Otitis Media

Halsted, Crystie C.

doi:10.1001/archpedi.1968.02100010544003

Cited by 148 publications

(2 citation statements)

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“…The most striking influence on reported rates of clinical failure was the definition used for this outcome. Authors that defined clinical failure in terms of persistent symptoms (fever or otalgia) reported the lowest rates of clinical failure (all <25% at the end of the first week) [14,16-19]. The median clinical failure rate for these studies was 15%.…”

Section: Discussionmentioning

confidence: 99%

The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

et al. 2005

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BackgroundIt is unclear why some children with acute otitis media (AOM) have poor outcomes. Our aim was to describe the clinical course of AOM and the associated bacterial nasopharyngeal colonisation in a high-risk population of Australian Aboriginal children.MethodsWe examined Aboriginal children younger than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and video-otoscopy of the tympanic membrane (TM) and tympanometry was done every weekday if possible. We followed children for either two weeks (AOM without perforation), or three weeks (AOM with perforation), or for longer periods if the infection persisted. Nasopharyngeal swabs were taken at study entry and then weekly.ResultsWe enrolled 31 children and conducted a total of 219 assessments. Most children had bulging of the TM or recent middle ear discharge at diagnosis. Persistent signs of suppurative OM (without ear pain) were present in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of AOM did not usually have a sudden onset or short duration. Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. Perforation size generally remained very small (<2% of the TM). Healing followed by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens.ConclusionIn this high-risk population, AOM was generally painless and persistent. These infections were associated with persistent bacterial colonisation of the nasopharynx and any benefits of antibiotics were modest at best. Systematic follow up with careful examination and review of treatment are required and clinical resolution cannot be assumed.

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Section: Discussionmentioning

confidence: 99%

The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

et al. 2005

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“…This organism was once thought to be a nonpathogen. However, in 1965, it was first identified as a cause of AOM 50 . Gradually, the percent of M. catarrhalis cases rose to 15% of total episodes.…”

Section: Igg‐specific Antibody Response (μG/ml) Of Children With Acutmentioning

confidence: 99%

Immunology of the Middle Ear: Role of Local and Systemic Antibodies in Clearance of Viruses and Bacteria

Faden

1997

Annals of the New York Academy of Sciences

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Acute otitis media may be defined as the sudden onset of inflammation in the middle-ear space characterized by ear pain and a bulging, thickened, and immobile tympanic membrane. The middle-ear fluid is typically purulent. A bacterial pathogen is recovered in 75% of the episodes. Streptococcus pneumoniae predominates at 35%, followed by nontypeable Hemophilus influenzae at 25%, and Moraxella catarrhalis at 15%. The remaining 25% of middle-ear fluids are sterile and presumably represent viral infections. Increasing evidence suggests that viruses may participate in more than 50% of all acute otitis media (AOM) episodes; however, pure viral AOM is relatively uncommon. IThe natural course of AOM has not been studied in the past decade. A review of articles concerning treatment of AOM demonstrates a spontaneous self-resolution rate between 30 and 80%.24 This rate varies with the specific pathogen from a high rate of 79% with M. catarrhalis to a low rate of 11% with S. pne~moniae.'.~ The mechanisms of eradication appear to involve various host defenses, including phagocytosis and destruction within neutrophils, lysis by host products outside of the cell, immunologic destruction by antibody and complement, and drainage of pus from the middle-ear space through the eustachian tube.Ample evidence has been accumulated that supports the role of serum antibody in protecting the middle-ear space from infection. For example, the incidence of AOM is relatively low during the first six months of life when maternally acquired antibody levels are relatively high in infants. More specifically, antibody concentrations to S. pneumoniae in cord blood correlate to susceptibility to the development of pneumococcal otitis media, as does the level of antibody to nontypeable H. influenzae in older Low levels of antibody can be corrected by passive immunization with serum containing high titers of antibody. By passively raising levels of pneumococcal antibody, the frequency of otitis media is reduced. I* Active immunization with S. pneumoniae has also been associated with a reduced frequency of

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Epidemiology of Otitis Media With Effusion in Children

Giebink

Le²,

Paparella

1982

Archives of Otolaryngology - Head and Neck Surgery

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\s=b\The recently accepted international classification for otitis media was applied to a study population of 898 children less than 12 years of age having otitis media with effusion persisting at least three months. Mucoid effusion was aspirated from 48% of ears, was found more often in younger than older patients, was more often bilateral, and was a more stable state during longitudinal observation than was serous otitis media or purulent otitis media (POM). Serous otitis media occurred in only 10% of ears, but was found more often in older than in younger patients; POM was found in only 7% of ears. Otoscopy did not distinguish among the three effusion types. Known middle\x=req-\ ear pathogens were cultured more often behind red and bulging tympanic membranes from these cases of chronic effusion than behind membranes lacking these characteristics. These observations provide an epidemiologic and clinical base for further investigations of these otitis media types. (Arch Otolaryngol 1982;108:563-566) There are few areas of medicine where so many terms have been employed to describe a disease process as have been used to characterize otitis media. Even before World War I, such terms as catarrhal, exudative, secretory, seromucus, and nonsuppurative had been introduced and were used interchangeably by different workers.1 Paparella2 and Senturia3 have noted the confusion that has developed among clinicians and researchers as they have attempted to communicate ideas with one another about this disease. A classification scheme for defining otitis media based on the physical characteristics of middle-ear effusion and the pres¬ ence of intractable or refractory mid¬ dle-ear abnormalities was suggested by Paparella2 in 1976 and amplified by an ad hoc Committee on Definition and Classification of Otitis Media at the Second International Symposium on Recent Advances in Otitis Media With Effusion." The classification was based on duration of the disease(acute, zero to three weeks; subacute, four to 12 weeks; chronic, more than three months) and on effusion charac¬ teristics. Physical characteristics of effusion that are readily apparent on gross inspection of the fluid include clarity (clear or cloudy) and viscosity (thin or thick). Accordingly, serous effusion has been grossly defined as a thin, clear liquid; mucoid effusion as a thick, usually cloudy liquid; and puru¬ lent effusion as a thin, cloudy liquid.Because this classification has not been applied to a large number of patients having otitis media with effusion, the present study was under¬ taken to describe the prevalence of each type of otitis media and the tympanic membrane characteristics associated with each diagnostic enti¬ ty. A large population of children hav¬ ing clinically manifest otitis media with effusion (OME) who were undergoing myringotomy and tympa¬ nostomy tube placement were studied.These results form the basis on which microbiologie, immunologie, biochem¬ ical, and histopathologic studies can further characterize each type of oti¬ tis media. M...

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Otitis Media

Cited by 148 publications

References 20 publications

The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

Immunology of the Middle Ear: Role of Local and Systemic Antibodies in Clearance of Viruses and Bacteria

Epidemiology of Otitis Media With Effusion in Children

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