Epidemiology of Otitis Media in Children

Abstract

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.

Parents’ and Physicians’ Views on Antibiotics

“…More than 70% of children have had at least one middle ear infection by the age of 3 years and 33% have had three or more episodes. 3 The incidence of AOM is increasing, as evidenced by the doubling of prescriptions written for AOM in the last decade from 12 million in 1980 to 24 million in 1992. 4 This increase in antibiotic usage is likely due to a number of factors, including increase in real disease, due in part to widespread day care attendance, 5,6 improved access to care, 7,8 and overprescription of antibiotics.…”

Mucociliary function and nasal resistance evaluation before and after adenoidectomy

“…Many variables seem to interfere with an accurate evaluation of the real effectiveness of adenoidectomy on OME, and they include age [26,30,51], sex [6,13,16,17], nasal obstruction [3,47,49], eustachian tube function [3,4,39] and, mainly, the high rate of spontaneous recovery of OME, especially in warmer seasons [18,52,54,551.…”

Diagnostic and Therapeutic Algorithmfor Acute Otitis Media

“…Инфи-цирование жидкости и рост колоний бактерий сопрово-ждаются клиническими проявлениями заболевания -выбуханием, отеком, гиперемией барабанной перепонки и оталгией. Экссудат может сохраняться в барабанной полости в течение нескольких месяцев, несмотря на сти-хание воспалительной реакции [4].…”

“…Эвакуация содержимого из барабанной полости обычно сопрово-ждается выраженным улучшением состояния. Показа-ниями к миринготомии являются тяжелое течение забо-левания, иммунодефицитные состояния и неэффектив-ность эмпирической терапии [4].…”