[Clinical case of tuberculous otitis media in early childhood]. / Klinicheskii sluchai tuberkuleznogo srednego otita v rannem detskom vozraste.

Nowadays, the incidence of tuberculosis remains high all over the world, despite the vaccination, medical support, social policy. The main reasons for this are the high level of migration, the prevalence of bad habits, the prevalence of immunodeficiency conditions, the formation of resistance to antimicrobial drugs, the tendency to refuse vaccination. At the same time, great difficulties arise in the diagnosis of extrapulmonary forms of infection. The purpose of this publication is to remind about the peculiarities of the course and diagnosis of tuberculous otitis media. According to the literature, the main characteristic features of tuberculous of the middle ear are prolonged suppuration without pronounced pain syndrome, inefficiency of standard antibacterial therapy, the anamnestic data about contacts or violation of the vaccination schedule, multiple perforations and a pronounced granulation process during otoscopy, a pronounced destructive process in the temporal bone during X-ray examination. The article presents a clinical case of the development of tuberculous otitis media in a young child with delayed diagnostics and the development of mastoiditis with required emergency surgical treatment. Verification of the etiology of the disease and the specific treatment carried out made it possible to achieve complete relief of ear symptoms, restoration of the tympanic membrane and ventilation of the middle ear.

Children with otitis media in Greenland - A qualitative study of parental experiences.

INTRODUCTION: The Greenlandic population has one of the world's highest prevalence of otitis media (OM). Approximately 9-14% of all children suffer from OM during childhood. Due to the climate, lack of infrastructure, and minimal access to specialist services, the Greenlandic healthcare system operates under significant challenges. To support treatment implementation, we explored parental experiences of having a child with recurrent acute otitis media (rAOM) and chronic suppurative otitis media in Greenland (CSOM). METHODS: We applied a qualitative methodology with semi-structured interviews, to investigate parents' individual experiences. We included parents from six selected towns and settlements in Greenland, who were primary caregivers to minimum one child who had suffered from rAOM or CSOM. The interviews followed a semi-structured interview guide. RESULTS: Eight interviews were conducted with ten parents (nine mothers, one father) to 13 children (nine girls, four boys) aged two to 20 years (median age five years). We carried out a hermeneutic-phenomenological, Ricoeur-inspired text analysis of data. The first episode of OM was associated with uncertainty about the condition, including pain relief and treatment. However, recurrence led to symptom recognition and a changed disease perception among the parents: from being a simple case of childhood OM to a recognition of a chronic condition that might lead to delayed linguistic development and hearing impairment. CONCLUSION: Under difficult healthcare situations, parents represented a unique resource in care and treatment implementation. Parents often feel alone with the responsibility of care and had concerns for their child's hearing and language development, and they wished for their experiences and observations to be actively included in consultations.

The views of parents and carers on managing acute otitis media in urban Aboriginal and Torres Strait Islander children: a qualitative study.

OBJECTIVES: To explore the views of parents and carers regarding the management of acute otitis media in urban Aboriginal and Torres Strait Islander children who are at low risk of complications living in urban communities. STUDY DESIGN: Qualitative study; semi-structured interviews and short telephone survey. SETTING, PARTICIPANTS: Interviews: purposive sample of parents and carers of urban Aboriginal and Torres Strait Islander children (18 months - 16 years old) screened in Aboriginal medical services in Queensland, New South Wales, and Canberra for the WATCH study, a randomised controlled trial that compared immediate antibiotic therapy with watchful waiting for Aboriginal and Torres Strait Islander children with acute otitis media. SURVEY: parents and carers recruited for the WATCH trial who had completed week two WATCH surveys. RESULTS: We interviewed twenty-two parents and carers, including ten who had declined participation in or whose children were ineligible for the WATCH trial. Some interviewees preferred antibiotics for managing acute otitis media, others preferred watchful waiting, expressing concerns about side effects and reduced efficacy with overuse of antibiotics. Factors that influenced this preference included the severity, duration, and recurrence of infection, and knowledge about management gained during the trial and from personal and often multigenerational experience of ear disease. Participants highlighted the importance of shared decision making by parents and carers and their doctors. Parents and carers of 165 of 262 WATCH participants completed telephone surveys (63%); 81 were undecided about whether antibiotics should always be used for treating acute otitis media. Open-ended responses indicated that antibiotic use should be determined by clinical need, support for general practitioners' decisions, and the view that some general practitioners prescribed antibiotics too often. CONCLUSIONS: Parents and carers are key partners in managing acute otitis media in urban Aboriginal and Torres Strait Islander children. Our findings support shared decision making informed by the experience of parents and carers, which could also lead to reduced antibiotic use for managing acute otitis media.

Eustachian Tube Balloon Dilation in Children: Short- and Long-Term Outcome.

OBJECTIVE: Eustachian Tube Balloon Dilation (ETBD) represents an innovative therapeutic approach for chronic Eustachian tube dysfunction (CETD), a common disease in children. Some evidence of a benefit of ETBD in the adults exist in contrast to sparse reports in children. The objective was to analyze short- and long-term outcome of ETBD in children with CETD. METHODS: A retrospective chart-review was performed in a cohort of 19 children (mean age 13 years, 7-17) who underwent ETBD. The following parameters were analyzed: tubomanometry (R-value), tympanogram, hearing (CPT-AMA, Air-bone gap [ABG]), Eustachian Tube Score (ETS and ETS-7), and Eustachian Tube Disease questionnaire (ETDQ). RESULTS: Twenty-four ears were dilated (in 5 patients subsequently after successful first intervention) and grouped as A (17) without and B (7) with additional T-tube insertion. Most children suffered from either chronic otitis media with effusion or chronic perforation (12, 63%), the remainder comprising recurrent otitis media, adhesive otitis media and CETD with barotrauma. Mean duration of symptoms were 7/8.2 years and mean follow-up 13.7/11.1 months. Eighty percent of patients reported a subjective benefit. Accordingly, the R-value, ETS, and ETS-7 were significantly (P < .05) improved. Tympanometry, CPT-AMA and ABG showed a positive trend, but the result was not significant. Tympanic retraction remained largely the same; a spontaneous closure of a chronic tympanic perforation was seen in 1 of 3 cases. CONCLUSIONS: The high subjective benefit and some significant objective improvement warrants further analysis of ETBD as part of the therapeutic management in pediatric CETD.

INdigenous Systems and Policies Improved and Reimagined for Ear and hearing care (INSPIRE): a multi-method study protocol.

INTRODUCTION: Otitis media (middle ear disease) severity and chronicity among Aboriginal and Torres Strait Islander people, as well as gaps in socioeconomic outcomes related to hearing loss, indicates a breakdown in the current ear and hearing care system. The ear and hearing care system spans multiple sectors due to long-term impacts of otitis media and hearing loss in health, education and employment, necessitating a multi-disciplinary cross-sectorial approach to ear and hearing care. Public policies shape the current ear and hearing care system and here it is argued that a critical public policy analysis across different sectors is needed, with strong Aboriginal and Torres Strait Islander leadership and guidance. The current study aims to establish consensus-based ear and hearing care policy solutions for Aboriginal and Torres Strait Islander people in Australia. METHODS AND ANALYSIS: This multi-method study will be guided by a Brains Trust with strong Aboriginal and Torres Strait Islander leadership. Public policies in hearing health, social services, and education will be scoped to identify policy gaps, using the World Health Organization framework. Qualitative data will be collected through a culturally specific process of yarning circles to identify policy challenges and/or limitations in enabling accessible ear and hearing care programs/services for Aboriginal and Torres Strait Islander people, using dimensions of Morestin's public policy appraisal tool as an interview guide for stakeholders. Themes from the yarning circles will be used to inform an expert Delphi process to establish consensus-based policy solutions for optimising the ear and hearing care system for Aboriginal and Torres Strait Islander people. ETHICS AND DISSEMINATION: This study has approval from the Australian Institute of Aboriginal and Torres Strait Islander Studies Ethics Committee. Study findings will be disseminated to community through Brains Trust members and study participants, as well as through publications in peer-reviewed journals and research forum presentations.

Cuando los vómitos no son causados por un virus / When vomiting is not caused by a virus

La otitis media aguda (OMA) es un diagnóstico muy frecuente en Atención Primaria, a veces se complica con supuración y, en otras ocasiones, menos frecuentemente, con mastoiditis. Se presenta el caso de una niña de 6 años que, tras ser diagnosticada de OMA supurada e instaurarse tratamiento antibiótico, comienza con vómitos, mareos y cefalea, así como con un mal control del dolor con la analgesia habitual y posterior fotofobia. Tras varias visitas, acaba por diagnosticarse una mastoiditis con trombosis del seno transverso, sigmoideo y yugular. La importancia del caso radica en una rápida sospecha de las posibles complicaciones de una otitis media para realizar un diagnóstico y tratamiento precoz de las mismas. (AU)

Acute otitis media (AOM) is a very frequent diagnosis in Primary Care, sometimes complicated with suppuration, and less frequently, with mastoiditis. We present the case of a 6-year-old girl who, after being diagnosed with suppurative AOM and starting antibiotic treatment, began with vomiting, dizziness and headache, as well as poor pain control with the usual analgesia and subsequent photophobia. After several visits, a mastoiditis with thrombosis of the transverse, sigmoid and jugular sinuses was finally diagnosed. The importance of the case lies in a rapid suspicion of possible complications of otitis media in order to diagnose and treat them early. (AU)

[Acute purulent otitis media in children]. / Ostryi gnoinyi srednii otit u detei.

OBJECTIVE: Improving the effectiveness of inpatient care for children with acute purulent otitis media. MATERIAL AND METHODS: 100 children at the age from 0 to 18 years were inspected from January to August 2021. The main diagnostic methods included otoscopy, pharyngoscopy, rhinoscopy. Bacteriological examination of the pus from the ear was done for all patients. RESULTS: Acute purulent otitis media is a common cause of hospitalization in children aged 0 to 3 years. The main causative agents of the disease in toddlers are Staphylococcus aureus and pneumococcus (38%), in preschoolers and primary school children - pyogenic streptococcus and pneumococcus (30%), in high school students - Staphylococcus aureus.

An evaluation of the quality of ear health services for Aboriginal children living in remote Australia: a cascade of care analysis.

BACKGROUND: In the Northern Territory (NT) the prevalence of otitis media (OM) in young Aboriginal children living in remote communities has persisted at around 90% over the last few decades. OM-associated hearing loss can cause developmental delay and adversely impact life course trajectories. This study examined the 5-year trends in OM prevalence and quality of ear health services in remote NT communities. METHODS: A retrospective analysis was performed on de-identified clinical data for 50 remote clinics managed by the NT Government. We report a 6-monthly cascade analysis of the proportions of children 0-16 years of age receiving local guideline recommendations for surveillance, OM treatment and follow-up at selected milestones between 2014 and 2018. RESULTS: Between 6,326 and 6,557 individual children were included in the 6-monthly analyses. On average, 57% (95%CI: 56-59%) of eligible children had received one or more ear examination in each 6-monthly period. Of those examined, 36% (95%CI: 33-40%) were diagnosed with some type of OM, of whom 90% had OM requiring either immediate treatment or scheduled follow-up according to local guidelines. Outcomes of treatment and follow-up were recorded in 24% and 23% of cases, respectively. Significant decreasing temporal trends were found in the proportion diagnosed with any OM across each age group. Overall, this proportion decreased by 40% over the five years (from 43 to 26%). CONCLUSIONS: This cascade of care analysis found that ear health surveillance and compliance with otitis media guidelines for treatment and follow-up were both low. Further research is required to identify effective strategies that improve ear health services in remote settings.

[Bullous myringitis demystified]. / La myringite bulleuse démystifiée.

Bullous myringitis - also called hemorrhagic myringitis or influenza otitis - is a vague entity, whose etiology and treatment are sources of controversy. In this review article, we demystify bullous myringitis in an illustrated way to recognize and treat it appropriately. Bullous myringitis seems to be a rare and peculiar manifestation of acute otitis media, which can be excessively painful and induce sensorineural hearing loss. Its management may be a medical emergency requiring the opening of hemorrhagic bullae and systemic corticotherapy. The responsible germs are the same as those found in acute otitis media (S. pneumoniæ, H. influenzæ, M. catarrhalis), and its treatment is identical, adapted to each clinical situation.

La myringite bulleuse ­ aussi appelée myringite hémorragique ou otite grippale ­ est une entité floue, dont l'étiologie et le traitement sont sources de controverse. Dans cet article de synthèse, nous démystifions la myringite bulleuse de façon illustrée, afin qu'elle puisse être reconnue et traitée adéquatement. La myringite bulleuse est une manifestation peu fréquente et particulière d'une otite moyenne aiguë, qui peut être excessivement douloureuse et entraîne volontiers une surdité neurosensorielle. Elle peut être une urgence médicale nécessitant l'ouverture des bulles et une corticothérapie systémique. Les germes responsables sont les mêmes que dans l'otite moyenne aiguë (S. pneumoniæ, H. influenzæ, M. catarrhalis) et son traitement identique, adapté à chaque situation clinique.

Ear tubes in children with otitis media reduce parental sick leave from work and socioeconomic costs.

INTRODUCTION: This study aimed to investigate changes in parental sick leave after tympanostomy tube (TT) insertion in children with otitis media (OM) and to estimate the overall cost reduction in case of decreased caregiver sick leave from work during a 12-month period after TT insertion. METHODS: A total of 4,708 children less-than 12 years from the database of the Danish ENT Specialists Organisation were included. Questionnaires were sent two days prior to TT insertion and subsequently 1, 3, 6, 9, 12, 15, 18, 21 and 24 months after TT insertion. The questions included symptom duration, patient satisfaction and symptom relief. Furthermore, parental sick leave occurrence was registered before and after TT insertion. The overall cost reduction estimate was based on comparison of the direct and indirect costs of two treatment regimes. Treatment A was non-surgical and antibiotics only. Treatment B comprised TT insertion and antibiotics as needed. RESULTS: The main results were that the risk of parental sick leave decreased significantly (p less-than 0.005) one month after TT insertion compared with baseline; odds ratio = 0.21 (95% confidence interval: 0.19-0.24). The decrease remained stable during the entire follow-up period. The estimate of the total cost reduction between Treatment A (non-TT insertion) and Treatment B (TT insertion) was 3,118.34 DKK/child/year. CONCLUSION: TT insertion is associated with a significant decrease in parental sick leave and may possibly contribute to substantial socioeconomic savings. FUNDING: None. TRIAL REGISTRATION: Not relevant.

X-linked Agammaglobulinemia Diagnosed Following Bezold's Abscess: A Case Report.

Bezold's abscess is an extracranial complication of otitis media, in which a cervical abscess forms from the mastoid process through an ostial fistula, and is a rare condition in recent years. In this study, we experienced a X-linked agammaglobulinemia, which was discovered due to Bezold's abscess. Case: A 12-year-old boy suffering from recurrent right suppurative otitis media for three months was treated with tympanostomy and oral antibacterial therapy at a local otorhinolaryngology clinic. The patient visited the clinic due to a recurrence of symptoms. CT showed bony defects in the cortical bone and mastoid process of the lateral side of the right mastoid cell. The patient was referred to our hospital, admitted the same day and underwent emergency surgery. Intraoperative findings led to the diagnosis of acute mastoiditis and Bezold's abscess c aused b y mastoiditis spreading to the s ternocleidomastoid muscle. After drainage and administration of ABPC/SBT, the abscess disappeared, and the patient's general condition improved. Subsequently, a blood typing test performed on admission suggested the influence of low immunoglobulin levels. A close examination by the pediatric department led to a diagnosis of X-linked agammaglobulinemia. As a result, the patient receives regular immunoglobulin therapy and has been free of infection, including Bezold's abscess. CONCLUSIONS: In the case of recurrent otitis media and rare infections, congenital immune abnormalities should be considered.

Ear and hearing care programs for First Nations children: a scoping review.

BACKGROUND: Ear and hearing care programs are critical to early detection and management of otitis media (or middle ear disease). Otitis media and associated hearing loss disproportionately impacts First Nations children. This affects speech and language development, social and cognitive development and, in turn, education and life outcomes. This scoping review aimed to better understand how ear and hearing care programs for First Nations children in high-income colonial-settler countries aimed to reduce the burden of otitis media and increase equitable access to care. Specifically, the review aimed to chart program strategies, map the focus of each program against 4 parts of a care pathway (prevention, detection, diagnosis/management, rehabilitation), and to identify the factors that indicated the longer-term sustainability and success of programs. METHOD: A database search was conducted in March 2021 using Medline, Embase, Global Health, APA PsycInfo, CINAHL, Web of Science Core Collection, Scopus, and Academic Search Premier. Programs were eligible or inclusion if they had either been developed or run at any time between January 2010 to March 2021. Search terms encompassed terms such as First Nations children, ear and hearing care, and health programs, initiatives, campaigns, and services. RESULTS: Twenty-seven articles met the criteria to be included in the review and described a total of twenty-one ear and hearing care programs. Programs employed strategies to: (i) connect patients to specialist services, (ii) improve cultural safety of services, and (iii) increase access to ear and hearing care services. However, program evaluation measures were limited to outputs or the evaluation of service-level outcome, rather than patient-based outcomes. Factors which contributed to program sustainability included funding and community involvement although these were limited in many cases. CONCLUSION: The result of this study highlighted that programs primarily operate at two points along the care pathway-detection and diagnosis/management, presumably where the greatest need lies. Targeted strategies were used to address these, some which were limited in their approach. The success of many programs are evaluated as outputs, and many programs rely on funding sources which can potentially limit longer-term sustainability. Finally, the involvement of First Nations people and communities typically only occurred during implementation rather than across the development of the program. Future programs should be embedded within a connected system of care and tied to existing policies and funding streams to ensure long term viability. Programs should be governed and evaluated by First Nations communities to further ensure programs are sustainable and are designed to meet community needs.

Fluorodeoxyglucose-positron emission tomography/computed tomography-positive ear lesions responsive to immunosuppressive therapy in a patient with otitis media with antineutrophil cytoplasmic antibody-associated vasculitis.

A 74-year-old woman presented with vertigo, left-beating nystagmus, and auditory disturbance 4 months prior, in whom a former physician suspected Meniere's disease. Her signs and symptoms mildly improved with a moderate dose of glucocorticoids, which was eventually tapered. Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) was performed 12 days prior to routine examination. Remarkable FDG uptake was observed in the surrounding areas of the bilateral Eustachian tubes and left middle ear, which was only partially detected on magnetic resonance imaging. The patient also tested positive for myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA). She was admitted to our hospital and diagnosed with otitis media with ANCA-associated vasculitis (OMAAV) based on the classification criteria. Four months after immunosuppressive therapy, the abnormal ear findings were not observed on follow-up FDG-PET/CT. The clinical course of this case suggests that FDG-PET/CT can detect occult ear involvement better than do other modalities in patients with OMAAV. In addition, FDG-PET/CT-positive ear lesions responded to immunosuppressive therapy. Therefore, FDG-PET/CT can help distinguish OMAAV from other ear diseases with non-inflammatory aetiologies and detect occult treatment-responsive OMAAV lesions in the clinical setting.

Intractable otitis media - Pathogenesis and treatment of Eosinophilic otitis media (EOM) and otitis media with Antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis (OMAAV).

Intractable otitis media is resistant to antimicrobial therapy, tympanostomy ventilation tube insertion, and surgery. In children, intractable acute otitis media, pathological tympanic membrane due to prolonged otitis media with effusion (OME), tympanic membrane atelectasis, and adhesive otitis media are common. Contrarily, in adults, otitis media caused by drug-resistant pathogens, tuberculous otitis media, cholesterol granuloma, malignant otitis externa (skull base osteomyelitis), eosinophilic otitis media (EOM), and otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) are common and require differentiation. Among them, EOM is increasing along with eosinophilic upper respiratory tract diseases, such as bronchial asthma and eosinophilic chronic rhinosinusitis (ECRS), a subgroup of chronic rhinosinusitis with nasal polyps (CRSwNP). EOM is associated with adult-onset bronchial asthma and is characterized by viscous middle ear effusion and middle ear mucosa thickness with eosinophilic infiltration, which requires treatment with glucocorticoids according to disease activity and symptoms. Recently, OMAAV was proposed because of the similarities in clinical features and therapeutic effects. The clinical course of OMAAV is characterized by a relatively rapid increase in the bone conductive hearing threshold, which progresses over 1-2 months, without response to antimicrobial agents or tympanostomy ventilation tube insertion, and in some cases, is complicated by facial paralysis and hypertrophic pachymeningitis. This new concept may explain the pathogenesis and clinical presentation of many cases of intractable otitis media, the cause of which was previously unknown. Although making a diagnosis of OMAAV is relatively easy based on the clinical course, such as vascular dilatation of the tympanic membrane and positive ANCA titer, it is often difficult because the ANCA titer becomes negative with previous administration of glucocorticoids. In adults with intractable otitis media, ANCA titers must be measured before glucocorticoid administration. Treatment consisted of remission induction therapy with a combination of glucocorticoids and immunosuppressive drugs.

Cost-Effectiveness of Management Strategies in Recurrent Acute Otitis Media.

OBJECTIVE: To evaluate the cost-effectiveness of tympanostomy tube placementvs nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM). STUDY DESIGN: A Markov decision model compared management strategies in children ages 6-35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs medical management. The model ran over a 2-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained. RESULTS: Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520 855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100 000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups. CONCLUSIONS: For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT02567825.

Temporomandibular Joint and Otitis Media: A Narrative Review of Implications in Etiopathogenesis and Treatment.

Otitis media (OM) and its recurring (rAOM), effusive (OME), and chronic forms, represent a frequent clinical challenge. The middle ear, the mandible, and the temporomandibular joint (TMJ) share several embryological and anatomical connections. Despite that, the role of mandibular malposition and TMJ dysfunction is frequently overlooked in the management of otitis media. In this narrative review, we present current evidence supporting the etiopathogenetic role of a dysfunctional stomatognathic system in the onset of OM and the effectiveness of orthognathic treatment in preventing rAOM and OME. In particular, a focus on the influence of TMJ on Eustachian tube function is provided.

[MULTIFACTORIAL METATYMPANAL MANIFESTATIONS OF NONPUURENT COMPLICATIONS OF ACUTE OTITHIS MEDIA (REVIEW AND OWN OBSERVATIONS)].

Data of otoneurologic, audiologic and vestibulometric research were analyzed in both adult and child patients suffering from acute otitis media with focus on probable spread of inflammatory non-purulent process into inner ear and brain. Combination of available printed data and own research during the 2010-2021 y.y. are presented. Following the analysis of the identified symptoms in the acute stage of otitis media main pathognomonic signs of development of otogenic encephalopathy in kids and adults were defined. Essential attention was paid to comparative analysis of cochleovestibular analyzer state with patients suffering from purulent and viral otitis media, as well as comparison of such state in inflamed ear and in intact side. All analysis were carried based on traditional diagnostics methods which enables medical practitioners to timely diagnose adverse signs of acute otitis media, determine risk level and improve treatment tactics.