Effectiveness criteria for the topical application of glucocorticosteroids to the treatment of exudative otitis media associated with allergic rhinitis

Vestnik Otorinolaringologii (5), 32-34 (2010)

Poliakova SD, Popova EA 

We undertook comparative analysis of ciliotoxic effect of glucocorticosteroids frequently used for catheterization of the eustachian tube in patients presenting with exudative otitis media and concomitant allergic rhinitis. It was shown that the recovery of transport function of ciliary epithelium and appreciable clinical effect of the treatment were achieved by the application of mometasone furoate. Dexamethasone was next to mometasone in terms of efficiency whereas hydrocortisone produced much lower beneficial effect. It is concluded that, taking into account high bioavailability of dexametasone and hydrocortisone (>80%) and contraindications to their intranasal administration, the preference should be given to medications with lower bioavailability.

Xylitol as a prophylaxis for acute otitis media: systematic review

International Journal of Audiology 49 (10), 754-61 (Oct 2010)

Danhauer JL, Johnson CE, Corbin NE, Bruccheri KG 

A systematic review was conducted to evaluate evidence regarding xylitol, a sugar alcohol, as a prophylaxis for acute otitis media (AOM) in children. The authors searched PubMed and other databases to identify evidence. Criteria for included studies were: appear in English-language, peer-reviewed journals; at least quasi-experimental designs; use xylitol; and present outcome data. The authors completed evaluation forms for the included studies at all phases of the review. 

The authors reviewed 1479 titles and excluded 1435. Abstracts and full texts were reviewed for the remaining 44; four randomized controlled trials met inclusion criteria. Xylitol was a generally well accepted prophylaxis for AOM with few side effects when administered via chewing gum or syrup at 10 g/day given five times daily. Meta-analysis revealed significant treatment effects (Risk ratio = 0.68; 95% confidence interval = 0.57 to 0.83). 

Xylitol can be a prophylaxis for AOM, but warrants further study, especially of vehicles other than chewing gum for young children, and information is needed regarding cost, duration of administration required, and expected long-term effects.

Acute otitis media: to follow-up or treat?;

International Journal of Pediatric Otolaryngology  74 (8), 930-3 (Aug 2010)
Stevanovic T, Komazec Z, Lemajic-Komazec S, Jovic R; .

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. Our study included 314 children, aged between 2 months and 6 years. Children were divided into two groups: the first group included children with less severe forms of AOM, who received symptomatic therapy and "wait-and-see" approach (237 children); the second group presented with purulent ear infection and received antibiotic treatment from the beginning (77 children). After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin. The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.

Usefulness of computed tomography Hounsfield unit density in preoperative detection of cholesteatoma in mastoid ad antrum

American Journal of Otolaryngology (Apr 2010)

Park MH, Rah YC, Kim YH, Kim JH;

PURPOSE: This study was performed to evaluate the usefulness of Hounsfield unit (HU) to better distinguish cholesteatoma from other inflammatory conditions in the mastoid ad antrum before primary mastoid surgery.

MATERIALS AND METHODS: We enrolled 82 patients who underwent tympanomastoidectomy for treatment of chronic otitis. Forty-one patients were pathologically diagnosed with cholesteatoma, whereas the others were diagnosed with inflammatory granulation. These lesions were confirmed, and HU was measured in preoperative computed tomography. The difference in HU between cholesteatoma and non-cholesteatoma tissues was analyzed, and the improvement in the diagnosis of cholesteatoma after inclusion of HU data was calculated.

RESULTS: The HU was calculated as 42.68 +/- 24.42 in the cholesteatoma group and 86.07 +/- 26.50 in the non-cholesteatoma group. The differences between the 2 groups were statistically different (Student t test, P<.01). By applying the HU, the sensitivity (51.2%-80.5%), specificity (80.5%-87.8%), positive predictive value (72.4%-86.8%), and negative predictive value (62.3%-81.8%) to diagnose cholesteatoma improved.

CONCLUSIONS: The HU density was found to be statistically different between cholesteatoma and inflammatory granulation tissue in mastoid antrum. An improved diagnosis of cholesteatoma was achieved after adjusting for the HU.

Impact of oseltamivir treatment on the incidence and course of acute otitis media in children with influenza

 

International Journal of Pediatric Otorhinolaryngology (Apr 2010)

 

Winther B, Block SL, Reisinger K, Dutkowski R

OBJECTIVE: Acute otitis media (AOM) is the most common complication of pediatric influenza, and imposes a substantial health care burden. We examined the influence of oseltamivir treatment on the incidence and course of AOM in children with influenza. 

METHODS: In the original study, 695 children 1-12 years who presented within 48h of the onset of influenza-like symptoms were randomized to oseltamivir (2mg/kg) or placebo given twice daily for 5 days. AOM was assessed at enrollment and days 3, 6 (+/-1), 10 (+/-2) and 28 (+/-7). AOM was clinically diagnosed by the participating primary care provider, supported by tympanometry when possible. We performed a retrospective analysis of those participants with laboratory-confirmed influenza (LCI). Assessments included the incidence and clinical course of new AOM cases. 

RESULTS: In all, 452 children had LCI; 217 received oseltamivir and 235 placebo. AOM was diagnosed on or after study day 3 at a significantly lower frequency in the oseltamivir versus placebo group (12.4% versus 21.7%; relative risk [RR]: 0.57 [95% CI: 0.37, 0.88], respectively). Treatment effects were greatest for children 1-2 years (RR=0.42 [95% CI: 0.20, 0.89]) and 3-5 years (RR=0.45 [95% CI: 0.19, 1.04]), in whom the incidence of AOM was highest. 

CONCLUSIONS: Oseltamivir treatment significantly reduces the emergence of new AOM infections in children with LCI; effects are most pronounced in those<5 years. Clinical trial number: WV15758.

Is sensorineural hearing loss with chronic otitis media due to infection or aging in older patients?

Auris Nasus Larynx 37 (3), 402-6 (Jun 2010)
Yoshida H, Miyamoto I, Takahashi H

OBJECTIVE: To clarify true incidence of sensorineural hearing loss in ears with chronic otitis media (COM).

METHODS: Bone conduction (BC) hearing thresholds of 180 preoperative patients (207 ears) with COM and 226 normal individuals (289 ears)were measured by audiometry, and the percentage of ears with BC thresholds being higher than normal range was evaluated in the COM group. In the COM group, the size of the perforation on the eardrum (n = 196) and the cross-sectional area of the mastoid air cells based on the axial CT image (n = 103) were also measured and correlated with the results of BC threshold.

RESULTS: The percentage of ears with BC thresholds being higher than normal range calculated from comparison to the control group tended to increase with age, ranging from 4.5% in the 20s to 34.1% in the 60s with an average of 26.6%. The increase in the BC thresholds did not correlate with the size of eardrum perforation, but correlated well with the size of the mastoid air cells.

CONCLUSION: These results may suggest that all measures for early cure, including surgery, should be considered as early as possible for patients with COM.

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.

Adenoidectomy for otitis media with effusion in 2-3-year-old children

Int J Pediatr Otorhinolaryngol
Casselbrant ML, Mandel EM, Rockette HE, Kurs-Lasky M, Fall PA, Bluestone CD; International Journal of Pediatric Otorhinolaryngology (Oct 2009)
OBJECTIVE: To compare the efficacy of three surgical treatment combinations - myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) - in reducing middle-ear disease in young children with chronic OME. METHODS: Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months. RESULTS: Ninety-eight subjects were randomly assigned to the three treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs. A-M&T, p=0.87; M&T vs. A-M, p=0.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups. CONCLUSIONS: Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.