Leif Ingvarsson

Eustachian tube function in otitis-prone and healthy children.

To evaluate the significance of Eustachian tube function in recurrent acute otitis media (rAOM), 50 otitis-prone children (greater than 11 episodes of AOM) were compared with 49 children without rAOM. Tubal function tests were: initial middle-ear pressure, active tubal function (muscular opening function), passive function (pressure opening and closing levels), and inflationary and deflationary capacity. The otitis-prone children were found to have significantly poorer active tubal function than controls. Other test results did not differ between the two groups. The otitis-prone children were also divided into subgroups with and without intermittent secretory otitis media (SOM), and with and without allergy, but no differences in tubal function tests were found between the different subgroups. The findings suggest active tubal function to be the most significant variable regarding proneness to rAOM, but not to distinguish between particular subgroups of otitis-prone children. The available technique for testing Eustachian tube function is insufficiently sensitive, however, to be conclusive in individual cases, and it is still not possible to predict individual outcome of the illness from tubal function test results alone.

Penicillin Treatment of Acute Otitis Media in Children

Two hundred and ninety-seven children, aged 6 months to 7 years, with AOM were treated with penicillin V. One hundred and forty-eight children were given 25 or 50 mg/kg body weight twice a day for 5 days, and 149 children 25 mg/kg body weight twice a day for 10 days. No differences were found in the rate of healing between the 5- and 10-day groups. The larger penicillin dose, which was given to half the 5-day group, did not lead to improved healing. Treatment with penicillin for 5 days instead of 10 does not mean any increased risk of complications such as SOM, relapses, or therapeutic failure. Nor does the risk of a recurrence of otitis increase either. The investigation showed that the treatment of AOM with penicillin for 10 days, which is the rule in Sweden, can be reduced to 5 days with maintained satisfactory healing and without risk of increasing the number of complications.

Otitis-prone Children and Controls: A Study of Possible Predisposing Factors. 1. Heredity, Family Background and Perinatal Period

In a retrospective study of 179 otitis-prone children and 305 controls, various possible predisposing factors for acute otitis media (AOM) were compared. The children were matched for age and sex. There were 61% boys and 39% girls in the otitis-prone group and 58% boys and 42% girls among the controls. Eighty-eight (49%) of the otitis-prone children experienced > or = 11 episodes of AOM and 162 (53%) of the controls had none or at the most one episode of AOM. There were no differences between the groups concerning dwelling districts, the size of family, number of siblings or the education and occupation of the parents. In the otitis-prone group there were more fathers who had been otitis-prone as children. This was not seen for the mothers when comparing all the children, but was seen when comparing the most otitis-prone (> or = 11 AOM) with the controls (0-1 AOM). The otitis-prone children more often had siblings who were otitis-prone compared with the controls. There were no differences between the two groups regarding pregnancy, birthweight or duration of breast-feeding. Thus, male gender and heredity for middle-ear problems appeared to be of importance for otitis-proneness.

ACUTE OTALGIA IN CHILDREN - FINDINGS AND DIAGNOSIS

ABSTRACT. One hundred and seventy‐one children up to 15 years of age and with acute otalgia were examined to find out whether otalgia or any other symptoms were so closely related to acute otitis media (AOM) as to make otoscopic examination unnecessary. AOM was diagnosed in 46%, simplex otitis in 15%, serous otitis media (SOM) in 17%, and normal eardrums in 22%. Children with AOM had fever and spontaneous perforation of the eardrums in 78% and 30% of the cases, respectively. Of the children who had not AOM (54%), the otalgia could in most cases be classified as referred pain due to, for instance, discomfort when swallowing, nasal obstruction or throat pain. Other reasons were general irritability due to fever, teething or moderate hearing loss. The difficulties in diagnosing AOM simply on the basis of symptoms were demonstrated in the investigation. Symptoms such as otalgia, otorrhea, fever or upper respiratory tract infection (URI), possibly except for the combination of otorrhea and fever, can occur without AOM. A correct otoscopic examination and evaluation of the eardrums is necessary in children with otalgia, other symptoms of URI or in doubtful cases of acute illness. Physicians without possibilities to evaluate the eardrums properly should thus refer the patient to an otologist without delay.

Middle ear disease and hearing impairment in northern Tanzania. A prevalence study of schoolchildren in the Moshi and Monduli districts

A total of 854 schoolchildren from one urban and one rural district in northern Tanzania were examined for the presence of middle ear pathology and hearing loss by means of pneumotoscopy and screening audiometry (air conduction). The prevalence of chronic otitis media (COM) was 1.6%, with no difference between urban and rural children. Scarred and sclerotic tympanic membranes were found in 10.9% of urban children and in 15.1% of rural children, the difference being significant. Hearing loss within the speech frequency range in all the children studied was found in 37% of the urban children and in 18% of the rural children. However, the prevalence of hearing loss above 30 dB HL was 3% in both districts. High frequency loss was significantly more common among urban than among rural children. Undetected severe hearing impairment/deafness was found in three children in the rural district, while none was found in the urban district.

Otitis-prone Children and Controls: A Study of Possible Predisposing Factors. 2. Physical Findings, Frequency of Illness, Allergy, Day Care and Parental Smoking

In a retrospective study of 179 otitis-prone children and 305 controls, various possible predisposing factors for acute otitis media (AOM) were compared. The children were matched with the controls for age and sex. There were 61% boys and 39% girls in the otitis-prone group and 58% boys and 42% girls among the controls. Information about the family and living conditions, the childrens illnesses, ear, nose and throat (ENT) operations and possible allergies were obtained from a questionnaire, and the children were called for a physical examination. The otitis-prone children had more middle-ear problems with pathological tympanograms and conductive hearing loss than the controls. No differences were found in bacterial colonization of the nasopharynx. Besides AOM and secretory otitis media, the otitis-prone children had more other ENT diseases and had consequently undergone more ENT operations and hospitalizations than the controls. There were no differences between the two groups regarding allergy, day care or parental smoking alone, but on comparing children with combinations of these factors there were more otitis-prone children than controls exposed, indicating an additive effect. The combination of different factors, less important separately, may for some children mean the difference between becoming otitis-prone or not.

Acute Otitis Media in Sweden

SummaryThe occurrence of Branhamella catarrhalis in the nasopharynx and middle ear exudate was investigated in 3 studies. Bacteria were isolated from the nasopharynx in 63% of 180 healthy children and B. catarrhalis, the most common bacterium present, was isolated in 36%. In 75 children with primary acute otitis media, bacteria were isolated from the nasopharynx in 98% and from the middle ear exudate in 80%. B. catarrhalis was found in the nasopharynx in 43% and in the middle ear exudate in pure culture in 9%. In those children in whom B. catarrhalis was isolated from the middle ear exudate it was also present in the nasopharynx. In 420 children, 338 with primary acute otitis media and 82 who relapsed or did not respond to previous antibiotic therapy, B. catarrhalis was isolated from the nasopharynx in approximately 50%. About half of the B. catarrhalis strains were β-lactamase-producing and the majority of these strains were isolated in children under 3 years of age. Of children with primary acute otitis media who had β-lactamase-producing B. catarrhalis about 50% had not previously received antibiotic treatment.B. catarrhalis is commonly found in the nasopharynx of healthy children as well as in children with acute otitis media. Many of the strains are β-lactamase-producing though many of the children have not been previously treated with antibiotics. In middle ear exudate, B. catarrhalis is found in about 10% of cases. The present incidence of β-lactamase production in B. catarrhalis has not necessitated a change from the choice of penicillin V as the first-line drug in the treatment of acute otitis media in children in Sweden. Penicillin V 50 mg/kg bodyweight/day is administered on a twice daily schedule for 5 days. Antibiotics with a broader spectrum are reserved for those cases which do not resolve following treatment with penicillin V.

Epidemiology of Acute Otitis Media in Children in An Urban Population

The epidemiology of acute otItIs media (AOM) in children is still to a great deal inadequately explored ( Hinchcliffe , 1972; McEldowney and Kessner , 1972; Manning et al ., 1974). Most earlier studies have been carried out in small selected groups of children. A few great incidence studies over I year have been published earlier (Medical Research Council, 1957; Pukander , 1982). There are very few cohort studies penetrating the relationship between AOM and demographic, medical and socio-economic factors ( Pukander , 1982; Paterson and MacLean , 1970; Teele et al ., 1980). Prospective investigations in a sufficiently large cohort of unselected children from a weel-defined population have been recommended ( Kudrjavcev and Schoenberg , 1979). Malmo, Sweden, is a well-defined geographic unit with unique conditions for epidemiologic studies. The aim of the present investigation was to study the incidence rate of AOM in children in a prospective cohort study with a special reference to children with recurrent episodes of AOM early in life.

A Prospective Study of Acute Otitis Media in Children: 2. Incidence in An Urban Population

Since 1977 a cohort study on the incidence of acute otitis media (AOM) is going on in Malmo, Sweden. The study includes 8 900 children born in 1977–1980. The maximum time of observation was 48 months. Children, aged 6–11 months, run the greatest risk of getting AOM. 54% of the children born in 1977 had at least one episode before the age of 48 months and 48% of these children had more than one episode. There was no difference with sex, but the boys had significantly higher cumulative incidence rate (CIR) than the girls. Recurrent episodes were significantly higher in children having their first episode before the age of 18 months. The CIR of AOM was higher among children in a modern villa suburb compared to those in a modern apartment-house district or in the centre of the city. Children at day-care centers run a greater risk of getting recurrent AOM than those at home or in family day-care homes.

Amoxycillin/Clavulanate versus Amoxycillin in Recurrent Otitis Media and Therapeutic Failure in Children

A total of 102 children with recurrent otitis media or therapeutic failure after treatment with phenoxymethyl penicillin were entered into a double-blind study with parallel groups, comparing treatment with amoxycillin/clavulanate suspension (Spektramox) for 7 days with amoxycillin suspension (Imacillin) for 10 days. Bacterial and clinical investigations were performed. A total of 91 patients were evaluated for efficacy at the first follow-up visit (10-12 days after start of treatment). Amoxycillin/clavulanate and amoxycillin showed equally high, satisfactory treatment results, i.e. more than a 90% response. Similarly, there was no statistically significant difference between the treatment groups at the second follow-up visit (about 30 days after start of treatment). Bacteriological cultures from the nasopharynx showed equal distribution of Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae between the study groups. Elimination of the initially occurring pathogens was equal in the two study groups with the exception of B. catarrhalis which was eliminated to a significantly higher extent with amoxycillin/clavulanate. Both drugs were well tolerated. In patients with recurrent otitis media or therapeutic failure, treatment with amoxycillin/clavulanate for 7 days results in high, satisfactory clinical effects and is comparable to treatment with amoxycillin for 10 days.