilaginous distance in microns.
Results Patient ages ranged from 8 months to 17 years (mean age, 4 years). In all but 1 case, the tracts were in close proximity to the cartilage. The average sinocartilaginous distance was 472 µm (median distance, 400 µm); the 25th percentile was 250 µm. In over 50% of the specimens, the sinocartilaginous distance was less than 0.5 mm, and in nearly all of the these, the epithelial tract was in continuity with stromal tissue histologically indistinguishable from perichondrium.
Conclusions The observed sinocartilaginous distances suggest that it may be difficult to dissect most sinus tracts from the cartilage. The routine removal of a small portion of auricular cartilage along with the sinus tract may yield a more thorough excision and help to prevent recurrence.
Location of Bacterial Biofilm in the Mucus Overlying the Adenoid by Light Microscopy Birgit Winther, MD; Brian C. Gross, MD; J. Owen Hendley, MD; Stephen V. Early, MD Arch Otolaryngol Head Neck Surg. 2009;135(12):1239-1245. Objective To determine the location of bacteria and biofilm in adenoid tissue and in mucus overlying the adenoid. Design Adenoids removed in 1 piece were oriented to the cephalic and caudal ends. Mucus was fixed by the gradual addition of Carnoy fluid. Consecutive histologic sections were stained with periodic acid–Schiff for visualization of the exopolysaccharide matrix, Giemsa for visualization of bacteria and cells, and fluorescent in situ hybridization with a universal probe for visualization of bacteria. Setting Department of Otolaryngology–Head and Neck Surgery, University of Virginia. Participants We obtained adenoids from children 10 years or younger who had chronic adenotonsillitis or obstructive sleep apnea. Twenty-seven adenoids were used to develop the fixation method. We examined histologic sections from 9 of 10 adenoids fixed using the final fixation protocol. One adenoid that was missing the surface epithelium was excluded from further evaluation. Main Outcome Measure Identification of bacteria by light microscopy. Results Bacteria in large numbers were present in the mucus overlying the surface of all 9 adenoids; bacteria were not found in the parenchyma of the adenoids below the epithelial surface. Bacterial biofilms were present on 8 of the 9 adenoids. Sessile (attached) biofilm was present on the caudal end of only 1 adenoid. Multiple planktonic (unattached) biofilms were present on 7 adenoids, always in areas not subject to mucus flow. Biofilms were most common on the caudal portions of adenoids. Conclusions Bacteria of the adenoid reside in secretions on the surface and in crypts. Biofilms, predominantly planktonic, were present on 8 of 9 adenoids excised because of hypertrophy. Whether biofilms have a role in the causation of adenoid hypertrophy is not known.
Arch Otolaryngol Head Neck Surg. 2009;135(12):1239-1245.
Birgit Winther, MD; Brian C. Gross, MD; J. Owen Hendley, MD; Stephen V. Early, MD
Objective To determine the location of bacteria and biofilm in adenoid tissue and in mucus overlying the adenoid.
Design Adenoids removed in 1 piece were oriented to the cephalic and caudal ends. Mucus was fixed by the gradual addition of Carnoy fluid. Consecutive histologic sections were stained with periodic acid–Schiff for visualization of the exopolysaccharide matrix, Giemsa for visualization of bacteria and cells, and fluorescent in situ hybridization with a universal probe for visualization of bacteria.
Setting Department of Otolaryngology–Head and Neck Surgery, University of Virginia.
Participants We obtained adenoids from children 10 years or younger who had chronic adenotonsillitis or obstructive sleep apnea. Twenty-seven adenoids were used to develop the fixation method. We examined histologic sections from 9 of 10 adenoids fixed using the final fixation protocol. One adenoid that was missing the surface epithelium was excluded from further evaluation.
Main Outcome Measure Identification of bacteria by light microscopy.
Results Bacteria in large numbers were present in the mucus overlying the surface of all 9 adenoids; bacteria were not found in the parenchyma of the adenoids below the epithelial surface. Bacterial biofilms were present on 8 of the 9 adenoids. Sessile (attached) biofilm was present on the caudal end of only 1 adenoid. Multiple planktonic (unattached) biofilms were present on 7 adenoids, always in areas not subject to mucus flow. Biofilms were most common on the caudal portions of adenoids.
Conclusions Bacteria of the adenoid reside in secretions on the surface and in crypts. Biofilms, predominantly planktonic, were present on 8 of 9 adenoids excised because of hypertrophy. Whether biofilms have a role in the causation of adenoid hypertrophy is not known.
Birgit Winther, MD; Brian C. Gross, MD; J. Owen Hendley, MD; Stephen V. Early, MD
Objective To determine the location of bacteria and biofilm in adenoid tissue and in mucus overlying the adenoid.
Design Adenoids removed in 1 piece were oriented to the cephalic and caudal ends. Mucus was fixed by the gradual addition of Carnoy fluid. Consecutive histologic sections were stained with periodic acid–Schiff for visualization of the exopolysaccharide matrix, Giemsa for visualization of bacteria and cells, and fluorescent in situ hybridization with a universal probe for visualization of bacteria.
Setting Department of Otolaryngology–Head and Neck Surgery, University of Virginia.
Participants We obtained adenoids from children 10 years or younger who had chronic adenotonsillitis or obstructive sleep apnea. Twenty-seven adenoids were used to develop the fixation method. We examined histologic sections from 9 of 10 adenoids fixed using the final fixation protocol. One adenoid that was missing the surface epithelium was excluded from further evaluation.
Main Outcome Measure Identification of bacteria by light microscopy.
Results Bacteria in large numbers were present in the mucus overlying the surface of all 9 adenoids; bacteria were not found in the parenchyma of the adenoids below the epithelial surface. Bacterial biofilms were present on 8 of the 9 adenoids. Sessile (attached) biofilm was present on the caudal end of only 1 adenoid. Multiple planktonic (unattached) biofilms were present on 7 adenoids, always in areas not subject to mucus flow. Biofilms were most common on the caudal portions of adenoids.
Conclusions Bacteria of the adenoid reside in secretions on the surface and in crypts. Biofilms, predominantly planktonic, were present on 8 of 9 adenoids excised because of hypertrophy. Whether biofilms have a role in the causation of adenoid hypertrophy is not known.
Tuesday, December 22, 2009
The role of neurotrophins in the pathophysiology of allergic rhinitis
Current Opinion in Allergy and Clinical Immunology (Nov 2009)
Raap U, Braunstahl GJ
PURPOSE OF REVIEW: Allergic rhinitis is characterized by allergic airway inflammation and a hyperresponsiveness to nonspecific stimuli which is partly neuronally controlled. In this regard, neurotrophins are prime candidates as mediators of neuronal and immunological plasticity and they will be the focus of the current review.
RECENT FINDINGS: Neurotrophins including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are expressed in the nasal mucosa. The majority of NGF expression has been found in eosinophil granulocytes, the glandular apparatus and peripheral nerves. As shown recently, nasal allergen provocation upregulates BDNF expression in nasal mucosa and NGF expression on peripheral nerves and nasal lavage in patients with allergic rhinitis. In this regard, increased BDNF expression positively correlates with the maximum increase in total nasal symptom score. The neurotrophin receptors including pan-neurotrophin receptor p75, tyrosine kinase A (trkA) and trkB are expressed in nasal tissue. TrkA is expressed on endothelial, p75 on peripheral nerves and trkB on nasal mucosa mast cells that decreases after allergen provocation. The expression of these neurotrophin receptors is increased on peripheral blood eosinophils in allergic rhinitis compared with nonatopic controls. Further, BDNF and NGF exert immunomodulatory functions on eosinophils of patients with allergic rhinitis. Finally, eosinophils of patients with allergic rhinitis are capable of BDNF and NGF production.
SUMMARY: Neurotrophins represent prime candidates in upper airway pathophysiology in allergic rhinitis. Research on neurotrophins in allergic rhinitis is thus becoming a progressively more exciting field and may reveal new and promising therapeutic options for the future.
Raap U, Braunstahl GJ
PURPOSE OF REVIEW: Allergic rhinitis is characterized by allergic airway inflammation and a hyperresponsiveness to nonspecific stimuli which is partly neuronally controlled. In this regard, neurotrophins are prime candidates as mediators of neuronal and immunological plasticity and they will be the focus of the current review.
RECENT FINDINGS: Neurotrophins including nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are expressed in the nasal mucosa. The majority of NGF expression has been found in eosinophil granulocytes, the glandular apparatus and peripheral nerves. As shown recently, nasal allergen provocation upregulates BDNF expression in nasal mucosa and NGF expression on peripheral nerves and nasal lavage in patients with allergic rhinitis. In this regard, increased BDNF expression positively correlates with the maximum increase in total nasal symptom score. The neurotrophin receptors including pan-neurotrophin receptor p75, tyrosine kinase A (trkA) and trkB are expressed in nasal tissue. TrkA is expressed on endothelial, p75 on peripheral nerves and trkB on nasal mucosa mast cells that decreases after allergen provocation. The expression of these neurotrophin receptors is increased on peripheral blood eosinophils in allergic rhinitis compared with nonatopic controls. Further, BDNF and NGF exert immunomodulatory functions on eosinophils of patients with allergic rhinitis. Finally, eosinophils of patients with allergic rhinitis are capable of BDNF and NGF production.
SUMMARY: Neurotrophins represent prime candidates in upper airway pathophysiology in allergic rhinitis. Research on neurotrophins in allergic rhinitis is thus becoming a progressively more exciting field and may reveal new and promising therapeutic options for the future.
Recent advances in otitis media
Pediatric Infectious Disease Journal 28 (10 Suppl), S133-7 (Oct 2009)
Pelton SI, Leibovitz E
Otitis media (OM) is a pervasive illness in infants and children, and many children suffer multiple episodes during the first years of life. High rates of acute otitis media (AOM) are reported in developed and emerging countries. Early onset is common in both settings. Recurrent OM is associated with several factors, including early onset of disease, having a sibling with a history of AOM and absence of breast-feeding. Early onset disease has been hypothesized to result from Eustachian tube dysfunction, immunologic naivete and immaturity, and viral upper respiratory tract infection. Nasopharyngeal colonization with bacterial otopathogens increases the likelihood of AOM and the disease is most frequent in children with viral respiratory tract infection colonized with multiple otopathogens (Streptococcus pneumoniae, nontypeable Haemophilus influenzae [NTHi], Moraxella catarrhalis), potentially as a result of inflammation resulting from competition among the bacterial species within the nasopharynx. Epidemiologic observations and studies of pathogenesis suggest that successful strategies for reducing the burden of disease will be best accomplished by targeting multiple viral and/or bacterial pathogens and preventing early onset disease. Guidelines (2004) for the treatment of AOM in children establish a clear hierarchy among the various antibacterials for the treatment of this disease. Failure to achieve early bacterial eradication during antibiotic therapy for AOM increases the clinical failure rates in AOM in young children. Most recurrent AOM episodes occurring within 1 month after successful completion of antibiotic therapy are due to new otopathogens. Failure to eradicate middle ear and/or nasopharyngeal pathogens is associated with higher rates of clinical recurrent AOM, even when the patients show clinical improvement or cure at the end of therapy for the initial episode. Optimal strategy for the prevention of AOM recurrences requires sterilization of the middle ear and eradication of nasopharyngeal carriage of otopathogens during antimicrobial therapy.
Pelton SI, Leibovitz E
Otitis media (OM) is a pervasive illness in infants and children, and many children suffer multiple episodes during the first years of life. High rates of acute otitis media (AOM) are reported in developed and emerging countries. Early onset is common in both settings. Recurrent OM is associated with several factors, including early onset of disease, having a sibling with a history of AOM and absence of breast-feeding. Early onset disease has been hypothesized to result from Eustachian tube dysfunction, immunologic naivete and immaturity, and viral upper respiratory tract infection. Nasopharyngeal colonization with bacterial otopathogens increases the likelihood of AOM and the disease is most frequent in children with viral respiratory tract infection colonized with multiple otopathogens (Streptococcus pneumoniae, nontypeable Haemophilus influenzae [NTHi], Moraxella catarrhalis), potentially as a result of inflammation resulting from competition among the bacterial species within the nasopharynx. Epidemiologic observations and studies of pathogenesis suggest that successful strategies for reducing the burden of disease will be best accomplished by targeting multiple viral and/or bacterial pathogens and preventing early onset disease. Guidelines (2004) for the treatment of AOM in children establish a clear hierarchy among the various antibacterials for the treatment of this disease. Failure to achieve early bacterial eradication during antibiotic therapy for AOM increases the clinical failure rates in AOM in young children. Most recurrent AOM episodes occurring within 1 month after successful completion of antibiotic therapy are due to new otopathogens. Failure to eradicate middle ear and/or nasopharyngeal pathogens is associated with higher rates of clinical recurrent AOM, even when the patients show clinical improvement or cure at the end of therapy for the initial episode. Optimal strategy for the prevention of AOM recurrences requires sterilization of the middle ear and eradication of nasopharyngeal carriage of otopathogens during antimicrobial therapy.
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