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1.
Pan Afr Med J ; 33: 323, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692867

RESUMO

Myringoplasty is one of the most frequent interventions in otology. It aims to restore the eardrum in order to protect against extrinsic contamination by water and to improve hearing. Our study aimed to analyze the factors that may affect anatomical and functional results of myringoplasty or type I tympanoplasty. A retrospective study was performed of a series of 140 cases of myringoplasty over a 6-years period from 2010 to 2015. The approach was post-auricular in 69% of cases and all the patients underwent an underlay technique. Temporal fascia was used in 90.71% of the cases. After an average follow-up of 13 months, the anatomical and functional results were acceptable, with a tympanic closure rate of 88% and an average audiometric gain of 14.22 dB. Several factors affected our results, including the location of the perforation, the active or inactive status of the chronic otitis media, the condition of the opposite ear and the graft material. In light of our results and those of the literature, we believe that the middle ear should be dry at least two months prior to surgery, use of cartilaginous graft material and underlay technique should be preferred and special precautions should be taken in case of anterior or contralateral perforation.


Assuntos
Miringoplastia/métodos , Otite Média/epidemiologia , Perfuração da Membrana Timpânica/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Timpanoplastia/métodos , Adulto Jovem
2.
Neumol. pediátr. (En línea) ; 14(2): 92-94, jul. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1015009

RESUMO

Primary Ciliary Diskinesia (PCD) is a heterogeneous, rare genetic disease that can be present in up to 5% of the patients with recurrent respiratory infections. The underlying pathogenesis is disrupted ciliary function which results in delayed mucus transportation leading to chronic inflammation in the upper and lower respiratory tract. Almost all PCD patients have otolaryngologic manifestations, characterized by recurrent ear and sinus infections, chronic inflammation at this level, sensorioneural and conductive hearing loss, and sleep-disordered breathing. This article reviews the diagnostic and therapeutic aspects of these manifestations.


La Disquinesia Ciliar Primaria (DCP) es una enfermedad genética heterogénea rara que puede estar presente en hasta un 5% de los pacientes que presentan infecciones respiratorias a repetición. La patogenia es secundaria a una alteración de la función ciliar que a su vez provoca una alteración del transporte de moco, resultando en una condición inflamatoria crónica en la vía aérea superior e inferior. Las manifestaciones clínicas de la esfera otorrinolaringológica en los pacientes portadores de DCP están presentes prácticamente en la totalidad de los mismos, y se caracterizan por infecciones recidivantes de oídos y cavidades perinasales, inflamación crónica a este nivel, hipoacusia neurosensorial y conductiva, y alteraciones respiratorias durante el sueño. En este artículo se revisarán los aspectos diagnósticos y terapéuticos de dicho compromiso.


Assuntos
Humanos , Criança , Adulto , Otite Média/epidemiologia , Sinusite/epidemiologia , Rinite/epidemiologia , Síndrome de Kartagener/epidemiologia , Otite Média/terapia , Rinite/terapia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/fisiopatologia
3.
Int J Pediatr Otorhinolaryngol ; 123: 102-109, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31085462

RESUMO

OBJECTIVE OF REVIEW: Acute otitis media (AOM) is the largest cause of antimicrobial prescriptions amongst children in developed countries. Excessive and inappropriate prescribing is known to drive antimicrobial resistance, but less is known of antimicrobial resistance in AOM-associated bacteria. TYPE OF REVIEW & SEARCH STRATEGY: We conducted a systematic review and meta-analysis of bacterial prevalence and antimicrobial resistance in studies of paediatric AOM identified from Ovid Medline, Embase and the Cochrane library. RESULTS: From 48 unique studies, 15,871 samples were included. Only 0.67 (CI 0.63-0.71) of all ear samples grew a bacterial pathogen. The most common bacterial causes of AOM in children were Streptococcus pneumoniae 0.30 (CI 0.27-0.32), Haemophilus influenza 0.23 (CI 0.20-0.26), and Moraxella catarrhalis 0.05 (CI 0.04-0.06). Resistance patterns varied amongst organisms and antimicrobial agents. The pooled proportion of bacterial culture-positive episodes of AOM that could be effectively treated with amoxicillin was 0.85 (CI 0.76-0.94), erythromycin was 0.64 (0.48-0.78) and amoxicillin-clavulanate was 0.95 (CI 0.85-0.98). CONCLUSION: We have demonstrated the bacteriology and antimicrobial resistance patterns of AOM. Of samples which grew bacteria, on average approximately 15% of isolates demonstrated resistance to amoxicillin; a typical first-line agent. Greater understanding of local bacteriology and resistance patterns is needed to enable improved antimicrobial stewardship.


Assuntos
Farmacorresistência Bacteriana , Otite Média/microbiologia , Doença Aguda , Amoxicilina , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Testes de Sensibilidade Microbiana , Moraxella (Branhamella) catarrhalis/isolamento & purificação , Otite Média/epidemiologia , Streptococcus pneumoniae/isolamento & purificação
4.
Rev. esp. quimioter ; 32(2): 121-129, abr. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-182813

RESUMO

Objetivo: Evaluar mediante análisis farmacocinético/farmadocinámico (PK/PD) si el cambio en la sensibilidad antimicrobiana tras la introducción en España de la vacuna anti-neumocócica heptavalente (VNC7) ha implicado cambios en la adecuación del tratamiento antibiótico de la otitis media aguda (OMA) en niños. Materiales y métodos: Los parámetros PK y datos de sensibilidad de Streptococcus pneumoniae y Haemophilus influenzae fueron obtenidos de la bibliografía. Mediante simulación de Montecarlo, calculamos la probabilidad de éxito del tratamiento antibiótico, expresada como fracción de respuesta acumulada (CFR). Para amoxicilina y amoxicilina/ácido clavulánico, el objetivo farmacodinámico considerado fue el tiempo durante el cual las concentraciones libres en sangre permanecen por encima de la concentración mínima inhibitoria (CMI), expresado como porcentaje del intervalo de dosificación (fT>CMI≥50%). Para cefuroxima axetilo y cefotaxima, el objetivo fue fT>CMI≥60%. Valores de CFR≥90% se consideraron indicativos de éxito. Resultados: Si se tienen en cuenta todos los serotipos de S. pneumoniae, amoxicilina y cefotaxima proporcionaron una alta probabilidad de éxito, sin apenas diferencia entre ambos periodos. En el caso de H. influenzae, los valores de CFR fueron más altos con amoxicilina/ácido clavulánico que con amoxicilina. Para ambos microorganismos, las probabilidades de éxito de cefuroxima axetilo fueron bajas en ambos periodos de estudio. Conclusiones: La introducción de la vacuna PCV7 no ha implicado cambios en la probabilidad de éxito del tratamiento antibiótico empírico de la OMA. Hemos demostrado la utilidad del análisis PK/PD para detectar cambios en la adecuación del tratamiento antibiótico tras la implantación de una vacuna, proporcionando información complementaria al seguimiento de los valores de CMI


Objetivo: Evaluar mediante análisis farmacocinético/farmadocinámico (PK/PD) si el cambio en la sensibilidad antimicrobiana tras la introducción en España de la vacuna anti-neumocócica heptavalente (VNC7) ha implicado cambios en la adecuación del tratamiento antibiótico de la otitis media aguda (OMA) en niños. Materiales y métodos: Los parámetros PK y datos de sensibilidad de Streptococcus pneumoniae y Haemophilus influenzae fueron obtenidos de la bibliografía. Mediante simulación de Montecarlo, calculamos la probabilidad de éxito del tratamiento antibiótico, expresada como fracción de respuesta acumulada (CFR). Para amoxicilina y amoxicilina/ácido clavulánico, el objetivo farmacodinámico considerado fue el tiempo durante el cual las concentraciones libres en sangre permanecen por encima de la concentración mínima inhibitoria (CMI), expresado como porcentaje del intervalo de dosificación (fT>CMI≥50%). Para cefuroxima axetilo y cefotaxima, el objetivo fue fT>CMI≥60%. Valores de CFR≥90% se consideraron indicativos de éxito. Resultados: Si se tienen en cuenta todos los serotipos de S. pneumoniae, amoxicilina y cefotaxima proporcionaron una alta probabilidad de éxito, sin apenas diferencia entre ambos periodos. En el caso de H. influenzae, los valores de CFR fueron más altos con amoxicilina/ácido clavulánico que con amoxicilina. Para ambos microorganismos, las probabilidades de éxito de cefuroxima axetilo fueron bajas en ambos periodos de estudio. Conclusiones: La introducción de la vacuna PCV7 no ha implicado cambios en la probabilidad de éxito del tratamiento antibiótico empírico de la OMA. Hemos demostrado la utilidad del análisis PK/PD para detectar cambios en la adecuación del tratamiento antibiótico tras la implantación de una vacuna, proporcionando información complementaria al seguimiento de los valores de CMI


Assuntos
Humanos , Criança , Otite Média/tratamento farmacológico , Antibacterianos/farmacocinética , Vacinas Pneumocócicas/administração & dosagem , Vacina Pneumocócica Conjugada Heptavalente/administração & dosagem , Doença Aguda/terapia , Otite Média/epidemiologia , Espanha/epidemiologia , Combinação Amoxicilina e Clavulanato de Potássio/farmacocinética , Amoxicilina/farmacocinética
5.
J Dairy Sci ; 102(6): 5501-5510, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30928271

RESUMO

The objective of this study was to evaluate one strategy for control (metaphylaxis) of bovine respiratory disease, with and without co-morbidity with otitis media, in dairy heifers at a commercial development facility. Individual heifers were the experimental unit. At weaning, 1 of 3 experimental treatments (gamithromycin, tulathromycin, or no medication) was randomly assigned to 1,567 heifers from 11 different dairies. Gamithromycin was administered to 631 heifers, tulathromycin was administered to 621 heifers, and no medication was administered to 315 heifers (negative control). Heifers were then commingled and penned according to body weight. Each pen contained heifers from each group, and periodically, larger numbers of heifers were penned together. All heifers were observed for the subsequent 42 d and treated according to protocols prescribed for the facility. Morbidity due to respiratory disease was less for heifers medicated with gamithromycin than for heifers medicated with tulathromycin. Morbidity due to respiratory disease was less for heifers medicated with gamithromycin than for heifers in the negative control group. Fewer heifers medicated with either antimicrobial were subsequently treated because of co-morbidity with otitis media. Mortality was not different among the treatment groups. Heifers medicated with either antimicrobial had greater average daily gain than did heifers in the negative control group.


Assuntos
Antibacterianos/farmacologia , Doenças dos Bovinos/prevenção & controle , Dissacarídeos/farmacologia , Compostos Heterocíclicos/farmacologia , Macrolídeos/farmacologia , Otite Média/veterinária , Doenças Respiratórias/veterinária , Animais , Peso Corporal , Bovinos , Doenças dos Bovinos/epidemiologia , Feminino , Morbidade , Otite Média/epidemiologia , Distribuição Aleatória , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/prevenção & controle , Desmame
6.
S Afr J Commun Disord ; 66(1): e1-e7, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30843412

RESUMO

BACKGROUND:  There is evidence that the factors contributing to the prevalence and aetiology of hearing impairment vary widely from one country to another. In South Africa, as in other low-income and middle-income countries, more context-specific information on the estimated prevalence of hearing impairment and the factors that contribute to its onset is required. AIM:  The aim of this study was to provide decision-makers and hearing health professionals with local and accurate information on the prevalence of ear and hearing disorders in the Elias Motsoaledi Local Municipal (EMLM) area of the Limpopo province, South Africa. METHODS:  The World Health Organization (WHO) protocol for population-based surveys of prevalence and causes of deafness, hearing impairment and other ear diseases was utilised. A random multi-stage cluster sampling strategy, two-stage sampling, was utilised to select the seven municipal wards and 357 households through the probability proportional to size method. A total of 850 participants were included in the study. RESULTS:  The overall prevalence of hearing impairment was 19.88% (95% confidence interval [CI]: 0.15-0.2) and 8.94 (95% CI: 0.08-0.12) for disabling hearing impairment. The prevalence of ear disease was 13.19% (95% CI: 0.10-0.15), with impacted cerumen and otitis media reported most often. Associations with hearing impairment were established for age, gender and hypertension. CONCLUSION:  The study has shown a higher prevalence of disabling hearing impairment in the rural EMLM area of the Limpopo province compared to global prevalence rates. In addition, known factors associated with hearing impairment were confirmed.


Assuntos
Perda Auditiva/epidemiologia , Adolescente , Adulto , Idoso , Cerume , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Otite Média/epidemiologia , Prevalência , Fatores de Risco , População Rural , África do Sul/epidemiologia , Adulto Jovem
7.
Int J Pediatr Otorhinolaryngol ; 119: 123-130, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30703661

RESUMO

OBJECTIVES: To evaluate the epidemiology, microbiology, Streptococcus pneumoniae serotypes distribution and serious bacterial infections (SBIs) occurrence in infants <2 months of age with tympanocentesis-documented acute otitis media (AOM), before and after the introduction of pneumococcal conjugate vaccines (PCVs). METHODS: The medical records of all hospitalized infants with AOM who underwent tympanocentesis during 2005-2014 were reviewed. RESULTS: Of the 303 infants with AOM who were diagnosed by an ENT specialist, 182 underwent tympanocentesis, 92 during 2005-2009 (prevaccine period) and 90 during 2010-2014 (postvaccine period). Streptococcus pneumoniae and nontypeable Hemophilus influenzae were isolated in 46/92 (50%) and 37/92 (40.2%) patients during 2005-2009 and decreased to 27/90 (30%) and 21/90 (23.3%). Respectively, during 2010-2014 (P = 0.006 and P = 0.001). The proportion of culture-negative patients increased from 18/92 (19.6%) during 2005-2009 to 32/90 (35.6%) during 2010-2014 (P = 0.02). There were only 6 (3.3%) patients <2 weeks of age. The most common S. pneumoniae vaccine serotypes isolated during 2005-2009 were 5, 3, 1, 19F and 14 (15.2%, 13.0%, 10.9%, 6.5%, and 4.3%, respectively) and 3, 5, 1, 14 and 19A (22.2%, 11.1%, 7.4%, 7.4%, and 7.4%, respectively) during 2010-2014. The proportion of culture-positive patients decreased during 2013-2014 compared with 2011-2012 (7/18, 38.9% vs. 40/54, 74.1%, P = 0.007). Serotypes 1 and 5 were not isolated during 2013-2014 and serotype 19A was not isolated during 2011-2014. . SBIs were recorded in 23/182 (12.64%) patients and urinary tract infections represented 19/23 (82.61%) of them (Escherichia coli isolated in 12, 63.2%). CONCLUSIONS: The overall number of AOM cases needing tympanocentesis seen at the PER and the proportion of S. pneumoniae and nontypeable H. influenzae-AOM decreased while the proportion of culture-negative AOM increased following the introduction of PCVs. SBIs associated with AOM were frequent and were represented mostly by urinary tract infections caused by pathogens unrelated to the etiologic agents of AOM.


Assuntos
Infecções por Haemophilus/epidemiologia , Otite Média/epidemiologia , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Antibacterianos/uso terapêutico , Feminino , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Israel/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Ventilação da Orelha Média , Otite Média/microbiologia , Otite Média/prevenção & controle , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/prevenção & controle , Prevalência , Estudos Retrospectivos , Sorogrupo , Streptococcus pneumoniae/isolamento & purificação , Timpanocentese/estatística & dados numéricos
8.
PLoS One ; 14(2): e0212777, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30794686

RESUMO

This study aims to assess prospectively whether there is an association between frequencies of upper respiratory tract infections (URTI) or asthma in early childhood and failed otoacoustic emission (OAE) screenings later in life. There are no clear recommendations for hearing testing following acute otitis media (AOM) infection. This is a retrospective, practice based chart review. Participants from a primary care setting were 517 pre-adolescent and adolescent children (49.9% female) (ages 10-21; mean, 15 y/o), who had presented with at least one specific bacterial URTI (AOM, Group A Streptococcus (GAS) tonsillitis, or Influenza) during childhood. Hearing testing was recorded incidentally at all subsequent routine health care maintenance visits (OAE hearing screen). Simple linear regression analyses were performed using R (v3.4.4). We found that number of episodes of AOM infections strongly correlated with number of failed OAE screenings later in life (F = 76.37; P = <0.001; R2 = 0.1279), while GAS (F = 1.859; P = 0.1733; R2 = 0.0016) or Influenza infection (F = 2.624; P = 0.1059; R2 = 0.0031) were not associated with failed OAE screening. Correlation between number of AOM infections and number of failed OAE screenings was not strengthened by presence of asthma. This study found evidence of an association between childhood history of AOM and failed OAE screenings in adolescence. Since this population may be at a higher risk for developing permanent or fluctuating hearing losses, further studies to clarify indications and timing of standard audiological testing among these children should be considered.


Assuntos
Programas de Rastreamento , Otite Média , Infecções Estreptocócicas , Streptococcus pyogenes , Adolescente , Adulto , Criança , Feminino , Testes Auditivos , Humanos , Masculino , Otite Média/epidemiologia , Otite Média/microbiologia , Estudos Retrospectivos , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia
9.
PLoS One ; 13(12): e0209048, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30562385

RESUMO

One of the beneficial effects of pneumococcal conjugate vaccines (PCVs) has been a decrease in the incidence of non-invasive infections, such as otitis media (OM) caused by vaccine serotypes. In this study, we analyzed the epidemiology of pneumococcal OM before and after PCV13 introduction in 2010. Between 2008 and 2016, the middle ear exudates from 2653 children under 14 years of age with OM were studied in two Spanish provinces (Gipuzkoa and Barcelona), and S. pneumoniae was isolated in 235 (8.9%) of cases. The 204 available isolates were serotyped and distributed in three 3-year periods: one before and two after PCV13 introduction (early and late post-PCV13). A significant decrease in the rate of OM caused by S. pneumoniae was observed mainly due to a decrease in infections caused by all PCV13 serotypes, although exceptions were observed including the persistence of serotype 3 in Gipuzkoa and a weak re-emergence of serotype 19F in both regions. The rate and diversity of non-PCV13 serotypes increased in both regions and an emerging clone causing OM was detected in each region: serotype 23B ST2372 in Gipuzkoa and serotype 11A ST838/ST6521 in Barcelona. The introduction of PCV13 has been followed by a change in the epidemiology of pneumococcal OM, with a decrease in the rate of vaccine serotypes accompanied by an increase in the diversity of non-vaccine serotype and the clonal spreading of different single clones in each region.


Assuntos
Otite Média/epidemiologia , Otite Média/prevenção & controle , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Streptococcus pneumoniae/imunologia , Adolescente , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/prevenção & controle , Orelha Média/imunologia , Orelha Média/microbiologia , Humanos , Lactente , Recém-Nascido , Otite Média/etiologia , Otite Média/microbiologia , Infecções Pneumocócicas/microbiologia , Estudos Prospectivos , Sorotipagem , Espanha/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Fatores de Tempo , Vacinas Conjugadas
10.
Pediatr. aten. prim ; 20(80): 397-400, oct.-dic. 2018.
Artigo em Espanhol | IBECS | ID: ibc-180976

RESUMO

Conclusiones de los autores del estudio: el empleo apropiado de la actitud expectante para el manejo de la otitis media aguda podría simultáneamente mejorar los resultados de salud y ahorrar costes a la sociedad. En contraposición, los autores interpretan que esta actitud podría suponer un aumento de las visitas, requiriendo educación adicional de los padres y del personal sanitario. Comentario de los revisores: este análisis de coste-efectividad demuestra que la actitud expectante basada en las pautas de la Academia Americana de Pediatría para el manejo de la otitis media se asocia con menores costes totales y evita la pérdida de años de vida ajustados por discapacidad. Sería necesario realizar estudios de costes en Atención Primaria y adaptados a nuestro medio, donde se puede asegurar un seguimiento más exhaustivo de los pacientes obteniendo incluso costes menores


Author's conclusions: the appropriate use of watchful waiting for the management of acute otitis media could simultaneously improve health outcomes and save costs for society. In contrast, the authors interpret that this attitude could imply an increase in visits, requiring additional education from parents and health personnel. Reviewer's commentary: this cost-effectiveness analysis demonstrates that watchful waiting management for acute otitis media in patients meeting criteria of the AAP guidelines, stratifying by age and severity symptoms, is associated with lower total costs and also avoids the loss of years of life due to disability. It would be necessary to conduct cost studies in Primary Care, adapted to our environment where it can be ensured a more exhaustive monitoring of patients and the costs could be even lower


Assuntos
Humanos , Conduta Expectante/economia , Otite Média/terapia , Custos Diretos de Serviços/estatística & dados numéricos , Otite Média/epidemiologia , Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício
11.
Int J Pediatr Otorhinolaryngol ; 113: 115-118, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173968

RESUMO

OBJECTIVES: To determine the risk of healthy children undergoing tympanostomy tubes of an additional surgery prior to age three and associated risk factors. METHODS: A retrospective chart review of pediatric patients at a tertiary metropolitan children's hospital who underwent tympanostomy tube insertion procedure before age of three from January 2010 through March 2015. We determined patient demographics, indication for tympanostomy tube insertion, as well as information about additional procedures requiring general anesthesia before the age of three years. A prospective telephone interview was also performed on a portion of the study population to assess if there were additional surgeries before the age of three that did not occur at our institution. RESULTS: In our institution there was a 13% risk of getting an additional surgery after tympanostomy tubes in children who are otherwise healthy. The most common second procedure was an otolaryngologic procedure in 77.8% of the cases. Children with a diagnosis of recurrent acute otitis media had a threefold greater chance of getting an additional surgery than those with a diagnosis of chronic otitis media with effusion. Patients that identified as Black or African American were 3.2 times more likely to have additional surgery. With every year increase at age of surgery, the odds of an additional surgery decreased by 77%. CONCLUSIONS: In healthy children undergoing tympanostomy tube insertion at our institution, the incidence of additional procedures under general anesthesia (GA) is low at 13%. Although there is evidence of possible deleterious effects of anesthesia on the developing brain, it is generally accepted that one short (≤1 h) anesthetic exposure under the age of three has not been associated with adverse neurodevelopmental outcomes. As a specialty that regularly performs procedures on young children, we need to be aware of the possible effects of anesthetic agents on our patients. However, this study shows that the exposure risk is low and should help reassure patient's families.


Assuntos
Ventilação da Orelha Média , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Anestesia Geral , Pré-Escolar , Colorado/epidemiologia , Feminino , Humanos , Lactente , Masculino , Otite Média/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco
12.
Int J Pediatr Otorhinolaryngol ; 113: 192-197, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173984

RESUMO

INTRODUCTION: As the ear development extends from the 4th to the 30th week of pregnancy, in utero exposure to ototoxic drugs might lead to hearing impairment in the fetus. The main study objective was to assess the association between in utero drug exposure and the occurrence of hearing impairment in 2-year-old children. METHODS AND MATERIALS: A case-control study was carried out using the EFEMERIS database, recording medications dispensed during pregnancy and the compulsory health certificates for child at 8 days, 9 and 24 months. Cases were defined as children with an abnormal hearing examination recorded on the 24-month certificate and controls as children with a normal hearing examination. Exposure was defined as at least one prescription and dispensation to the mother of drugs grouped at the 3rd level of the Anatomical Therapeutic and Chemical Classification level, compared to no exposure. Univariate logistic regressions were carried out. If the 95% confidence interval (95% CI) of the odds ratio (OR) was significant, a multivariable logistic regression was performed, adjusted on confounders. RESULTS: A total of 1,245 cases with abnormal hearing evaluation and 28,046 controls were selected for analysis. Case and control mothers were comparable in terms of age, education and congenital infection. Cases and controls were comparable in terms of prematurity, asphyxia and weight at birth. However, among cases (versus controls), there were more ear deformities (0.6% vs 0.0% p≤0.001), and more recurring otitis (11.3% vs 5.3% p≤0.0001). When adjusted on confounders, the following drugs remained significant versus no exposure: acetylsalicylic acid at low dosage (OR 95% CI 1.61 [1.09-2.37]), valproic acid or valpromide (OR 95% CI 5.20 [1.93-14.00]), systemic corticosteroids (OR 95% CI 0.75 [0.61-0.93]. In a sensitivity analysis which excluded children with recurrent otitis at 24 months, these three results remained significant. CONCLUSIONS: This is the first study evaluating the risk of hearing disorders due to in utero exposure to drugs. Hearing loss was associated with valproic acid and low-dose acetylsalicylic acid exposure during pregnancy. Conversely, children with normal hearing were more likely to have been exposed in utero to corticosteroids than children with hearing loss.


Assuntos
Perda Auditiva/induzido quimicamente , Perda Auditiva/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticonvulsivantes/efeitos adversos , Aspirina/efeitos adversos , Estudos de Casos e Controles , Pré-Escolar , Bases de Dados Factuais , Feminino , França/epidemiologia , Glucocorticoides/efeitos adversos , Humanos , Masculino , Otite Média/epidemiologia , Gravidez , Ácido Valproico/efeitos adversos , Ácido Valproico/análogos & derivados
13.
Int J Pediatr Otorhinolaryngol ; 113: 223-228, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30173991

RESUMO

OBJECTIVE: The present study aimed to assess the prevalence of otitis media and associated hearing loss among primary school students in the Solomon Islands. METHODS: A total of 604 primary school students (280 males, 324 females) aged 4-15 years were assessed in two primary schools (government, nongovernment) in the capital city Honiara. School-based ear examinations were performed, including otoscopy and tuning-fork tests. Students were referred to the ENT Clinic for medical intervention and/or pure-tone audiometry assessment. RESULTS: A total of 342 students (56.6%) did not pass their ear examination, with a significantly higher fail rate among younger students (p < 0.001). The most common ear pathology was Otitis Media with Effusion (OME) (34.2%), followed by impacted wax (22.8%), and Chronic Suppurative Otitis Media (3.1%). The follow-up attendance rate at the ENT Clinic was 81.1%. Among students with OME in at least one ear, 50% failed audiometry screening in the affected ear. While age was a significant factor for OME, it was not a significant factor for OME-associated hearing loss. CONCLUSIONS: Ear diseases with associated hearing loss are a significant public health problem among primary school students in the Solomon Islands. The implementation of routine School Ear and Hearing Programs could be beneficial, and should reduce the national burden of ear diseases.


Assuntos
Perda Auditiva/epidemiologia , Otite Média/epidemiologia , Adolescente , Audiometria de Tons Puros/métodos , Criança , Pré-Escolar , Feminino , Perda Auditiva/etiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Melanesia/epidemiologia , Otite Média/complicações , Otoscopia/métodos , Prevalência , Saúde Pública , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos
14.
Int J Pediatr Otorhinolaryngol ; 111: 21-25, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29958609

RESUMO

OBJECTIVES: The present study aimed to assess the prevalence of otitis media and risk-factors for sensorineural hearing loss among infants in the Solomon Islands, in order to recommend an Infant Ear and Hearing Program that would be suitable to the Pacific Island context. METHODS: Ear examinations and the JCIH Risk-Factor Questionnaire were administered to 288 infants attending Child Welfare Clinics in the Solomon Islands. RESULTS: Overall, 150 infants (52.084%) presented with bilateral normal ear examinations and no risk-factors for SNHL. There were 73 infants (25.34%) with ear pathology in at least one ear, 13 (4.5%) of whom required referral to the ENT Clinic for medical management. The most common pathology was otitis media with effusion (OME) (21.87%). Infants aged 7-12 months were significantly more likely to present with OME (p<0.001) and a history of otitis media (p=0.017) than infants aged 0-6 months. There were 71 infants (24.65%) with at least one risk-factor for sensorineural hearing loss. The most common risk-factors were ototoxicity (8.3%), non-elective caesarean delivery (6.59%), and possible in-utero syphilis infection (5.55%). CONCLUSIONS: The prevalence of otitis media and risk-factors for sensorineural hearing loss indicate the importance of initiating Infant Ear and Hearing Programs in the Solomon Islands. Program should facilitate early education on prevention of ear disease, as well as early diagnosis and management of children with hearing loss.


Assuntos
Perda Auditiva Neurossensorial/etiologia , Otite Média/epidemiologia , Pré-Escolar , Surdez , Diagnóstico Precoce , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/prevenção & controle , Testes Auditivos , Humanos , Lactente , Recém-Nascido , Masculino , Melanesia/epidemiologia , Otite Média/complicações , Otite Média/diagnóstico , Otite Média/terapia , Prevalência , Fatores de Risco , Inquéritos e Questionários
15.
Artigo em Chinês | MEDLINE | ID: mdl-29798202

RESUMO

Objective:To discuss the effects of PM 2.5 and air quality index on the emergency of otolaryngology. Method:Collect in 2015 Beijing tongren hospital emergency department patients with acute otitis media, epistaxis, acute epiglottitis as well as the same time Beijing AQI value and the PM 2.5 density data as the experimental group 1, chooses in 2015 first Affiliated Hospital of Hebei North University similar patient as well as the same time Zhangjiakou AQI value and the PM 2.5 density as the experimental group 2. Statistics the quantity of each sickness of two groups, and the relationships with PM 2.5 and AQI value; Group all data by AQI value and statistics the differences in the incidence rates of each group. Result:The number of cases of acute otitis media and epistaxis in the 2 experimental group were all correlated with the change of PM 2.5 and AQI value, and the correlation was positive between the two groups, However, the incidence of acute epiglottitis was not significantly correlated with the concentration of PM 2.5 and AQI, and there was no significant correlation between the two. The air quality when severe and more pollution when the number of the cases of acute otitis media and epistaxis compared with good air quality for the number of P<0.05, the difference was statistically significant. Conclusion:The increase of PM 2.5 concentration and AQI index is a health risk factor for acute otitis media and epistaxis.


Assuntos
Poluentes Atmosféricos/toxicidade , Serviços Médicos de Emergência/estatística & dados numéricos , Otite Média/epidemiologia , Doença Aguda , Poluição do Ar , Epistaxe/epidemiologia , Humanos , Otolaringologia , Material Particulado
16.
Homo ; 69(1-2): 6-16, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29724408

RESUMO

This study examines the evidence of three skeletal markers relating to childhood health that leave permanent observable changes in the adult skeleton. Two are well known to paleopathology, namely Harris lines (HL) and linear enamel hypoplasia (LEH). The third skeletal marker is less commonly used; the permanent changes in the temporal bones, induced by chronic or recurrent infectious middle ear disease (IMED) in childhood. A total of 291 adult skeletons from an urban (n = 109) and a rural (n = 182) cemetery, from the Danish medieval period (1050-1536 CE) were included. The markers were examined for their co-occurrence, and differences between the two samples. No statistically significant difference for the three skeletal markers between the two samples was found. A trend was nevertheless apparent, with greater frequencies for all three skeletal markers for the urban population. A statistically significant relationship was found only between IMED and HL. This positive relation was very low (rɸ = 0.307, 0.275) and may be considered non-existent. The lack of co-occurrence is interpreted as if an individual was exposed to conditions that could cause the osteological expression of all three markers this could be a life-threatening health condition, during developing years.


Assuntos
Saúde da Criança/história , Adulto , Osso e Ossos/patologia , Criança , Dinamarca/epidemiologia , Hipoplasia do Esmalte Dentário/epidemiologia , Hipoplasia do Esmalte Dentário/história , Feminino , História Medieval , Humanos , Masculino , Otite Média/epidemiologia , Otite Média/história , Paleopatologia , Saúde da População Rural/história , Osso Temporal/patologia , Saúde da População Urbana/história
17.
PLoS One ; 13(3): e0194275, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29561891

RESUMO

BACKGROUND: Middle ear disease (otitis media) is endemic among Aboriginal and Torres Strait Islander children in Australia and represents an important cause of hearing loss. The disease is the result of a mix of biological, environmental and host risk factors that interact in complex, non-linear ways along a dynamic continuum. As such, it is generally recognised that a holistic, systems approach is required to reverse the high rates of otitis media in Aboriginal and Torres Strait Islander children. The objective of this paper is to examine the alignment between efforts designed to address otitis media in Aboriginal and Torres Strait Islander children in Queensland, Australia and core concepts of systems thinking. This paper's overall purpose is to identify which combination of activities, and at which level, hold the potential to facilitate systems changes to better support ear health among Aboriginal and Torres Strait Islander children. METHODS: We began with a review of documents identified in consultation with stakeholders and an online search. In addition, key informants were invited to participate in an online survey and a face-to-face or phone interview. Qualitative interviews using a semi-structured interview guide were used to explore survey responses in more depth. We also undertook interviews at the community level to elicit a diverse range of views. Ideas, statements or activities reported in the documents and interviews as being performed under the Intervention Level Framework were identified using qualitative thematic and content analysis. A quantitative descriptive analysis was also undertaken, whereby data was extracted into an Excel spreadsheet and coded under the relevant strategic directions and performance indicators of the Framework. Subsequently, we coded activities against the five-level intervention framework developed by Malhi and colleagues, that is: 1) paradigm; 2) goals; 3) system structure; 4) feedback and delays; and 5) structural elements. RESULTS: Overall, twenty documents were reviewed. We examined surveys and interviews with six key informants. Twenty-four individual and 3 group interviews were conducted across central and community level informants. One hundred and four items were coded from the 20 documents and 156 items from interview data. For both data sets, the majority of activities were coded at the structural elements level. The results suggested three key areas where further work is needed to drive sustained improvements: 1) build the governance structures needed for paradigm shift to achieve a multi-sectoral approach; 2) develop shared system level goals; 3) develop system-wide feedback processes. CONCLUSIONS: Sustained progress in improving ear health within Aboriginal and Torres Strait Islander children requires a holistic, system-wide approach. To advance such work, governance structures for multi-sectoral collaboration including the development of joint goals and monitoring and feedback are required. Intervening at these higher leverage points could have a profound effect on persistent public health issues.


Assuntos
Planejamento em Saúde , Grupo com Ancestrais Oceânicos , Otite Média/epidemiologia , Vigilância em Saúde Pública , Saúde Pública , Austrália/epidemiologia , Austrália/etnologia , Meio Ambiente , Humanos , Fatores de Risco , Inquéritos e Questionários
18.
Cochrane Database Syst Rev ; 2: CD004879, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29388195

RESUMO

BACKGROUND: The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years of age. This is an update of a review published in 2011. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions. OBJECTIVES: To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in healthy children. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 12), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (1966 to 31 December 2016), Embase (1974 to 31 December 2016), WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017), and ClinicalTrials.gov (1 July 2017). SELECTION CRITERIA: Randomised controlled trials comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy children under 16 years. Previous versions of this review included 19 cohort and 11 case-control studies. We are no longer updating the searches for these study designs but have retained the observational studies for historical purposes. DATA COLLECTION AND ANALYSIS: Review authors independently assessed risk of bias and extracted data. We used GRADE to rate the certainty of evidence for the key outcomes of influenza, influenza-like illness (ILI), complications (hospitalisation, ear infection), and adverse events. Due to variation in control group risks for influenza and ILI, absolute effects are reported as the median control group risk, and numbers needed to vaccinate (NNVs) are reported accordingly. For other outcomes aggregate control group risks are used. MAIN RESULTS: We included 41 clinical trials (> 200,000 children). Most of the studies were conducted in children over the age of two and compared live attenuated or inactivated vaccines with placebo or no vaccine. Studies were conducted over single influenza seasons in the USA, Western Europe, Russia, and Bangladesh between 1984 and 2013. Restricting analyses to studies at low risk of bias showed that influenza and otitis media were the only outcomes where the impact of bias was negligible. Variability in study design and reporting impeded meta-analysis of harms outcomes.Live attenuated vaccinesCompared with placebo or do nothing, live attenuated influenza vaccines probably reduce the risk of influenza infection in children aged 3 to 16 years from 18% to 4% (risk ratio (RR) 0.22, 95% confidence interval (CI) 0.11 to 0.41; 7718 children; moderate-certainty evidence), and they may reduce ILI by a smaller degree, from 17% to 12% (RR 0.69, 95% CI 0.60 to 0.80; 124,606 children; low-certainty evidence). Seven children would need to be vaccinated to prevent one case of influenza, and 20 children would need to be vaccinated to prevent one child experiencing an ILI. Acute otitis media is probably similar following vaccine or placebo during seasonal influenza, but this result comes from a single study with particularly high rates of acute otitis media (RR 0.98, 95% CI 0.95 to 1.01; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. Vaccinating children may lead to fewer parents taking time off work, although the CI includes no effect (RR 0.69, 95% CI 0.46 to 1.03; low-certainty evidence). Data on the most serious consequences of influenza complications leading to hospitalisation were not available. Data from four studies measuring fever following vaccination varied considerably, from 0.16% to 15% in children who had live vaccines, while in the placebo groups the proportions ranged from 0.71% to 22% (very low-certainty evidence). Data on nausea were not reported.Inactivated vaccinesCompared with placebo or no vaccination, inactivated vaccines reduce the risk of influenza in children aged 2 to 16 years from 30% to 11% (RR 0.36, 95% CI 0.28 to 0.48; 1628 children; high-certainty evidence), and they probably reduce ILI from 28% to 20% (RR 0.72, 95% CI 0.65 to 0.79; 19,044 children; moderate-certainty evidence). Five children would need to be vaccinated to prevent one case of influenza, and 12 children would need to be vaccinated to avoid one case of ILI. The risk of otitis media is probably similar between vaccinated children and unvaccinated children (31% versus 27%), although the CI does not exclude a meaningful increase in otitis media following vaccination (RR 1.15, 95% CI 0.95 to 1.40; 884 participants; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. We identified no data on parental working time lost, hospitalisation, fever, or nausea.We found limited evidence on secondary cases, requirement for treatment of lower respiratory tract disease, and drug prescriptions. One brand of monovalent pandemic vaccine was associated with a sudden loss of muscle tone triggered by the experience of an intense emotion (cataplexy) and a sleep disorder (narcolepsy) in children. Evidence of serious harms (such as febrile fits) was sparse. AUTHORS' CONCLUSIONS: In children aged between 3 and 16 years, live influenza vaccines probably reduce influenza (moderate-certainty evidence) and may reduce ILI (low-certainty evidence) over a single influenza season. In this population inactivated vaccines also reduce influenza (high-certainty evidence) and may reduce ILI (low-certainty evidence). For both vaccine types, the absolute reduction in influenza and ILI varied considerably across the study populations, making it difficult to predict how these findings translate to different settings. We found very few randomised controlled trials in children under two years of age. Adverse event data were not well described in the available studies. Standardised approaches to the definition, ascertainment, and reporting of adverse events are needed. Identification of all global cases of potential harms is beyond the scope of this review.


Assuntos
Vacinas contra Influenza/uso terapêutico , Influenza Humana/prevenção & controle , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Conflito de Interesses , Humanos , Lactente , Números Necessários para Tratar , Otite Média/diagnóstico , Otite Média/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Apoio à Pesquisa como Assunto , Vacinas Atenuadas/uso terapêutico , Vacinas de Produtos Inativados/uso terapêutico
19.
Expert Rev Anti Infect Ther ; 16(3): 187-196, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29415569

RESUMO

INTRODUCTION: Nontypeable Haemophilus influenzae (NTHi) is an opportunistic pathogen of the respiratory tract and the greatest contributor to invasive Haemophilus disease. Additionally, in children, NTHi is responsible for the majority of otitis media (OM) which can lead to chronic infection and hearing loss. In adults, NTHi infection in the lungs is responsible for the onset of acute exacerbations in chronic obstructive pulmonary disease (COPD). Unfortunately, there is currently no vaccine available to protect against NTHi infections. Areas covered: NTHi uses an arsenal of adhesins to colonise the respiratory epithelium. The adhesins also have secondary roles that aid in the virulence of NTHi, including mechanisms that avoid immune clearance, adjust pore size to avoid antimicrobial destruction, form micro-colonies and invoke phase variation for protein mediation. Bacterial adhesins can also be ideal antigens for subunit vaccine design due to surface exposure and immunogenic capabilities. Expert commentary: The host-pathogen interactions of the NTHi adhesins are not fully investigated. The relationship between adhesins and the extracellular matrix (ECM) play a part in the success of NTHi colonisation and virulence by immune evasion, migration and biofilm development. Further research into these immunogenic proteins would further our understanding and enable a basis for better combatting NTHi disease.


Assuntos
Adesinas Bacterianas/metabolismo , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae/patogenicidade , Adulto , Animais , Biofilmes , Criança , Infecções por Haemophilus/microbiologia , Infecções por Haemophilus/prevenção & controle , Haemophilus influenzae/isolamento & purificação , Interações Hospedeiro-Patógeno , Humanos , Otite Média/epidemiologia , Otite Média/microbiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/microbiologia , Mucosa Respiratória/microbiologia , Virulência
20.
Int J Pediatr Otorhinolaryngol ; 106: 1-9, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29447878

RESUMO

INTRODUCTION: Otitis media is the primary cause of antibiotic prescription in children. Two-thirds of all children experience at least one episode of otitis media before the age of 7 years. The aim of this study was to characterise the attributable effect of several modifiable risk exposures on the risk of >3 episodes of otitis media at age 18 months and 7 years within a large prospective national birth cohort. METHODS: The study used the Danish National Birth Cohort comprising information about otitis media and risk exposures from more than 50,000 mother-child pairs from the period 1996-2002. Logistic regression models were used to estimate odds ratios for the risk factors and to calculate the population attributable fraction. RESULTS: Short time with breastfeeding, early introduction to daycare, cesarean section, and low compliance to the national vaccination program were all associated with an increased risk of >3 episodes of otitis media at 18 months of age and at 7 years of age. The fraction of children with otitis media attributed from breastfeeding lasting for less than 6 months was 10%. Introduction to daycare before the age of 12 months attributed with 20% of the cases of >3 episodes of otitis media. CONCLUSIONS: Short duration of breastfeeding, early introduction into daycare, cesarean section, and low compliance with the national vaccination program increased the risk of experiencing >3 episodes of otitis media at 18 months, and at 7 years of age. These are factors that all can be modulated.


Assuntos
Otite Média/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Modelos Logísticos , Masculino , Razão de Chances , Otite Média/etiologia , Gravidez , Estudos Prospectivos , Fatores de Risco
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