Vitamin D and Otitis Media.

PURPOSE OF REVIEW: To examine the relationship between vitamin D and otitis media. RECENT FINDINGS: Vitamin D deficiency has been associated with several respiratory diseases, including otitis media. Vitamin D supplementation may reduce the risk of otitis media. This relationship may be explained by vitamin D supporting the immune system by upregulating antimicrobial peptides which are effective against otopathogens and biofilm formation, supporting a less inflammatory immune response, or promoting beneficial commensal bacteria. This review will explore risk factors of both otitis media and vitamin D deficiency, the evidence of vitamin D being beneficial for various forms of otitis media, and possible mechanisms of action.

Vitamin D and respiratory tract infections in childhood.

BACKGROUND: Respiratory tract infections (RTIs) remain among of the most important causes of morbidity and mortality among children. Several studies have associated vitamin D deficiency with an increased risk of RTIs, and vitamin D supplementation has been proposed as a possible preventive measure against RTIs in children. The main aim of this review is to summarize the current evidence from the literature about the link between vitamin D and RTIs in children. DISCUSSION: Several recent studies have shown that vitamin D has different immunomodulatory properties associated with the risk of RTIs in childhood. In this regard, it is very important to understand the definition of deficiency and insufficiency of vitamin D and when and how to treat this condition. Unfortunately, there is no consensus, although a level of at least 10 ng/mL 25-hydroxycholecalciferol (25[OH]D) is thought to be necessary to promote bone mineralization and calcium homeostasis, and a concentration between 20 ng/mL and 50 ng/mL is considered adequate to provide an immunomodulatory effect. Available data support a role for vitamin D deficiency in the risk of pediatric tuberculosis, recurrent acute otitis media, and severe bronchiolitis, whereas further studies are needed to confirm an association in children with recurrent pharyngotonsillitis, acute rhinosinusitis and community-acquired pneumonia. CONCLUSIONS: Maintenance of adequate vitamin D status may be an effective and inexpensive prophylactic method against some RTIs, but the supplementation regimen has not been clearly defined. Further clinical trials are needed to determine the 25(OH)D concentrations associated with an increased risk of RTIs and optimal vitamin D supplementation regimen according to the type of RTI while also taking into consideration vitamin D receptor polymorphisms.

Otitis media aguda / Acute otitis media

We review differents topics about acute otitis media without complication. There is a frequent cause of visit to pediatric office. We showed risk factors, to consider how to prevent it. As viral infection are frequent cause there is not necessary to start antibiotics. Finally we describe complications as otitis effusion.

Se revisan diversos aspectos de la otitis media aguda no complicada, causa muy frecuente de consulta en nuestra práctica pediátrica. Se mencionan sus factores de riesgo, que constituyen los principales elementos a considerar para su prevención. Debido a la frecuente etiología viral, la conducta terapéutica actual considera en ciertas situaciones postergar el inicio del tratamiento antibiótico. Finalmente se describen sus complicaciones, siendo la más frecuente la efusión en oído medio.

Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda / Consensus document on the aetiology, diagnosis and treatment of acute otitis media

Se presenta el documento de consenso sobre otitis media aguda (OMA) de la Sociedad Española de Infectología Pediátrica (SEIP), la Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria (SEPEAP), la Sociedad Española de Urgencias Pediátricas (SEUP) y la Asociación Española de Pediatría de Atención Primaria (AEPap). Se analizan la etiología de la enfermedad y los posibles cambios de esta después de la introducción de la vacunas antineumocócicas 7-valente, 10-valente y 13-valente. Se hace una propuesta diagnóstica basada en la clasificación de la OMA en confirmada o probable. Se considera OMA confirmada si hay coincidencia de tres criterios: comienzo agudo, signos de ocupación del oído medio (u otorrea) y signos o síntomas inflamatorios, como otalgia o intensa hiperemia timpánica, y OMA probable cuando existan solo dos criterios. Se propone como tratamiento antibiótico de elección la amoxicilina oral en dosis de 80 mg/kg/día repartidas cada ocho horas. El tratamiento con amoxicilina-ácido clavulánico en dosis de 80 mg/kg/día se indica si el niño es menor de seis meses, en lactantes con clínica grave (fiebre >39 ºC o dolor muy intenso), cuando haya historia familiar de secuelas óticas por OMA o un fracaso terapéutico de la amoxicilina(AU)

We present the consensus document on acute otitis media (AOM) written by the Spanish Society of Pediatric Infectology (SEIP), the Spanish Society of Outpatient and Primary Care Pediatrics (SEPEAP), the Spanish Society of Pediatric Emergency Care (SEUP) and the Spanish Association of Primary Care Pediatrics (AEPAP). The document analyses the etiology of the disease and the possible shifts in it following the introduction of the 7-valent, 10-valent, and 13-valent pneumococcal vaccines. The document proposes diagnosing AOM as confirmed or probable. The AOM diagnosis is considered confirmed if three criteria are met: acute onset, signs of fluid in the middle ear (or otorrhea), and symptoms of inflammation, such as otalgia or marked erythema in the middle ear, and considered probable when only two of these criteria are met. The proposed first choice for antibiotic treatment is 80 mg/kg/day of amoxicillin administered orally in doses at eight hour intervals. Treatment with amoxicillin-clavulanic acid in doses of 80 mg/kg/day are indicated in children younger than six months, in infants with a severe presentation (fever >39 °C or acute pain), when there is a family history of AOM sequelae, or in cases of amoxicillin treatment failure(AU)

Prevention and treatment of meningitis and acute otitis media in children with cochlear implants.

OBJECTIVE: To provide recommendations for 1) prevention of acute otitis media and meningitis via immunization and 2) antimicrobial therapy of acute otitis media and meningitis in children with cochlear implants. DATA SOURCES: Literature review and policy statement from the American Academy of Pediatrics. CONCLUSION: 1) Children who are candidates for cochlear implants or have received cochlear implants should receive all-age appropriate vaccinations, including indicated doses of 13-valent pneumococcal conjugate vaccine, Haemophilus influenzae type b conjugate vaccine, and influenza vaccine. A supplemental dose of 13-valent pneumococcal conjugate vaccine is indicated for children who have received indicated doses of 7-valent pneumococcal vaccine, but have not received 13-valent pneumococcal conjugate vaccine. In addition, children 24 months and older should receive a single dose of 23-valent pneumococcal polysaccharide vaccine. 2) Acute otitis media in children with cochlear implants should be treated with an antimicrobial. During the first 2 months after implant, initial treatment of acute otitis media with a parenteral antimicrobial, e.g., cetriaxone, is indicated. High-dose amoxicillin or amoxicillin-clavulanate is an appropriate antimicrobial choice for empiric treatment of acute otitis media occurring 2 or more months after implant. In cases of meningitis occurring during the first 2 months after implantation, broad spectrum empiric antimicrobial therapy, e.g., meropenem and vancomycin, should be initiated pending the results of CSF culture. Empiric antimicrobial therapy with ceftriaxone and vancomycin is appropriate for cases of meningitis occurring 2 or more months after implant.

Oral health of indigenous children and the influence of early childhood caries on childhood health and well-being.

Dental caries in Indigenous children is a child health issue that is multifactorial in origin and strongly influenced by the determinants of health. The evidence suggests that extensive dental caries has an effect on health and well-being of the young child. This article focuses on early childhood caries as an overall proxy for Indigenous childhood oral health because decay during early life sets the foundation for oral health throughout childhood and adolescence. Strategies should begin with community engagement and always include primary care providers and other community health workers.

Knowledge, attitudes and practices with respect to risk factors for otitis media in a rural South Indian community.

OBJECTIVES: (a) To study knowledge, attitudes and practices with respect to risk factors of otitis media in a rural South Indian Community where the prevalence of otitis media is high. (b) To discover the association between parental education, socioeconomic status (SES) and family type (nuclear or joint) with knowledge, attitudes and practices regarding risk factors for otitis media. METHODS: Using a cluster sampling design, the caregivers of 150 children attending daycare were interviewed to note knowledge, attitudes and practices with respect to risk factors for otitis media. Data on level of education of the caregiver, house type (an indicator of SES) and type of family structure were noted. A questionnaire was administered to collect all the relevant data. Statistical analysis of the data obtained was performed to note frequencies. Correlations between sociodemographic parameters and knowledge, attitudes and practices were studied using Chi-square test of proportions. RESULTS: Over 50% of the population showed knowledge deficits with regard to the various risk factors for otitis media. Caregivers from nuclear families were slightly less knowledgeable regarding lack of immunization and household smoke as risk factors for the disease. There was no correlation between any of the sociodemographic factors and attitudes. However, educated mothers were more likely than illiterate mothers to clean their children's ears of wax on a regular basis with the belief that it would prevent ear disease (p=0.05). Treatment practices in the community were more or less uniform in that earache was either disregarded (26.4%) or treated with home remedies (67.2%) by most caregivers, while a doctor's opinion was often sought for ear discharge (50%). Parents of higher SES were more likely to use home remedies than those of lower SES (p=0.008). CONCLUSIONS: Sociodemographic factors as well as poor knowledge and attitudes and unhealthy practices with respect to risk factors of otitis media contribute to the high prevalence of otitis media in this rural South Indian community. Health education regarding risk factors and provision of accessible health care is essential to reduce the disease burden.

[Etiology and rational therapy of severe otitis media purulenta acuta in children].

Etiology and antibiotic susceptibility of the pathogens of otitis media purulenta acuta in children was studied within 2000-2005. A total of 161 children at the age of 1 to 14 years were examined. The middle ear discharge collected during paracentosis (79.5%) or spontaneous perforation of the tympanic membrane (20.5%) was used in the bacteriological tests. The microflora growth in the culture was detected in 80% of the cases. The leading pathogen was Streptococcus pyogenes (47.5%), the part of Streptococcus pneumoniae amounted to 36.6% of all the etiologically significant microflora, the part of Staphylococcus aureus amounted to 6.9% and that of Haemophilus influenzae amounted to 4.0%. The part of the associations of 2 microorganisms equaled 5.0%. The species composion of the pathogens differed from that described in the literature. The isolates of S. pneumoniae and S. pyogenes were characterized by low resistance to macrolides (4.0-6.3%). As for the S. pneumoniae isolates, 97.3% of them was susceptible to penicillin. The results of the etiology study and the pathogen antibiotic susceptibility showed that the drugs of choice for the empirical antibacterial therapy of otitis media purulenta acuta in children should be amoxicillin and 1st generation cepholosporins. When the antibacterial therapy within the first 3 days fails, it is advisable to use protected aminopenicillins or 2nd generation cephalosporins. In case of the drug intolerance, macrolide antibiotics should be used.

Otitis media. A scholarly review of the evidence.

Antibiotic therapy remains the treatment of choice for otitis media in most countries despite persuasive evidence that antibiotic therapy provides limited clinical benefit and promotes bacterial resistance. Meta-analysis of randomized, placebo-controlled trials demonstrated that antibiotics increased resolution at 1 week by only 13%. Amoxicillin remains as effective as any other antibiotic, despite increasing resistance to amoxicillin among the major bacterial pathogens. Immediate antibiotic treatment has been shown to reduce the duration of symptoms by 1 day but not until after the first 24 hours when symptoms were already improving. A delayed prescribing strategy is currently utilized in most children for management of acute otitis media in the Netherlands; this method is now being evaluated elsewhere. Antibiotic therapy is delayed for 48-72 hours after diagnosis; thereafter, antibiotics are initiated only if symptoms persist or worsen. In 2 studies utilizing this strategy (England and the United States), only 24-30% of the patients in the delayed treatment group initiated antibiotic therapy; a majority of parents of children in the delayed group were satisfied with their child's treatment. Treatment of bacterial otitis media ("pus drum") with high dose amoxicillin (80-100 mg/kg/kd) is recommmended; for acute otitis media without bulging, watchful waiting with a delayed prescribing strategy and treatment of pain is preferred. Yearly administration of the influenza vaccine and/or treatment of influenza with an antiviral (oseltamivir) can significantly decrease the incidence of acute otitis media during influenza season. Although pneumococcal vaccination effectively reduces the incidence of acute otitis media due to vaccine-related serotypes, there is a significant increase in the number of episodes of acute otitis media due to other serotypes of S. pneumoniae such that the overall incidence of acute otitis media is reduced only minimally by pneumoccocal vaccine. The careful use of strict diagnostic criteria coupled with judicious use of antibiotic therapy will direct antibiotic treatment to only those patients likely to benefit.

Acute otitis media disease management.

A first step in management decisions regarding otitis media must focus on accurate diagnosis to distinguish normal from acute otitis media (AOM) from otitis media with effusion (OME) or a retracted tympanic membrane without middle ear effusion. There are several classification schemes for AOM that may impact management decisions: patients with acute, persistent, recurrent, or chronic AOM may have a different distribution of bacterial pathogens and a different likelihood of success from antimicrobial therapy. Patient age, prior treatment history and daycare attendance are other important variables. The natural history of AOM without antibiotic treatment is generally favorable; however, from the few studies available, this is difficult to quantitate because the diagnosis was infrequently confirmed by tympanocentesis leaving the possibility that many patients entered into these trials may not have had bacterial AOM. Antibiotic choices should reflect pharmacokinetic/pharmacodynamic data and clinical trial results demonstrating effectiveness in eradication of the most likely pathogens based on tympanocentesis sampling and antibiotic sensitivity testing. Thereafter, compliance factors such as formulation, dosing schedule and duration of treatment and accessibility factors such as availability and cost should be taken into account. The increasing prevalence of antibiotic resistance among AOM pathogens and the changing susceptibility profiles of these bacteria should be considered in antibiotic selection. Current best practice recommends amoxicillin for uncomplicated AOM; continuing or switching to an alternative antibiotic based on clinical response after 48 hours of therapy; and selection of second line antibiotics as first line choices when the patient has already been on an antibiotic within the previous month or is otitis prone. Preferred second-line agents frequently noted in various guidelines include amoxicillin/clavulanate, cefdinir, cefpodoxime, cefprozil, and cefuroxime. Three injections of ceftriaxone or gatifloxacin (when approved) or diagnostic/therapeutic tympanocentisis (when approved) become a third-line treatment option. No single antibiotic or management strategy is ideal for all patients.

Rinitis en la edad infanto-juvenil / Rhinitis in children and adolescent

La rinitis es un síndrome producido por la inflamación de la mucosa de las fosas nasales cuya expresión clínica es la congestión nasal, estornudos e hipersecreción seromucosa; su origen puede ser alérgico o no alérgico.En la rinitis alérgica el mecanismo inmunopatológico está determinado por el tipo I de hipersensibilidad mediada por IgE; los alérgenos más frecuentes son los pneumoalérgenos siendo de menos importancia los trofoalérgenos. Las manifestaciones clínicas pueden tener presentación estacional -principalmente en la temporada de polinización- o perenne, que no presenta variación estacional y tienen síntomas todo el año.En la rinitis no alérgica no existe reacción de hipersensibilidad mediada por IgE y comprende un numeroso grupo de afecciones de origen inflamatorio y no inflamatorio.El tratamiento de la rinitis alérgica consiste en medidas de desalergenización, diversas clases de fármacos y terapéutica de hiposensibilización con vacunas alergénicas.Asociaciones comórbidas (asma, conjuntivitis, sinusitis, otitis...) acompañan con frecuencia a las rinitis alérgicas (AU)

Adjunctive hyperbaric oxygen in irradiated patients requiring dental extractions: outcomes and complications.

PURPOSE: This study assessed complications of hyperbaric oxygen (HBO) therapy, potential predictors of poor outcome, and treatment outcomes in irradiated patients undergoing dental extractions. PATIENTS AND METHODS: This was a prospective, descriptive study of 40 consecutive patients treated with HBO before and after dental extractions in an irradiated field. All patients had radiation caries; none had osteoradionecrosis (ORN). All were prescribed a protocol of 20 pre-extraction and 10 postextraction HBO treatments at 2.4 ATA for 90 minutes. Potential risk factors for poor healing and risk factors for complications were identified. All complications were recorded. Extraction site healing was evaluated at the conclusion of HBO therapy, at 1 month, and 1 year later. RESULTS: There were no serious complications. There was no correlation between preidentified risk factors and poor healing. At 1 year, 98.5% of all extraction sites were healed. Patients who did not heal were an average of 8 years since radiation, compared with 3.3 years for those who healed (P <.001). CONCLUSION: Use of HBO is associated with a very low incidence of ORN at 1-year follow-up. However, the time since radiation has a positive correlation with risk for ORN.

Galbreath technique: a manipulative treatment for otitis media revisited.

Otitis media is a common disorder that results in numerous visits to the physician each year. Antimicrobials, antihistamines, steroids, and surgery have all been used to treat otitis media; however, the literature makes little mention of osteopathic manipulative treatment in this regard. This article describes a technique that was first described in 1929 by William Otis Galbreath, DO. By simple mandibular manipulation, the eustachian tube is made to open and close in a "pumping action" that allows the ear to drain accumulated fluid more effectively. Physicians can easily teach this procedure to parents for use at home.

Valoración de la eficacia y seguridad de ciprofloxacino ótico tópico (0,3 por ciento) en el tratamiento de la otitis externa difusa y de la otitis media crónica / Valuation of the effectiveness and security of topic and otic cipofloxacine (0,3 por ciento) in the processing of diffuse external otitis and chronic meddium otitis

El servicio de ORL del Hospital Clínico de Zaragoza, realizó un estudio en el que participaron 60 pacientes, 19 afectos de Otitis Externa Difusa (OED) y 41 afectos de Otitis Media Crónica (OMC), para observar la eficacia clínica y bacteriológica del ciprofloxacino ótico tópico al 0,3 por ciento (Cetraxal Ótico) en el tratamiento de estas patologías, así como la incidencia de efectos adversos, en condiciones asistenciales reales, en las consultas externas del hospital.En la primera visita (V1) los pacientes acudieron a la consulta, donde tras ser confirmado el diagnóstico de otitis externa difusa o de otitis media crónica, se les prescribió Cetraxal Ótico. El tratamiento consistió en la administración de 5 gotas cada 8 horas durante 8 días en el oído afecto. Transcurrido este tiempo, todos los pacientes acudieron a una segunda visita (V2). Sólo en el caso de los pacientes afectos de OMC se realizó una tercera visita de control (V3) al mes de haber finalizado el tratamiento para verificar que no se habían producido recidivas.La finalidad del estudio era observar la eficacia de Cetraxal Ótico frente a la OED y la OMC, así como la incidencia de efectos adversos del tratamiento en condiciones asistenciales reales.En los pacientes afectos de OED, el porcentaje de curaciones al finalizar el tratamiento fue del 100 por ciento.En los pacientes con OMC el porcentaje de curaciones fue superior al 91 por ciento tras el tratamiento, aunque en la visita de control (V3) el porcentaje de curaciones se elevó al 97,6 por ciento. (AU)

The new dental-medical renaissance. Medically efficacious functional jaw orthopedics.

Functional Jaw Orthopedics (FJO) is medically efficacious, exceptionally unique and unequaled in speed of a cure for a number of very common medical conditions currently only "managed" by modern medicine. This publication combines scientific citations and case presentations to show how and why dentists who advocate and provide early FJO treatment will lead a New Dental-Medical Renaissance into some of the most profound areas of medicine. Nocturnal enuresis (chronic bed-wetting) otitis media (ear infections), cor pulmonare, cognitive thought, vision, hearing, cardio-pulmonary dysfunction, and myocardial infarction have FJO dental-medical relationships. Early FJO treatment fulfills the ADA Code of Ethics which "calls upon dentists to follow high ethical standards which have the benefit of the patient as their primary goal: Do No Harm and Do Good."

Malignant infantile osteopetrosis: otolaryngological complications and management.

OBJECTIVES: To inform otolaryngologists about upper airway obstruction requiring tracheotomy and other otolaryngological manifestations of malignant infantile osteopetrosis (MIOP) and to discuss pathophysiological features, management, and new treatment strategies in MIOP. DESIGN: Ongoing case series combined with a retrospective chart review. SETTING: International tertiary pediatric hospital. INTERVENTIONS: Patients with MIOP were initially referred for treatment and routine follow-up. Tracheotomy was performed to manage obstructive sleep apnea. Audiograms were also performed at regular intervals. RESULTS: The records of 9 patients were examined. The otolaryngological findings of hearing loss, obstructive sleep apnea (sometimes requiring tracheotomy), otitis media, and chronic osteomyelitis with facial fistulas were identified. CONCLUSIONS: Osteopetrosis is a rare condition caused by a failure of the osteoclast to resorb bone. This results in thickened dense, deformed, and easily fractured bone. As a result, growth failure, anemia, hypoplastic dentition, chronic infections, facial fistulas, blindness, hearing loss, nasal congestion, and upper airway obstruction may occur. The management of otolaryngological problems in a child with osteopetrosis is an important component in comprehensive care. To our knowledge, this study represents the largest case series of MIOP in the otolaryngology literature.