Diagnosis and treatment of acute otitis media: review

Toll, Edward C; Nunez, Desmond A.

doi:10.1017/s0022215112001326

Cited by 18 publications

(29 citation statements)

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“…Acute OM is characterized by middle ear inflammation with signs of middle ear effusion and acute symptoms of infection including middle ear pain and fever (Coker et al 2010;Toll and Nunez 2012). A minority of children who suffer from acute OM will develop either chronic otitis media with effusion (COME) or recurrent otitis media (ROM).…”

Section: Introductionmentioning

confidence: 99%

A Genome-Wide Association Study of Chronic Otitis Media with Effusion and Recurrent Otitis Media Identifies a Novel Susceptibility Locus on Chromosome 2

Allen

Chen

Weeks

et al. 2013

JARO

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Chronic otitis media with effusion (COME) and recurrent otitis media (ROM) have been shown to be heritable, but candidate gene and linkage studies to date have been equivocal. Our aim was to identify genetic susceptibility factors using a genome-wide association study (GWAS). We genotyped 602 subjects from 143 families with 373 COME/ROM subjects using the Illumina Human CNV370-Duo DNA Bead Chip (324,748 SNPs). We carried out the GWAS scan and imputed SNPs at the regions with the most significant associations. Replication genotyping in an independent family-based sample was conducted for 53 SNPs: the 41 most significant SNPs with PG10 −4 and 12 imputed SNPs with PG10 −4 on chromosome 15 (near the strongest signal). We replicated the association of rs10497394 (GWAS discovery P= 1.30×10 −5 ) on chromosome 2 in the independent otitis media population (P=4.7×10 −5 ; meta-analysis P= 1.52×10 −8 ). Three additional SNPs had replication PvaluesG0.10. Two were on chromosome 15q26.1 including rs1110060, the strongest association with COME/ROM in the primary GWAS (P=3.4×10 −7 ) in KIF7 intron 7 (P=0.072), and rs10775247, a nonsynonymous SNP in TICRR exon 2 (P=0.075). The third SNP rs386057 was on chromosome 5 in TPPP intron 1 (P=0.045). We have performed the first GWAS of COME/ROM and have identified a SNP rs10497394 on chromosome 2 is significantly associated with COME/ROM susceptibility. This SNP is within a 537 kb intergenic region, bordered by CDCA7 and SP3. The genomic and functional significance of this newly identified locus in COME/ROM pathogenesis requires additional investigation.

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Section: Introductionmentioning

confidence: 99%

A Genome-Wide Association Study of Chronic Otitis Media with Effusion and Recurrent Otitis Media Identifies a Novel Susceptibility Locus on Chromosome 2

Allen

Chen

Weeks

et al. 2013

JARO

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“…The presence or absence of a light reflex is probably not a useful sign, and the tympanic membrane of a febrile or screaming child will sometimes appear reddened, even in the absence of middle ear disease. Injection of the TM alone has 7% positive predictive value (PPV) [7]; bulging of the TM is the single most important sign in diagnosing AOM with high PPV [2,7,8,23] and its PPV is increased if combined with discoloration of TM and reduced mobility [4,23], but poorly mobile, opacified, bulging TM is found only in 19% of cases [4].…”

Section: Otoscopymentioning

confidence: 99%

“…Pneumatic otoscopy is an important tool [1,3,7,11], it has 90 % sensitivity and 80 % specificity [5,11]. The position of the TM is the most important sign to distinguish between AOM and OME [5,23]. Pneumatic otoscopy in general needs skills, good illumination and cerumen removal in order to accurately diagnose the case [4,11].…”

Section: Otoscopymentioning

confidence: 99%

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Acute Otitis Media- An Update

Shawabkeh¹,

Haidar²,

Larem³

et al. 2017

JOENTR

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Objective: To review the literature about Acute otitis media (AOM).Introduction: AOM is a common condition with an incidence of 10.8/ 100 people per year; it is more common in pediatric age group and tends to occur more in male patients. It is considered the main cause of prescribing antibiotics in pediatrics. Physicians tend to over diagnose this disease leading to an unnecessary antibiotics prescription which exposes the child to an unwanted side effects mainly diarrhea. USA spends $2-3.5 billion per year for the treatment of AOM. Taking these points in our mind, it is important to know how to accurately diagnose this condition and how to treat it and what is the pathophysiology that underlies that disease, all of which are discussed in details in this review article.Methodology: a comprehensive review of the literature about AOM.Results: AOM is a result of different host, environmental, microbiological and genetic factors. It is highly related to upper respiratory infection and the disease is thought to be viral in origin with bacterial superinfection happens later on. Respiratory syncytial virus (RSV) has the best link with AOM. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are still the most important pathogens. It is a symptomatic disease; Ear pain is the most important symptom, and bulging of the tympanic membrane is the most important sign that can lead to diagnosis. The American Academy of Pediatrics has put certain guidelines for the treatment of AOM. Prevetive measures play an important role in decreasing of its incidence. Conclusion:AOM has an impact on the child, family, and the community as a whole, in term of health and costs.

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“…182 Antibiotic prescriptions for OM contribute significantly to increasing multidrug resistance 182 , and insertion of ventilation tubes into the tympanic membrane in the middle ear to assist fluid drainage remains one of most common childhood surgeries performed in the U.S. 183 Acute OM is characterized by middle ear inflammation with signs of middle ear effusion and acute symptoms of infection including middle ear pain and fever. 184,185 A minority of children who suffer from acute OM will develop either chronic otitis media with effusion (COME) or recurrent otitis media (ROM). Estimates suggest that by two years of age, nearly a third of all children will have had more than three episodes of OM within six months or four episodes within one year.…”

Section: Introductionmentioning

confidence: 99%

Chronic Otitis Media: Microbial Environment During Viral Infection and Genetics of Host Susceptibility

Allen

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Otitis media (OM), inflammation of the middle ear, is an upper respiratory tract infection (URTI) caused by viral and bacterial infections. OM is the most common pediatric disease and the leading cause of pediatric health care visits, antibiotic usage and surgery. A subset of OM affected children develops chronic otitis media with effusion (COME) and/or recurrent otitis media (ROM), with significant consequences on hearing and development. The aim of this research was to find novel risk factors that increase OM susceptibility by looking at both bacterial communities during URTI and host genetics. To discover novel OM host risk factors, a multi-stage approach was used. First, a genome-wide association study (GWAS) of COME/ROM was conducted using a familyii based population. The most significantly associated SNP, rs1110060, is located on chromosome 15 in an intron of kinesin family member 7 (KIF7). Association at SNP rs10497394, an intergenic SNP on chromosome 2, was replicated in an independent family-based population of OM. Fine-mapping of associated regions of chromosomes 2 and 15 was carried out using targeted resequencing and subsequent genotyping. Six SNPs were significantly associated (P<2.6x10 -4 ), two in the chromosome 2 region and four in the chromosome 15 region. Explorations of the functional potential of these two loci were carried out. Investigation of chromatin marks revealed an enhancer region on chromosome 2 in the human middle ear epithelial cell line, HMEEC-1. The -G‖ risk allele of the most significantly-associated chromosome 15 SNP, rs1110060, was found to impact expression of IQGAP1 in adenoids (P=0.026). Also, both lipopolysaccharide (LPS) and TGFβ treatment were found to regulate expression of KIF7 in HMEEC-1.The data presented in this dissertation show the complex nature of the microbiome of the nasopharynx during URTI, and we have identified novel regions and genes involved in susceptibility to OM. Moreover, functional assays support the participation of previously unsuspected mechanisms in OM pathogenesis. In summary, this research has provided insights into OM susceptibility from both host and bacterial perspectives.iii Acknowledgements

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Diagnosis and treatment of acute otitis media: review

Abstract: Level 1A evidence shows that selected cases of acute otitis media benefit from antibiotic prescription.

Cited by 18 publications

References 50 publications

A Genome-Wide Association Study of Chronic Otitis Media with Effusion and Recurrent Otitis Media Identifies a Novel Susceptibility Locus on Chromosome 2

A Genome-Wide Association Study of Chronic Otitis Media with Effusion and Recurrent Otitis Media Identifies a Novel Susceptibility Locus on Chromosome 2

Acute Otitis Media- An Update

Chronic Otitis Media: Microbial Environment During Viral Infection and Genetics of Host Susceptibility

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