Chronic Otitis Media with Effusion
University of Minnesota, Otitis Media Research Center, Department of Otolaryngology, University of Minnesota School of Medicine, Minneapolis, USA. Pediatrics in Review
(Impact Factor: 0.82).
04/1999; 20(3):85-93; quiz 94. DOI: 10.1542/pir.20-3-85
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.
Available from: PubMed Central
- "Being a well-documented method for the diagnose of OME, tympanometry has a sensitivity varying between 82–90% and a specificity between 68–98% relative to findings in myringotomy [4,5,12]. "
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ABSTRACT: Otitis media with effusion (OME) is one of the most frequently met pathologies in small children. Long-term persistence of the liquid in the middle ear cavity correlates with the impairment in speech acquisition and poor results in school.
To evaluate the predictive value of impedancemetry in recovery of the normal middle ear status.
30 children (age 4 month - 9 years) with OME were periodically monitored by means of tympanometry. The children were treated with the same treatment protocol for 7 days minimum and tympanometry was repeated after seven and fourteen days. After follow-up tympanometry at 7 days, children with abnormal middle ear condition were randomly allocated into two groups: one, which continued the same treatment for another 7 days and one group with no treatment for the next 7 days.
After 7 days, 64% of the patients had an improvement in tympanometry (type C tympanogram) and 10% had a complete resolution of the middle ear effusion (type A tympanogram). After 14 days, tympanometry was normal in 74% of the patients (53.9% rate of success in the no-treatment group).
Complete resolution of the middle ear effusion is obtained in various periods of time, depending on numerous factors, with an appropriate treatment. Tympanometry proved to be a good tool in predicting the length of the treatment.
Available from: Matthew Robert Moore
- "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. "
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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.
Available from: Garth D Ehrlich
- "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. "
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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.
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