Chronic otitis media with effusion.
ABSTRACT Chronic OME, which arises from a complex series of inflammatory events in the middle ear, affects approximately 5% to 30% of children. The mean duration of MEE is 16 to 20 weeks during the first 2 years of life. This condition is diagnosed best with pneumatic otoscopy and tympanometry. The risk of chronic OME is increased by environmental factors and characteristics of the child, including disease history. Approximately 70% of MEE are culture-positive, with approximately 50% of these yielding S pneumoniae, H influenzae, or M catarrhalis. However, antibiotic treatment of acute otitis media and OME has only a minimal effect on the long-term resolution of MEE. Research has shown that 70% of children who have chronic OME suffer mild-to-moderate hearing loss, so a child who has bilateral MEE for 3 months should undergo hearing evaluation. If the child has hearing impairment, referral to an otolaryngologist for myringotomy and tympanostomy tube insertion is a treatment option that the AHCPR recommends after 4 months of effusion with hearing loss. Sequelae of chronic OME include deficient expressive language and poorer attention skills due to the temporary hearing loss associated with OME, high-frequency sensorineural hearing loss, tympanic membrane atrophy, perforation, retraction, atelectasis, and cholesteatoma.
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- "However, the role played by Pneumococci in causing chronic forms of otitis media is probably no larger than their role in causing acute otitis media   ; therefore it is unlikely that the difference between the incidence of chronic forms of otitis media in children who received PCV7 on the 2 + 1 schedule and their incidence in children who got PCV7 on the 3 + 1 schedule is larger than the difference observed for AOM. Also, our findings on AOM likely apply to the bulk of all OM cases in developed countries since chronic forms of OM account for a minority of developed countries' OM   . Fourth, here we have examined 7-valent PCV instead of the recently licensed and recommended 13-valent PCV. "
ABSTRACT: Seven-valent pneumococcal conjugate vaccination (PCV7) has been shown to reduce rates of otitis media (OM) when given as a 2- or 3-dose primary series followed by a booster dose. However, data on the 2- or 3-dose primary series' relative effectiveness against OM is very limited. Using data from the United States after the 2000 introduction of PCV7, we compared the effectiveness of a 2- versus a 3-dose primary series against acute otitis media (AOM). We examined the 2002 birth cohort from the Medstat MarketScan insurance claims database and compared the incidence of AOM in children that received two or three doses in the primary PCV7 series using propensity score matching. We assessed AOM rates after completion of the primary series and before the booster dose, and after the booster dose until four years of age. Among the 2002 birth cohort captured by MarketScan, we identified 38,786 children we could match with immunization data; of these 8515 (22%) received a 2-dose primary series and 10,152 (26%) received a 3-dose primary series. After matching, cumulative AOM incidence between 6 and 12 months among children who did not receive a PCV7 dose between the primary series and the booster dose was 37.6% for the 2-dose series and 35.0% for the 3-dose series. This difference was not statistically significant (p=0.22). Cumulative AOM incidence between one and four years, i.e., after the booster dose, was 104.4% for the 2-dose primary series and 102.5% for the 3-dose primary series, and the difference between them was also statistically insignificant. In a population of highly-insured children, a 2-dose primary series of PCV7 appears to provide similar protection against AOM as a 3-dose primary series. These data have important implications for national immunization programs where AOM is an important driver of cost-effectiveness.Vaccine 08/2012; 30(44):6256-62. DOI:10.1016/j.vaccine.2012.08.011 · 3.49 Impact Factor
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- "Bluestone and Klein  reported that otorrhea is the most common complication of childhood tympanostomy tube placement, developing in 12—32% of cases. Chronic infectious middle-ear disease is the most common cause of conductive hearing loss during childhood  . Teele et al.  noted that the length of time with chronic middle-ear infection is negatively corre- 2 G. Erdos et al. "
ABSTRACT: To create, array, and characterize a pooled, high-coverage, genomic library composed of multiple biofilm-forming clinical strains of the opportunistic pathogen, Pseudomonas aeruginosa (PA). Twelve strains were obtained from patients with otorrhea, otitis media, and cystic fibrosis as a resource for investigating: difference in the transcriptomes of planktonic and biofilm envirovars; the size of the PA supragenome and determining the number of virulence genes available at the population level; and the distributed genome hypothesis. High molecular weight genomic DNAs from 12 clinical PA strains were individually hydrodynamically sheared to produce mean fragment sizes of approximately 1.5 kb. Equimolar amounts of the 12 sheared genomic DNAs were then pooled and used in the construction of a genomic library with approximately 250,000 clones that was arrayed and subjected to quality control analyses. Restriction endonuclease and sequence analyses of 686 clones picked at random from the library demonstrated that >75% of the clones contained inserts larger than 0.5 kb with the desired mean insert size of 1.4 kb. Thus, this library provides better than 4.5x coverage for each of the genomes from the 12 components clinical PA isolates. Our sequencing effort ( approximately 1 million nucleotides to date) reveals that 13% of the clones present in this library are not represented in the genome of the reference P. aeruginosa strain PA01. Our data suggests that reliance on a single laboratory strain, such as PA01, as being representative of a pathogenic bacterial species will fail to identify many important genes, and that to obtain a complete picture of complex phenomena, including bacterial pathogenesis and the genetics of biofilm development will require characterization of the P. aeruginosa population-based supra-genome.International Journal of Pediatric Otorhinolaryngology 11/2006; 70(11):1891-900. DOI:10.1016/j.ijporl.2006.06.016 · 1.32 Impact Factor
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ABSTRACT: The study objective was to determine whether pneumatic otoscopy would improve the diagnostic accuracy of otitis media with effusion (OME) in clinical practice over otoscopy only. A randomized single-blind control trial was undertaken in 30 pediatric residents. Residents were randomized into pneumatic otoscopy (intervention) or otoscopy-only (control) groups. Both study groups received one hour of theory on OME; the intervention group also received a 30-minute teaching session that included both video-otoendoscopic examination (VOE) pneumatic assessments and one practice session. Each resident examined 10 ears and made a diagnosis of either normal or OME ears. Tympanograms were considered as the gold standard. The percent correct diagnoses in the intervention and control groups were 60% and 59%, respectively (p = 0.85). In conclusion, pneumatic otoscopy did not significantly improve the diagnosis of otitis media with effusion in clinical settings. Further studies are needed to confirm these findings. L'objectif de l'étude était de déterminer si l'apprentissage et la formation portant sur l'otoscopie pneumatique pouvaient augmenter la précision du diagnostic de l'otite moyenne séreuse (avec épanchement) en pratique clinique. Une étude de contrôle, à sélection aléatoire, à simple insu, a été entreprise auprès de 30 résidents en pédiatrie de l'Université McGill. Les résidents ont été affectés de façon aléatoire, soit au groupe d'otoscopie pneumatique (groupe d'intervention), soit au groupe d'otoscopie uniquement (groupe témoin). Les deux groupes de l'étude ont suivi un cours théorique d'une heure portant sur l'otite moyenne séreuse (avec épanchement). Le groupe d'intervention a également pris part à une séance d'enseignement de 30 minutes, y inclus une évaluation de l'examen otoendoscopique avec système vidéo et de l'otoscopie pneumatique et une séance d'entraînement. Chaque résident devait examiner 10 oreilles et poser un diagnostic, soit de normalité, soit d'otite moyenne séreuse (avec épanchement). Le tympanogramme a été utilisé comme norme d'excellence. Le pourcentage de diagnostics justes dans les groupes d'intervention et de témoin était de 60 % et de 59 % respectivement (p = 0,85). En conclusion, l'otoscopie pneumatique n'a pas augmenté la précision du diagnostic de l'otite moyenne en pratique clinique.