|
| ||
|
|
||
Chronic Suppurative Otitis Media (chronic + suppurative_otitis_media)
Selected AbstractsManagement of children with otitis media: A summary of evidence from recent systematic reviewsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2009Hasantha Gunasekera Abstract Health-care professionals who manage children are regularly confronted with clinical questions regarding the management of the full spectrum of otitis media: acute otitis media; otitis media with effusion; and chronic suppurative otitis media. Given the variety of potential therapies available, the wide spectrum of middle ear disorders, and the lack of consensus about management strategies, clinicians are in a difficult position when managing these children. In this review, we seek to summarise the current best evidence for answering otitis media management questions by collating existing systematic reviews. [source] Ototoxic eardrops and tympanic membrane perforations: Time for a change?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2005Harvey Coates Abstract: Until recently the only available antibiotic eardrops for treatment of the discharging middle ear and mastoid cavity have been potentially ototoxic. With the advent of non-ototoxic fluoroquinolone eardrops, consensus panels in the USA, Canada and the UK have advocated the preferential use of these agents in the open middle ear. However, in Australia, no fluoroquinolone topical agent is approved for use with tympanic membrane perforations, and when used as an ,off label' eardrop, none is on the Pharmaceutical Benefits Scheme. This creates an ethical dilemma, particularly with best practice management of chronic suppurative otitis media in indigenous children. Despite concerns regarding resistance issues with ototopical use of systemic antibiotics, bacterial resistance has not been documented in major studies. For equity and ethical reasons, Australian regulatory authorities should consider approving a sterile non-ototoxic eardrop for use in the open middle ear. [source] Missed opportunities for a diagnosis of acute otitis media in Aboriginal childrenJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2003KB Gibney Objective: Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory. Methods: Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff. Results: Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test). Conclusions: In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management. [source] The Treatment for Postirradiation Otitis Media With Effusion: A Study of Three MethodsTHE LARYNGOSCOPE, Issue 11 2008Yao-Dong Xu MD Abstract Objective: To explore treatments for postirradiation otitis media with effusion (OME) in patients with nasopharyngeal carcinoma. Study Design: This study is a prospective quasi-randomized clinical trial. Methods: Ninety-six patients (135 ears) with OME after the first course of radiotherapy for nasopharyngeal carcinoma were divided into three groups: simple auripuncture plus aspiration, tympanic membrane fenestration with cauterization, and myringotomy plus grommet insertion. Cure rates and incidences of complications were compared. Results: Two deaths occurred. The other 94 patients (132 ears) finished a 2-year follow-up. In group 1, four ears (8.9%) were cured after the first treatment and 17 ears overall (37.8%) were cured by the end of the follow-up. Twenty ears (44.4%) had persistent fluid, two ears (4.4%) developed chronic suppurative otitis media, and five ears (11.1%) developed dry eardrum perforation. In group 2, seven ears (15.6%) were cured after the first treatment and 21 ears overall (46.7%) were cured by the end of the follow-up. Fourteen ears (31.1%) had persistent fluid, three ears (6.7%) developed chronic suppurative otitis media, and seven ears (15.6%) developed dry eardrum perforation. In group 3, eight ears (17.8%) were cured after the first treatment and 23 ears overall (51.1%) were cured by the end of the follow-up. Seven ears (15.6%) had persistent fluid, five ears (11.1%) developed chronic suppurative otitis media, three ears (6.7%) developed eardrum perforation with effusion, and five ears (11.1%) developed dry eardrum perforation. Conclusion: The methods each have advantages and disadvantages. We believe that a step by step approach should be used when choosing the treatment method for postirradiation OME. That is, first apply auripuncture plus aspiration, and then the other methods if this approach is inadequate. Enhanced local care after grommet insertion can effectively reduce the incidence of complications. [source] Studies in Otitis Media: Children's Hospital Of Pittsburgh,University of Pittsburgh Progress Report,2004THE LARYNGOSCOPE, Issue S105 2004Charles D. Bluestone MD Abstract Objectives/Hypothesis: The present Progress Report has summarized the key otitis media clinical trials and laboratory studies conducted since 1969 by investigators at the Children's Hospital of Pittsburgh,University of Pittsburgh (Pittsburgh, PA). Study Design: Review. Methods: Included in the discussion are the following: 1) studies of the epidemiology and risk factors; 2) anatomy and pathology of the eustachian tube,middle ear from human temporal bone histopathological specimens; 3) physiology and pathophysiology of the eustachian tube,middle ear in humans and animal models; 4) pathogenesis; 5) otitis media in special populations (e.g., patients with cleft palate, Native Americans, patients with Down syndrome); 6) microbiology; 7) diagnosis; 8) outcomes of randomized clinical trials that evaluated efficacy of nonsurgical and surgical methods of treatment and prevention; 9) studies of certain complications and sequelae (e.g., effect of middle-ear effusion on hearing, early child development, and the vestibular system; chronic suppurative otitis media). Also included are relevant summary tables and 256 references. [source] Bone anchored hearing aids: a preliminary assessment of the impact on outpatients and cost when rehabilitating hearing in chronic suppurative otitis mediaCLINICAL OTOLARYNGOLOGY, Issue 4 2008G.J. Watson Objectives:, To compare the difference in ENT and Audiology visits, treatments dispensed and potential savings pre- and post-bone anchored hearing aid (BAHA) insertion in patients with chronic suppurative otitis media exacerbated by behind the ear hearing aids. Design:, A retrospective pilot study. Setting:, District General Hospital. Participants:, All patients who had BAHA inserted from January 2001 to January 2006. Parameters:, Age, gender, number of visits per month, treatments per month dispensed from the ENT and Audiology Departments and direct and limited indirect medical costs pre- and post-BAHA insertion. Results:, Twelve of 26 (46%) adult patients had BAHA inserted over the 5-year period for CSOM. The male to female ratio was 1 : 3 with a median age of 61 (range 29,81). The number of visits and treatments dispensed per month in the ENT Department fell from a mean of 0.42,0.33 (P < 0.08) and 0.22,0.14 (P < 0.02) respectfully. When the difference in medical cost was taken into account BAHA offered a potential saving of £627.80 per patient. Conclusion:, Although the initial acquisition of surgical equipment and BAHA sound processors is expensive, there is a reduction in the number of treatments and visits required for patients with chronic suppurative otitis media after BAHA is inserted leading to a reduction in average costs. [source] | ||||||||||