Otitis Media in Infancy: Tympanometric Findings

PEDIATRICS ◽  
1979 ◽  
Vol 63 (3) ◽  
pp. 435-442
Author(s):  
Jessie R. Groothuis ◽  
Sarah H. W. Sell ◽  
Peter F. Wright ◽  
Judith M. Thompson ◽  
William A. Altemeier
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Normal Pressure ◽  
Pressure Curve ◽  
Type B ◽  
History Of ◽  
Life Type ◽  
Insight Into

Ninety-one normal infants were followed longitudinally for varying periods from November 1975 to April 1977 to assess the correlation between tympanometry and pneumatic otoscopy and to study the pathogenesis of acute and chronic otitis media early in life. Type A (normal) tympanograms correlated with normal otoscopic findings in 92% of instances. Type B tympanograms, indicating reduced drum compliance with a relatively flat pressure curve, were associated with abnormal otoscopic findings in 93% of cases. The A8 (reduced compliance, normal pressure) and C (normal compliance, negative pressure) tympanograms were less consistent predictors of otoscopic findings. The correlation of tympanometric and otoscopic findings were similar in infants above and below 7 months of age. Tympanometry provided some insight into the natural history of otitis in 71 infants followed 12 to 17 months. Infants who failed to develop otitis had type B curves in only one of 240 determinations (0.4%). This pattern did not appear in those who developed acute otitis media (AOM) until the month preceding the first attack; nine of 29 tests (31%) made under these circumstances were type B. When a type B curve appeared in an asymptomatic study infant who had not previously had otitis, AOM developed within a month in nine of ten instances. At the time of diagnosis of first AOM, 87% of tympanograms were type B with the remainder type A8 or C. Sixty-three percent of tympanograms obtained from 25 infants during the six months following first AOM were type B, indicating that abnormal middle ear function was often prolonged. Fifteen of these 25 developed recurrent otitis during follow-up.

Management of Otitis Media Using Agency for Health Care Policy and Research Guidelines

1998 ◽  
Vol 118 (4) ◽  
pp. 437-443 ◽  
Author(s):  
Griffith S. Hsu ◽  
Samuel C. Levine ◽  
G. Scott Giebink
Keyword(s):  
Health Care ◽  
Otitis Media ◽  
Health Care Policy ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Care Policy ◽  
Research Guidelines ◽  
Recurrent Acute Otitis Media ◽  
History Of

Increased costs of managing otitis media and its complications may result from delays in diagnosis and treatment. The Agency for Health Care Policy and Research developed guidelines to assist in the management of chronic otitis media with effusion. We examined the medical care adherence to Agency for Health Care Policy and Research guidelines in 59 consecutive patients referred because of chronic otitis media with effusion and recurrent acute otitis media. Patient history and examination data were collected prospectively. In the group with chronic otitis media with effusion, the rate of adherence to Agency for Health Care Policy and Research guidelines was 0%; in those with recurrent acute otitis media, adherence was 5%. Delayed referral occurred in 34% of patients; 25% of patients were referred early. The average duration of effusion in patients with chronic otitis media with effusion was 5.2 months; the duration of recurrent acute otitis media immediately before referral was 9.3 months. Eighteen patients (47%) in the chronic otitis media with effusion group had a history of recurrent chronic otitis media with effusion spanning an average of 22.7 months. On referral, hearing loss was discovered in 92% of all patients, and in 69% the tympanogram was flat. The complication and sequelae rate was 49.1%, and speech delay was the most frequent at 16.9%. We conclude that in our study patients there is a significant referral delay, long history of chronic otitis media with effusion in patients before referral, high rate of hearing loss, and high complication rate. Continued efforts should be directed toward improving education of all clinicians so that diagnostic tools and timely otolaryngologic referral are better used.

scholarly journals Genomic Sequence of an Otitis Media Isolate of Nontypeable Haemophilus influenzae: Comparative Study with H. influenzae Serotype d, Strain KW20

2005 ◽  
Vol 187 (13) ◽  
pp. 4627-4636 ◽  
Author(s):  
Alistair Harrison ◽  
David W. Dyer ◽  
Allison Gillaspy ◽  
William C. Ray ◽  
Rachna Mungur ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Otitis Media ◽  
Genomic Sequence ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Genomic Research ◽  
Gene Repertoire ◽  
Virulence Determinants ◽  
Nontypeable Haemophilus Influenzae ◽  
Insight Into

ABSTRACT In 1995, the Institute for Genomic Research completed the genome sequence of a rough derivative of Haemophilus influenzae serotype d, strain KW20. Although extremely useful in understanding the basic biology of H. influenzae, these data have not provided significant insight into disease caused by nontypeable H. influenzae, as serotype d strains are not pathogens. In contrast, strains of nontypeable H. influenzae are the primary pathogens of chronic and recurrent otitis media in children. In addition, these organisms have an important role in acute otitis media in children as well as other respiratory diseases. Such strains must therefore contain a gene repertoire that differs from that of strain Rd. Elucidation of the differences between these genomes will thus provide insight into the pathogenic mechanisms of nontypeable H. influenzae. The genome of a representative nontypeable H. influenzae strain, 86-028NP, isolated from a patient with chronic otitis media was therefore sequenced and annotated. Despite large regions of synteny with the strain Rd genome, there are large rearrangements in strain 86-028NP's genome architecture relative to the strain Rd genome. A genomic island similar to an island originally identified in H. influenzae type b is present in the strain 86-028NP genome, while the mu-like phage present in the strain Rd genome is absent from the strain 86-028NP genome. Two hundred eighty open reading frames were identified in the strain 86-028NP genome that were absent from the strain Rd genome. These data provide new insight that complements and extends the ongoing analysis of nontypeable H. influenzae virulence determinants.

scholarly journals The spontaneous resolution of a vortex vein varix: case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sara L Weidmayer ◽  
Hakan Demirci
Keyword(s):  
Case Report ◽  
Natural History ◽  
Extended Period ◽  
Spontaneous Resolution ◽  
Case Presentation ◽  
Clinical Resolution ◽  
History Of ◽  
Vortex Vein ◽  
Insight Into

Abstract Background The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring. Case presentation An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix. Conclusion This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.

Otitis media in Indigenous Australian children: review of epidemiology and risk factors

2013 ◽  
Vol 128 (S1) ◽  
pp. S16-S27 ◽  
Author(s):  
Jake Jervis-Bardy ◽  
L Sanchez ◽  
A S Carney
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Otitis Media ◽  
Bacterial Load ◽  
Grey Literature ◽  
Acute Otitis Media ◽  
Chronic Otitis Media ◽  
Health Concern ◽  
Indigenous Australian ◽  
Indigenous Children

AbstractBackground:Otitis media represents a major health concern in Australian Indigenous children (‘Indigenous children’), which has persisted, despite public health measures, for over 30 years.Methods:Global searches were performed to retrieve peer-reviewed and ‘grey’ literature investigating the epidemiology of and risk factors for otitis media in Indigenous children, published between 1985 and 2012.Results:In Indigenous children, the prevalence of otitis media subtypes is 7.1–12.8 per cent for acute otitis media, 10.5–30.3 per cent for active chronic otitis media and 31–50 per cent for tympanic membrane perforation. The initial onset of otitis media in Indigenous children occurs earlier and persists for longer after the first year of life, compared with non-Indigenous children. Indigenous children are colonised by otopathogens more frequently, at younger ages and with a higher bacterial load. Poor community and domestic infrastructure, overcrowding and exposure to tobacco smoke increase the risk of otitis media in Indigenous children; however, the availability of swimming pools plays no role in the prevention or management of otitis media.Conclusion:Despite awareness of the epidemiological burden of otitis media and its risk factors in Indigenous children, studies undertaken since 1985 demonstrate that otitis media remains a significant public health concern in this population.

Antimicrobial Treatment of Acute Otitis Media

1994 ◽  
Vol 103 (5_suppl) ◽  
pp. 11-14 ◽  
Author(s):  
Daniel M. Canafax ◽  
G. Scott Giebink
Keyword(s):  
Hearing Loss ◽  
Otitis Media ◽  
Antimicrobial Agents ◽  
Acute Otitis Media ◽  
Antimicrobial Treatment ◽  
Speech Delay ◽  
Significant Morbidity ◽  
Antimicrobial Drugs ◽  
Etiologic Role ◽  
History Of

Episodes of acute otitis media frequently occur in childhood and are attended by significant morbidity, such as hearing loss and possible speech delay. Bacteria play an important etiologic role in the pathogenesis of otitis media; therefore, antimicrobial agents are the cornerstone in the treatment of this disease. Many antimicrobial choices are available for treating children with acute otitis media. To choose an antimicrobial for each patient, consideration must be given to the patient's age, history of otitis media episodes, and responses to previously used antimicrobial drugs, and the regional antimicrobial susceptibility of the otitis media pathogens.

Clonal similarity of salivary and nasopharyngeal Fusobacterium nucleatum in infants with acute otitis media experience

2004 ◽  
Vol 53 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Gunnsteinn Haraldsson ◽  
W. Peter Holbrook ◽  
Eija Könönen
Keyword(s):  
Oral Cavity ◽  
Otitis Media ◽  
Anaerobic Bacteria ◽  
Acute Otitis Media ◽  
Fusobacterium Nucleatum ◽  
Potential Source ◽  
History Of ◽  
Arbitrarily Primed Pcr ◽  
Inoculation Route ◽  
Media Experience

The environment of an infant's nasopharynx during acute otitis media (AOM) favours the growth of anaerobic bacteria, which can be recovered frequently during infection, but hardly at all if the infant is healthy. The aim of this investigation was to identify the potential source and inoculation route of anaerobes that were present in the nasopharynx. Eleven Fusobacterium nucleatum isolates that were collected through the nasal cavity from the nasopharynx of eight infants with a history of AOM, and 161 F. nucleatum isolates from the saliva of the same infants, were typed to the clonal level by using arbitrarily primed PCR (AP-PCR). In five of the eight infants examined, identical AP-PCR types were found among nasopharyngeal and salivary isolates. As anaerobes seem to be present only transiently in the nasopharynx and salivary contamination of the nasopharyngeal samples can be excluded, this observation indicates that the source of nasopharyngeal anaerobes is the oral cavity and that saliva is their transmission vehicle.

Comparison of Cefpodoxime Proxetil and Cefixime in the Treatment of Acute Otitis Media in Infants and Children

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 847-852
Author(s):  
Basim I. Asmar ◽  
Adnan S. Dajani ◽  
Mark A. Del Beccaro ◽  
Paul M. Mendelman ◽  
Keyword(s):  
Otitis Media ◽  
Acute Otitis Media ◽  
Drug Efficacy ◽  
Oral Suspension ◽  
Suppurative Otitis Media ◽  
Once Daily ◽  
Cefpodoxime Proxetil ◽  
Long Term Follow Up ◽  
Cure Rates

Objective. To compare the use of once-a-day cefpodoxime proxetil to once-a-day cefixime in the treatment of acute suppurative otitis media. Design. Randomized, multicenter, investigator-blinded. Setting. Outpatient. Patients. A total of 368 patients (age 2 months to 17 years) were randomized to receive either cefpodoxime or cefixime in a 2:1 ratio (245 cefpodoxime, 123 cefixime); 236 patients (155 cefpodoxime, 81 cefixime) were evaluable for drug efficacy. Interventions. Patients received either cefpodoxime proxetil oral suspension (10 mg/kg/day, once daily for 10 days) or cefixime oral suspension (8 mg/kg/day, once daily for 10 days). Main outcome measures. Clinical evaluations were performed before treatment (study day 1), at an interim visit (study day 3 through 6), at the end of therapy (study day 12 through 15), and at final follow-up (study day 25 through 38). Microbiologic evaluations were performed at enrollment and whenever appropriate thereafter. Results. End-of-therapy clinical cure rates in evaluable patients were 56% for the cefpodoxime group and 54% for the cefixime group. Clinical improvement rates were 27% for both groups. Clinical response rates were not significantly different between treatment groups (P = .541; 95% confidence interval = -8.1%, 15.2%). At long-term follow-up, 17% of patients in the cefpodoxime group and 20% in the cefixime group had a recurrence of infection. Drug-related adverse events (eg, diarrhea, diaper rash, vomiting, rash) occurred in 23.3% of cefpodoxime-treated patients and 17.9% of cefixime-treated patients (P = .282). Conclusions. These findings suggest that cefpo-doxime proxetil administered once daily is as effective and safe as cefixime given once daily in the treatment of acute suppurative otitis media in pediatric patients.

scholarly journals Comparative study of once-weekly azithromycin and once-daily amoxicillin treatments in prevention of recurrent acute otitis media in children.

1996 ◽  
Vol 40 (12) ◽  
pp. 2732-2736 ◽  
Author(s):  
P Marchisio ◽  
N Principi ◽  
E Sala ◽  
L Lanzoni ◽  
S Sorella ◽  
...  
Keyword(s):  
Otitis Media ◽  
Randomized Study ◽  
Acute Otitis Media ◽  
Occurrence Rate ◽  
Once Daily ◽  
Recurrent Acute Otitis Media ◽  
Periodic Administration ◽  
Resistant Strains ◽  
Selection Of

Continuous chemoprophylaxis is effective in the prevention of new episodes of acute otitis media (AOM) in otitis-prone children, but compliance can be a problem and thus efficacy can be decreased. Intermittent chemoprophylaxis has so far shown conflicting results. Azithromycin, which has a peculiar pharmacokinetics, resulting, even after a single dose, in persistently elevated concentrations in respiratory tissues, could permit a periodic administration with higher compliance. We compared a 6-month course of once-weekly azithromycin (5 or 10 mg/kg of body weight) with that of once-daily amoxicillin (20 mg/kg) in a single-blind, randomized study of prophylaxis for recurrent AOM in 159 children aged 6 months to 5 years with at least three episodes of AOM in the preceding 6 months. In the amoxicillin group, 23 (31.1%) of 74 children developed 29 episodes of AOM, while in the 10-mg/kg azithromycin group, 11 (14.9%) of 74 children experienced 15 episodes. The 5-mg/kg/week azithromycin trial was prematurely interrupted after nine cases, due to the high occurrence rate of AOM (55.5%). During the 6-month prophylaxis period, the proportion of children with middle ear effusion declined similarly in both groups. No substantial modification of the nasopharyngeal flora was noted at the end of prophylaxis in both antimicrobial groups. In the 6-month-postprophylaxis follow-up period, about 40% of children in both groups again developed AOM. Azithromycin at 10 mg/kg once weekly can be regarded as a valid alternative to once-daily low-dose amoxicillin for the prophylaxis of AOM. Although in the present study no microbiological drawback was noted, accurate selection of children eligible for prophylaxis is mandatory to avoid the risk of emergence of resistant strains.

scholarly journals Case Report: Petrous Apicitis and Otogenic Thrombosis of the Cavernous Sinus in a 10-Year-Old Boy

2021 ◽  
Vol 8 ◽  
Author(s):  
Patrick Bergsma ◽  
Seraina Kunz ◽  
Anna-Lena Kienle ◽  
Yves Brand
Keyword(s):  
Otitis Media ◽  
Cavernous Sinus ◽  
Sinus Thrombosis ◽  
Acute Otitis Media ◽  
Petrous Apex ◽  
Cavernous Sinus Thrombosis ◽  
Petrous Apicitis ◽  
Air Cells ◽  
Ct And Mri

Background: Petrous apicitis and cavernous sinus thrombosis are exceedingly rare complications of acute otitis media with only few reported cases in the post-antibiotic era. Especially in children, the appropriate management is a subject of controversy.Case Presentation: We report the case of a 10-year-old boy who presented to the emergency department with left-sided otalgia, otorrhea, and hearing loss, accompanied by somnolence and high spiking fevers. CT and MRI revealed partially obstructed mastoid air cells including a pneumatized petrous apex. Furthermore, thrombosis of the cavernous sinus and vasculitis of the internal carotid artery on the left side were present. The patient was treated with antibiotics for 6 weeks and anticoagulant therapy for 3 months. Follow-up carried out 3 months post-admission showed complete recanalization of the cavernous sinus on MRI and fatigue as the only remaining symptom.Conclusion: A complicated otitis media with petrous apicitis and cavernous sinus thrombosis in a child can in some cases be managed without a surgical intervention.

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