Oral Antibiotic Use for Otitis Media with Effusion

Roditi, Rachel E.; Liu, C. Carrie; Bellmunt, Angela M.; Rosenfeld, Richard M.; Shin, Jennifer J.

doi:10.1177/0194599816633457

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…Although antibiotic treatment is not recommended in the current guidelines, studies have shown that a diagnosis of OME is often followed by the prescription of a course of oral antibiotics – especially in the emergency room, more than in ENT departments (Roditi et al., 2016). For example, some centres prescribe treatment with macrolide antibiotics if OME is combined with rhinosinusitis, since the latter is a trigger for OME.…”

Section: Treatmentsmentioning

confidence: 99%

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Vanneste

Page

2019

Journal of Otology

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Otitis media with effusion (OME) is a frequent paediatric disorder. The condition is often asymptomatic, and so can easily be missed. However, OME can lead to hearing loss that impairs the child's language and behavioural development. The diagnosis is essentially clinical, and is based on otoscopy and (in some cases) tympanometry. Nasal endoscopy is only indicated in cases of unilateral OME or when obstructive adenoid hypertrophy is suspected. Otitis media with effusion is defined as the observation of middle-ear effusion at consultations three months apart. Hearing must be evaluated (using an age-appropriate audiometry technique) before and after treatment, so as not to miss another underlying cause of deafness (e.g. perception deafness). Craniofacial dysmorphism, respiratory allergy and gastro-oesophageal reflux all favour the development of OME. Although a certain number of medications (antibiotics, corticoids, antihistamines, mucokinetic agents, and nasal decongestants) can be used to treat OME, they are not reliably effective and rarely provide long-term relief. The benchmark treatment for OME is placement of tympanostomy tubes (TTs) and (in some cases) adjunct adenoidectomy. The TTs rapidly normalize hearing and effectively prevent the development of cholesteatoma in the middle ear. In contrast, TTs do not prevent progression towards tympanic atrophy or a retraction pocket. Adenoidectomy enhances the effectiveness of TTs. In children with adenoid hypertrophy, adenoidectomy is indicated before the age of 4 but can be performed later when OME is identified by nasal endoscopy. Children must be followed up until OME has disappeared completely, so that any complications are not missed.

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Section: Treatmentsmentioning

confidence: 99%

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Vanneste

Page

2019

Journal of Otology

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“…In the studies that compared the practices of different types of clinicians, substantially higher adherence to guideline recommendations was displayed by otolaryngologists when compared to nonotolaryngologists, particularly for the recommendations in the Otitis Media with Effusion, Adult Sinusitis, and Sudden Hearing Loss guidelines ( Tables 2 , 5 , and 6 ). 16,22-27 Table 2 shows that adherence to the Otitis Media with Effusion guideline is high for otolaryngologists and low for nonotolaryngology clinicians. The potentially inappropriate (and not recommended) use of medical treatments such as intranasal steroids (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.60-8.01), oral antihistamines (OR, 3.53; 95% CI, 1.62-7.71), and oral antibiotics (OR, 6.24; 95% CI: 4.17-9.39) was associated with encounters with nonotolaryngologists but not with otolaryngologists.…”

Section: Resultsmentioning

confidence: 99%

Section: Comparison Of Clinician and Setting Typementioning

confidence: 99%

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Adherence to American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines: A Systematic Review

Ryan¹,

Leu

Boss³

et al. 2020

Otolaryngol.--head neck surg.

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Objective Clinical practice guidelines synthesize and disseminate the best available evidence to guide clinical decisions and increase high-quality care. Since 2004, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) has published 16 guidelines. The objective of this review was to evaluate clinicians’ adherence to these guidelines’ recommendations as measured in the literature. Data Sources We searched PubMed, Embase, and Web of Science on August 29, 2019, for studies published after June 1, 2004. Review Methods We systematically identified peer-reviewed studies in English that reported clinician adherence to AAO-HNSF guideline recommendations. Two authors independently reviewed and abstracted study characteristics, including publication date, population, sample size, guideline adherence, and risk of bias. Results The search yielded 385 studies. We excluded 331 studies during title/abstract screening and 32 more after full-text review. The remaining 22 studies evaluated recommendations from 8 of the 16 guidelines. The Otitis Media with Effusion, Polysomnography, Tonsillectomy, and Sinusitis guidelines were studied most. Study designs included retrospective chart reviews (7, 32%), clinician surveys (7, 32%), and health care database analyses (8, 36%). Studies reported adherence ranging from 0% to 99.8% with a mean of 56%. Adherence varied depending on the recommendation evaluated, type of recommendation, clinician type, and clinical setting. Adherence to the polysomnography recommendations was low (8%-65.3%). Adherence was higher for the otitis media with effusion (76%-90%) and tonsillectomy (43%-98.9%) recommendations. Conclusions Adherence to recommendations in the AAO-HNSF guidelines varies widely. These findings highlight areas for further guideline dissemination, research about guideline adoption, and quality improvement.

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“…An ongoing program during preschool age could in fact result in additional public health benefits: it would allow a reduction of family mobility in accessing to more expensive audiologic evaluations. Moreover, a self-help diagnosis would favor a more aware and appropriate prescription of antibiotic therapy in case of otitis media (16), possibly contributing to the strategies of the national plan against antimicrobial resistance. Ultimately, a better triage of children with HI would allow a more targeted referral of OMEs that require a surgical decision, with further reduction in direct and indirect surveillance costs.…”

Section: Discussionmentioning

confidence: 99%

Modeling Postnatal Hearing Case Finding Within the Italian National Health System

Orzan

Pizzamiglio²,

Marchi³

et al. 2021

Front. Pediatr.

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Objective: Despite the successful implementation of newborn hearing screening (NHS), a debate is emerging as to what should be the best means of enabling timely diagnosis and intervention for preschoolers with educationally significant sensorineural or conductive hearing impairment (HI) missed at the time of NHS or occurred after birth. Our study aims to document the proportion and characteristics of HIs diagnosed in children in need of audiologic assessment, in order to outline the optimization areas of an operational framework for auditory surveillance during preschool age.Method: The referral routes and outcomes of 730 audiological assessments performed in 3 years within the framework of the early hearing identification program in Trieste (Italy) were retrospectively analyzed.Results: Among 570/595 completed evaluations, an HI was diagnosed in 114 children, 73.7% of which presenting an exclusively conductive HI due to middle ear effusion. HIs were found in 36/141 who failed NHS, and 60/385 preschoolers who were referred by the primary care pediatrician's surveillance activity during well-child visits, with diagnostic yield of 25.5 and 15.5%, respectively.Conclusion: Ongoing preschool surveillance in primary care setting integrated into a NHS program is feasible to conduct and may effectively identify HIs that missed NHS or were related with a risk factor. New triage instruments and protocols for immediate audiology referral could allow to obtain the diagnosis of educationally significant conductive and sensorineural HIs ahead of the development concern and in the same way reduce patient mobility, thus optimizing timing efficiency and economic impact of the program.

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Oral Antibiotic Use for Otitis Media with Effusion

Abstract: Oral antibiotics continue to be administered in children with OME in the absence of acute infection, with risk varying by location of service. There is a potential opportunity for quality improvement through reducing antibiotic administration for pediatric OME.

Cited by 9 publications

References 16 publications

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

Adherence to American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines: A Systematic Review

Modeling Postnatal Hearing Case Finding Within the Italian National Health System

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