Otitis media: Concepts and controversies

Current Opinion in Otolaryngology and Head and Neck Surgery

Volumn 11, Issue 6, 2003, Pages 416-423

  Darrow, David H ^a   Dash, Nariman ^b   Derkay, Craig S ^b  

^a CHILDREN S HOSPITAL OF THE KING S DAUGHTERS   (United States)

^b NONE

Author keywords

Acute otitis media; Development; Diagnosis; Management; Microbiology; Otitis media with effusion; Risk factors; Vaccination

Indexed keywords

AMOXICILLIN; AMOXICILLIN PLUS CLAVULANIC ACID; AZITHROMYCIN; CEFTRIAXONE; CEFUROXIME; CEPHALOSPORIN DERIVATIVE; ERYTHROMYCIN; PNEUMOCOCCUS VACCINE;

ACUTE DISEASE; ANTIBIOTIC RESISTANCE; BIOFILM; CHRONIC DISEASE; CHRONIC DRUG ADMINISTRATION; EVIDENCE BASED MEDICINE; GASTROINTESTINAL SYMPTOM; HAEMOPHILUS INFLUENZAE; HEREDITY; HUMAN; INFECTION RISK; LOW DRUG DOSE; MEDICAL EDUCATION; MORAXELLA CATARRHALIS; MYRINGOTOMY; OTITIS MEDIA; OTOSCOPY; PATHOGENESIS; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; PROPHYLAXIS; RECURRENT INFECTION; REFLECTOMETRY; REVIEW; RISK FACTOR; SEROTYPE; STREPTOCOCCUS INFECTION; STREPTOCOCCUS PNEUMONIAE; TREATMENT OUTCOME; TYMPANOMETRY; VACCINATION;

HUMANS; OTITIS MEDIA;

EID: 0344121636     PISSN: 10689508     EISSN: None     Source Type: Journal    
DOI: 10.1097/00020840-200312000-00002     Document Type: Review

References (76)

1. Fried VM, Makuc DM, Rooks RN: Ambulatory health care visits by children: principal diagnosis and place of visit. Vital Health Stat 10 1998, 13:1-23.
2. Nash DR, Harman J, Wald ER, et al.: Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med 2002, 156:1114-1119.
3. Chan LS, Takata GS, Shekelle P, et al.: Evidence assessment of management of acute otitis media, II: research gaps and priorities for future research. Pediatrics 2001, 108:248-254.
4. Lim DJ, Chun YM, Lee HY, et al.: Cell biology of tubotympanum in relation to pathogenesis of otitis media-a review. Vaccine 2000, 19(suppl 1): S17-S25.
5. Ehrlich GD, Veeh R, Wang X, et al.: Mucosal biofilm formation on middle-ear mucosal in the chinchilla model of otitis media. JAMA 2002, 287:1710-1715.
6. Post JC: Direct evidence of bacterial biofilms in otitis media. Laryngoscope 2001, 111:2083-2094.
7. Casselbrant ML, Mandel EM: Epidemiology. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD, Hamilton, Ontario: BC Decker; 1999:117-136.
8. Paradise JL, Rockette HE, Colborn DK, et al.: Otitis media in 2253 Pittsburgh area infants: prevalence and risk factors during the first two years of life. Pediatrics 1997, 99:318-332.
9. Uhari M, Mantysaari K, Niemela M: A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996, 22:1079-1083.
10. Ball TM, Holberg CJ, Aldous M, et al.: Influence of attendance at day care on the common cold from birth through 13 years of age. Arch Pediatr Adolesc Med 2002, 156:121-126.
11. Dubin MG, Pollock HW, Ebert CS, et al.: Eustachian tube dysfunction after tobacco smoke exposure. Otolaryngol Head Neck Surg 2002, 126:14-19.
12. Lieu JEC, Feinstein AR: Effects of gestational and passive smoke exposure on ear infections in children. Arch Pediatr Adolesc Med 2002, 156:147-154.
13. Tasker A, Dettmar PW, Panetti M, et al.: Is gastric reflux a cause of otitis media with effusion in children? Laryngoscope 2002, 112:1930-1934.
14. Rovers M, Haggard M, Gannon M, et al.: Heritability of symptom domains in otitis media: a longitudinal study of 1,373 twin pairs. Am J Epidemiol 2002, 155:958-964.
15. Bluestone CD, Stephenson JS, Martin LM: Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992, 11:S7-S11.
16. Eskola J, Kilpi T, Palmu A, et al.: Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001, 344:403-409.
17. Sutton DV, Derkay CS, Darrow DH, et al.: Resistant bacteria in middle ear fluid at the time of tympanostomy tube surgery. Ann Otol Rhinol Laryngol 2000, 109:24-29.
18. Poole MD: Declining antibiotic effectiveness in otitis media: a convergence of data. Ear Nose Throat J 1998, 77:444-447.
19. Zapalac JS, Billings KR, Schwade ND, et al.: Suppurative complications of acute otitis media in the era of antibiotic resistance. Arch Otolaryngol Head Neck Surg 2002, 128:660-663.
20. Jacobs MR, Bajaksouzian S, Zilles A, et al.: Susceptibilities of Streptococcus pneumoniae and Haemophilus influenzae to 10 oral antimicrobial agents based on pharmacodynamic parameters: 1997 U.S. surveillance study. Antimicrob Agents Chemother 1999, 43:1901-1908.
21. Heikkinen T, Chonmaitree T: Importance of respiratory viruses in acute otitis media. Clin Microbiol Rev 2003, 16:230-241. An excellent article reviewing the viral pathogenesis of otitis media.
22. Carlson LH, Stool SE: Diagnosis. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, Ontario: BC Decker; 1999:105-115.
23. Brody R, Rosenfeld RM, Goldsmith AJ, et al.: Parents cannot detect mild hearing loss in children. Otolaryngol Head Neck Surg 1999, 121:681-686.
24. Steinbach WJ, Sectish TC: Pediatric resident training in the diagnosis and treatment of acute otitis media. Pediatrics 2002, 109:404-408.
25. MacClements JE, Parchman M, Passmore C: Otitis media in children: use of diagnostic tools by family practice residents. Fam Med 2002, 34:598-603.
26. Rosenfeld RM: Diagnostic certainty for acute otitis media. Int J Pediatr Otorhinolaryngol 2002, 64:89-95.
27. Garbutt J, Jeffe DB, Shackelford P: Diagnosis and treatment of acute otitis media: an assessment. Pediatrics 2003, 112:143-149. This study assessed the compliance of St. Louis area pediatricians with the Centers for Disease Control and Prevention evidence-based guidelines for the judicious use of antimicrobials in children with AOM. Compliance with recommended diagnostic criteria was 38% by chart audit and 41% by self-report. Antimicrobial selection assessed by chart audit was consistent with Centers for Disease Control and Prevention guidelines in 68% of visits for a new infection, 63% of visits for treatment failure, and 50% for recurrent disease. Self-reported compliance with treatment guidelines for new infection was 100%, and 83% for treatment failure. The authors recommend improving diagnostic accuracy, limiting the use of broad-spectrum antimicrobials, and ensuring that amoxicillin dosing regimens are optimal.
28. Barnett ED, Klein JO, Hawkins KA, et al.: Comparison of spectral gradient acoustic reflectometry and other diagnostic techniques for detection of middle ear effusion in children with middle ear disease. Pediatr Infect Dis J 1998, 17:556-559.
29. Rosenfeld RM: Natural history of untreated otitis media. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, Ontario: BC Decker; 1999:157-177.
30. Rosenfeld RM, Vertrees JE, Carr J, et al.: Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr 1994, 124:355-367.
31. Froom J, Culpepper L, Green LA, et al.: A cross-national study of acute otitis media: risk factors, severity, and treatment at initial visit: report from the International Primary Care Network (IPCN) and the Ambulatory Sentinel Practice Network (ASPN). J Am Board Fam Pract 2001, 14:406-417.
32. Rosenfeld RM: What to expect from medical therapy. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, Ontario: BC Decker; 1999:179-205.
33. Dowell SF, Butler JC, Giebink GS, et al.: Acute otitis media: management and surveillance in an era of pneumococcal resistance-a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Pediatr Infect Dis J 1999, 18:1-9.
34. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, et al.: Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. JAMA 1998, 279:1736-1742.
35. Jacobs J, Springer DA, Crothers D: Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J 2001, 20:177-183.
36. Rosenfeld RM: What to expect from surgical therapy. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, Ontario: BC Decker; 1999:207-221.
37. Alho OP: How common is recurrent acute otitis media? Acta Otolaryngol Suppl 1997, 529:8-10.
38. Block SL, Harrison CJ, Hedrick J, et al.: Restricted use of antibiotic prophylaxis for recurrent acute otitis media in the era of penicillin non-susceptible Streptococcus pneumoniae. Int J Pediatr Otorhinolaryngol 2001, 61:47-60.
39. Roark R, Berman S: Continuous twice daily or once daily amoxicillin prophylaxis compared with placebo for children with recurrent acute otitis media. Pediatr Infect Dis J 1997, 16:376-381.
40. Gebhart DE: Tympanostomy tubes in the otitis media-prone child. Laryngoscope 1981, 91:849-866.
41. Gonzalez C, Arnold JE, Woody EA, et al.: Prevention of recurrent acute otitis media: chemoprophylaxis versus tympanostomy tubes. Laryngoscope 1986, 96:1330-1334.
42. Casselbrant ML, Kaleida PH, Rockette HE, et al.: Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J 1992, 11:278-286.
43. Rosenfeld RM, Bhaya MH, Bower CM, et al.: Impact of tympanostomy tubes on child quality of life. Arch Otolaryngol Head Neck Surg 2000, 126:585-592.
44. Richards M, Giannoni C: Quality-of-life outcomes after surgical intervention for otitis media. Arch Otolaryngol Head Neck Surg 2002, 128:776-782. The authors used a prospective questionnaire-based study design to assess the change in disease-specific quality of life in children with rAOM, OME, or both treated with surgical intervention. They demonstrated a significant improvement in quality of life of children with rAOM, OME, or both after surgical intervention. The amount of parental worry concerning their children's ear problems also significantly improved after surgery, and most caregivers would opt again for tube placement.
45. Linder TE, Marder HP, Munzinger J: Role of adenoids in the pathogenesis of otitis media: a bacteriologic and immunohistochemical analysis. Ann Otol Rhinol Laryngol 1997, 106:619-623.
46. Brook I, Shah K, Jackson W: Microbiology of healthy and diseased adenoids. Laryngoscope 2000, 110:994-999.
47. Mattila PS, Joki-Erkkila VP, Kilpi T, et al.: Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol Head Neck Surg 2003, 129:163-168. This prospective study investigated the effect of adenoidectomy with tympanostomy compared with tympanostomy alone in the prevention of otitis media in children younger than 2 years. Over a mean follow-up of 7 months, the average reduction in the rate of all AOM media episodes in the adenoidectomy group was 19% in the randomized arm of the trial and 25% in the nonrandomized arm. Although the authors concluded that concurrent adenoidectomy during the insertion of tympanostomy tubes has little advantage over tubes alone in preventing otitis media, the results suggest that the procedure may be of value in severely affected people.
48. Paradise JL, Bluestone CD, Colborn DK, et al.: Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes. JAMA 1999, 282:945-953.
49. Madell JR: Impact of otitis media on auditory function. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, Ontario: BC Decker; 1999:337-351.
50. Feagens LV: Impact of otitis media on speech, language, cognition, and behavior. In Evidence-Based Otitis Media. Edited by Rosenfeld RM, Bluestone CD. Hamilton, Ontario: BC Decker; 1999:353-373.
51. Feagens LV, Sanyal M, Henderson F, et al.: Relationship of middle-ear disease in early childhood to later narrative and attention skills. J Pediatr Psychol 1994, 19:347-367.
52. Bennett KE, Haggard MP, Silva PA, et al.: Behaviour and developmental effects of otitis media with effusion into the teens. Arch Dis Child 2001, 85:91-95.
53. Paradise JL, Dollaghan CA, Campbell TF, et al.: Otitis media and tympanostomy tube insertion during the first three years of life: developmental outcomes at the age of four years. Pediatrics 2003, 112:265-277. The authors reported updated results from their long-term study of effects of persistent otitis media in the first 3 years of life on later impairments of cognitive, language, speech, or psychosocial development, and of the effect of prompt insertion of tympanostomy tubes on such impairments. They concluded that in otherwise healthy children who are younger than 3 years, persistent MEE meeting the criteria for duration in this study is negligibly associated with and probably does not affect developmental outcomes at 4 years of age; and furthermore, that prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 4 years of age. It is recommended that the reader consider the distribution of hearing loss and the duration of middle ear disease in the study cohort when interpreting the results.
54. Paradise JL, Feldman HM, Campbell TF, et al.: Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels. Pediatr Infect Dis J 2003, 22:309-314. The authors returned to their 2001 report of 429 children meeting criteria for tube insertion in whom delay of the procedure did not seem to affect subsequent developmental impairment assessed at 3 years of age. In the present study, they analyzed subgroups of these children who may have been the most severely affected, including those who had been randomized on the basis of bilateral, continuous MEE rather than unilateral or discontinuous MEE or both and those who had the greatest degrees of hearing loss. In none of the subgroups were scores on any outcome measure significantly more favorable in children in the early treatment group than in the late treatment group.
55. Bluestone CD, Klein JO: Complications and sequelae: intratemporal. In Otitis Media in Infants and Children, edn 2. Philadelphia: WB Saunders; 1995:241-291.
56. Brook I, Yocum P, Shah K, et al.: Microbiology of serous otitis media in children: correlation with age and length of effusion. Ann Otol Rhinol Laryngol 2001, 110:87-90.
57. Rayner MG, Zhang Y, Gorry MC, et al.: Evidence of bacterial metabolic activity in culture-negative otitis media with effusion. JAMA 1998, 279:296-299.
58. Lin J, Juhn SK, Adams GL, et al.: Dexamethasone inhibits mucous glycoprotein secretion via a phospholipase A2-dependent mechanism in cultured chinchilla middle ear epithelial cells. Acta Otolaryngol 1997, 117:406-413.
59. Jang CH, Kim YH: Characterization of cytokines present in pediatric otitis media with effusion: comparison of allergy positive and negative. Int J Pediatr Otorhinolaryngol 2002, 66:37-40.
60. Hurst DS, Venge P: The impact of atopy on neutrophil activity in middle ear effusion from children and adults with chronic otitis media. Arch Otolaryngol Head Neck Surg 2002, 128:561-566.
61. Mandel EM, Casselbrant ML, Rockette HE, et al.: Systemic steroid for chronic otitis media with effusion in children. Pediatrics 2002, 110:1071-1080. This study investigates the efficacy of a short course of prednisolone given with amoxicillin compared with amoxicillin alone for the treatment of OME. The efficacy of additional treatment with amoxicillin was also assessed. The authors found a significant difference in the proportion of children who were effusion-free immediately after 14 days of treatment with steroid and amoxicillin compared with those who were treated with amoxicillin only for 14 days. However, within 2 weeks of finishing treatment, there was no longer a significant difference between the two groups regardless of whether amoxicillin was continued. The study supports judicious use of medical therapy for OME.
62. Tracy JM, Demain JG, Hoffman KM, et al.: Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion. Ann Allergy Asthma Immunol 1998, 80:198-206.
63. Ruohola A, Heikkinen T, Waris M, et al.: Intranasal fluticasone propionate does not prevent acute otitis media during viral upper respiratory infection in children. J Allergy Clin Immunol 2000, 106:467-471.
64. Testa B, Testa D, Masolella M, et al.: Management of chronic otitis media with effusion: the role of glutathione. Laryngoscope 2001, 111:1486-1489.
65. McGuire JF: Surfactant in the middle ear and eustachian tube: a review. Int J Pediatr Otorhinolaryngol 2002, 66:1-15.
66. Venkatayan N, Troublefield YL, Connelly PE, et al.: Intranasal surfactant aerosol therapy for otitis media with effusion. Laryngoscope 2000, 110:1857-1860.
67. Siegel G, Brodsky L, Waner M, et al.: Office-based laser assisted tympanic membrane fenestration in adults and children: pilot data to support an alternative to traditional approaches to otitis media. Int J Pediatr Otorhinolaryngol 2000, 53:111-120.
68. Gates GA, Avery CA, Prihoda TJ, et al.: Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. N Engl J Med 1987, 317:1444-1451.
69. Coyte PC, Croxford R, Mclsaac W, et al.: The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. New Engl J Med 2001, 344:1188-1195.
70. Boston M, McCook J, Burke B, et al.: Incidence of and risk factors for additional tympanostomy tube insertion in children. Arch Otolaryngol Head Neck Surg 2003, 129:293-296. In this retrospective case review, the authors investigated the incidence and risk factors that account for additional tympanostomy tube placement among children who have undergone an initial placement of ventilation tubes. Data revealed that one in five patients subsequently required a second set of ventilation tubes. Age younger than 18 months at the time of the initial procedure was associated with an increased risk for additional surgery but was not an independent risk factor. Adenoidectomy reduced the incidence of subsequent tube insertion after initial surgery.
71. Cunningham MJ, Darrow DH, Goldstein MN, et al.: Follow-up management of children with tympanostomy tubes. Pediatrics 2002, 109:328-329.
72. Dagan R, Givon-Lavi N, Zamir O, et al.: Reduction of nasopharyngeal carriage of Streptococcus pneumoniae after administration of a 9-valent pneumococcal conjugate vaccine to toddlers attending day care centers. J Infect Dis 2002, 185:927-936.
73. American Academy of Pediatrics, Committee on Infectious Diseases: Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics 2000, 106:362-366.
74. Rafei K: Influenza virus vaccines in children and their impact on the incidence of otitis media. Semin Pediatr Infect Dis 2002, 13:129-133.
75. Murphy TF: Respiratory infections caused by non-typeable Haemophilus influenzae. Curr Opin Infect Dis 2003, 16:129-134.
76. Jiao X, Hirano T, Hou Y, et al.: Specific immune responses and enhancement of murine pulmonary clearance of Moraxella catarrhalis by intranasal immunization with a detoxified lipooligosaccharide conjugate vaccine. Infect Immun 2002, 70:5982-5989.