To determine the epidemiology of acute otitis media (AOM) and duration of middle ear effusion (MEE), we followed consecutively enrolled children from shortly after birth until 7 y of age. Because some children dropped out of the study, data were analyzed for 877 children observed for at least 1 y; 698 were observed for at least 3 y, and 498 were observed until 7 y of age. By 1 y of age, 62% of the children had greater than or equal to 1 episode of AOM and 17% had greater than or equal to 3 episodes; by 3 y of age, 83% had greater than or equal to 1 episode of AOM and 46% had greater than or equal to 3 episodes. The peak incidence occurred during the second 6-mo period of life. Significantly increased risk (by multivariate analysis) for AOM was associated with male gender, sibling history of recurrent AOM, early occurrence of AOM, and not being breast fed. MEE persisted after onset of AOM for weeks to months; prolonged duration of MEE was associated with male gender, sibling history of ear infection, and not being breast fed.
To determine intellectual and linguistic sequelae of middle ear disease, 207 children were randomly selected from a cohort of 498 followed prospectively from birth until age 7 years. After controlling for confounding variables, estimated time spent with middle ear effusion (MEE) during the first 3 years of life was significantly associated with lower scores on tests of cognitive ability, speech and language, and school performance at age 7 years. The adjusted mean full-scale WISC-R were 113.1 for those with least time with MEE, 107.5 for those with moderate time, and 105.4 for those with most time. Similar significant differences were found for verbal and performance IQ scores. For the Metropolitan Achievement Test, we found that middle ear disease in the first 3 years of life was associated with significantly lower scores in mathematics and reading. Similar differences were found for articulation and use of morphologic markers. After considering time spent with MEE during the first 3 years of life, time spent after age 3 years was not a significant predictor of scores on any of the tests administered.
Otitis media is the most common respiratory tract infection of infancy and early childhood that is managed with antibacterial agents. A bacterial pathogen is isolated from the middle ear fluids of approximately two-thirds of children with acute otitis media; S. pneumoniae is the leading bacterial pathogen followed by nontypable strains of H. influenzae and M. catarrhalis. Clearance of bacteria from middle ear fluid without use of antibacterial drugs is evident in studies in which a placebo is used. Whereas pneumococci continued to be isolated from middle ear fluids when the infection was not treated, approximately one-half of infections due to nontypable H. influenzae and up to 80% of those due to M. catarrhalis cleared. The microbiological data suggest that only one-third of patients with acute otitis media require antibacterial therapy for resolution of clinical signs and symptoms. However, without the results of prior tympanocentesis, the physician cannot identify the patients for whom the infection will resolve. Thus, the data support use of antibacterial agents for all episodes of acute otitis media to cover adequately the one-third of children who will need the antimicrobial agent to recover from the infection. Effusion persists in the middle ear for weeks to months after every episode of acute otitis media. Conductive hearing loss of some degree occurs whenever the middle ear space is filled with effusion. Decreased scores in tests of speech and cognitive abilities for infants and children who had prolonged middle ear effusion has stimulated investigators to seek means to reduce the duration of middle ear effusion following acute otitis media. Because the pathogenesis of persistent middle ear effusion is uncertain, the results with medical therapies, including antibiotics and steroids, have been inconsistent. Placement of ventilating or tympanostomy tubes to produce drainage and ventilation of the middle ear and to restore hearing is effective and is now the second most frequent surgical procedure in children (after circumcision), but the criteria for placement of tubes are controversial. Prevention of otitis media is possible by use of chemoprophylaxis or vaccines. Chemoprophylaxis has been effective in children with recurrent acute otitis media by reducing new episodes by 40%-90%. A serum antibody response that is age- and type-specific follows pneumococcal infection and protects against subsequent homotypic infection. Polysaccharide pneumococcal vaccines are not consistently immunogenic in children > 2 years of age, but experimental conjugate polysaccharide vaccines are immunogenic in infants as young as 2 months.(ABSTRACT TRUNCATED AT 400 WORDS)
To determine the epidemiology of otitis media (OM) during the first three years of life, physicians participating in the Greater Boston Collaborative Otitis Media Program followed prospectively from birth 2,565 children. At every visit we recorded results of pneumatic otoscopy and epidemiology data. By three years of age 71% of the children had had one or more episodes of acute otitis media including 33% who had three or more episodes. Features associated significantly with first episode of OM were: sibling with recurrent OM, race (white > black), and sex (male > female). Having a sibling with allergy disposed propositi to first episode. Features associated significantly with recurrent OM (≥ three episodes) were those noted above. A parent with recurrent OM disposed propositi to recurrent OM. Middle ear effusion (MEE) persisted for prolonged periods after OM; after the first episode of OM, 70% of children still had MEE at two weeks, 40% had fluid at one month, 20% had fluid at two months, and 10% had fluid at three months. The sole feature associated significantly with persistent effusion in the middle ear after the first episode of OM was the practice of giving a child a bottle in bed.
Pediatricians acknowledge prescribing antimicrobial agents when they are not indicated. Pediatricians believe educating parents is necessary to promote the judicious use of antimicrobial agents.
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