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Nonsevere acute otitismedia: a clinical trial comparing outcomes of watchful waiting versus immediate antibiotic treatment Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Otitismedia. Otitismedia (OM) continues to be one of the most common childhood infections and is a major cause of morbidity in children. The pathogenesis of OM is multifactorial, involving the adaptive and native immune system, Eustachian-tube dysfunction, viral and bacterial load, and genetic and environmental factors. Initial observation seems to be suitable for many children with OM, but only if appropriate follow-up can be assured. In children younger than 2 years with a certain diagnosis
Pneumococcal vaccines for preventing otitismedia. Acute otitismedia (AOM) is one of the most common diseases in early infancy and childhood. Long term effects of recurrent episodes of otitismedia, rapid emergence of drug resistant bacteria associated with AOM worldwide and huge estimated direct and indirect annual costs associated with otitismedia have emphasized the need for an effective vaccination program to prevent episodes of AOM.The object of this review was to assess the effect
Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitismedia in children aged under 2 years: randomised controlled trial. To evaluate the efficacy of adenoidectomy compared with long term chemoprophylaxis and placebo in the prevention of recurrent acute otitismedia in children aged between 10 months and 2 years.Randomised, double blind, controlled trial.Oulu University Hospital, a tertiary centre in Finland.180 children aged 10 months to 2 years with recurrent acute (...) otitis media.Adenoidectomy, sulfafurazole (sulphisoxazole) 50 mg/kg body weight, given once a day for six months or placebo. Follow up lasted for two years, during which time all symptoms and episodes of acute otitismedia were recorded.Intervention failure (two episodes in two months or three in six months or persistent effusion) during follow up, number of episodes of acute otitismedia, number of visits to a doctor because of any infection, and antibiotic prescriptions Number of prescriptions
Screening children in the first four years of life to undergo early treatment for otitismedia with effusion. Otitismedia with effusion (OME) is the most common cause of acquired hearing loss in childhood and has been associated with delayed language development and behavioural problems. This condition has a prevalence of about 20% at the age of two years, a time of rapid language development. It is most often asymptomatic. Effective treatment exists for clearing effusions. Some have argued
Effectiveness of inactivated influenza vaccine in preventing acute otitismedia in young children: a randomized controlled trial. Acute otitismedia (AOM) frequently complicates influenza infection. Previous studies have found influenza vaccine effective in reducing the occurrence of AOM in children mainly older than 2 years.To evaluate the effectiveness of inactivated influenza vaccine in preventing AOM in children aged 6 to 24 months.Randomized, double-blind, placebo-controlled trial of 786
Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitismedia: a randomised study. Pneumococcal conjugate vaccine prevents recurrent acute otitismedia (AOM) in infants immunised at 2, 4, 6, and 12-15 months of age. We aimed to find out whether this vaccine also prevents AOM in older children who have had previous episodes of AOM.In this double-blind, randomised study, we enrolled 383 patients aged 1-7 years who had had two or more (...) to the use of pneumococcal conjugate vaccine to prevent otitismedia in previously unvaccinated toddlers and children with a history of recurrent AOM.
2003LancetControlled trial quality: predicted high
Diagnosis, natural history, and late effects of otitismedia with effusion Diagnosis, natural history, and late effects of otitismedia with effusion Diagnosis, natural history, and late effects of otitismedia with effusion Shekelle P, Takata G, Chan L S, Mangione-Smith R, Corley PM, Morphew T, Morton S Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA (...) database. Citation Shekelle P, Takata G, Chan L S, Mangione-Smith R, Corley PM, Morphew T, Morton S. Diagnosis, natural history, and late effects of otitismedia with effusion. Rockville: Agency for Healthcare Research and Quality (AHRQ). Evidence Report/Technology Assessment No. 55. 2003 Authors' objectives The purpose of this evidence-based report is to review the evidence on the natural history of otitismedia with effusion (OME), the late effects of early life otitismedia on hearing and speech
Does this child have acute otitismedia? Does this child have acute otitismedia? Does this child have acute otitismedia? Rothman R, Owens T, Simel D L CRD summary This review assessed history taking and physical examination in the diagnosis of acute otitismedia in children. The authors concluded that although many studies had methodological limitations, a cloudy, bulging or clearly immobile tympanic membrane is highly suggestive of acute otitismedia. The conclusions were based on poor (...) -quality studies and may not be reliable. Authors' objectives To assess the precision and accuracy of history taking and physical examination in the diagnosis of acute otitismedia (AOM) in children. Searching MEDLINE was searched from inception to May 2002 for studies published in English. The bibliographies of selected studies and general and specialist textbooks were also checked. Study selection Study designs of evaluations included in the review Studies that used a nonindependent comparison
Mucosal biofilm formation on middle-ear mucosa in the chinchilla model of otitismedia. Chronic otitismedia with effusion (OME) has long been considered to be a sterile inflammatory process. The previous application of molecular diagnostic technologies to OME suggests that viable bacteria are present in complex communities known as mucosal biofilms; however, direct imaging evidence of mucosal biofilms associated with OM is lacking.To determine whether biofilm formation occurs in middle-ear (...) microscopy indicated that bacteria within the biofilms are viable.These preliminary findings provide evidence that mucosal biofilms form in an experimental model of otitismedia and suggest that biofilm formation may be an important factor in the pathogenesis of chronic otitismedia with effusion.
Pneumococcal vaccines for preventing otitismedia. Acute otitismedia (AOM) is one of the most common diseases in early infancy and childhood. Long term effects of recurrent episodes of otitismedia, rapid emergence of drug resistant bacteria associated with AOM worldwide and huge estimated direct and indirect annual costs associated with otitismedia have emphasized the need for an effective vaccination program to prevent episodes of AOM.The object of this review was to assess the effect (...) in specific high-risk (otitis-prone) populations.
Predictors of poor outcome and benefits from antibiotics in children with acute otitismedia: pragmatic randomised trial. To identify which children with acute otitismedia are at risk of poor outcome and to assess benefit from antibiotics in these children.Secondary analysis of randomised controlled trial cohort.Primary care.315 children aged 6 months to 10 years.Immediate or delayed (taken after 72 hours if necessary) antibiotics.Predictors of short term outcome: an episode of distress (...) was less likely with immediate antibiotics (32% for immediate v 53% for delayed, chi2=4.0; P=0.045, number needed to treat 5) as was night disturbance (26% v 59%, chi2=9.3; P=0.002; number needed to treat 3). In children without higher temperature or vomiting, immediate antibiotics made little difference to distress by day three (15% v 19%, chi2=0.74; P=0.39) or night disturbance (20% v 27%, chi2=1.6; P=0.20). Addition of cough did not significantly improve prediction of benefit.In children with otitis
Ventilation tubes after surgery for otitismedia with effusion or acute otitismedia and swimming: systematic review and meta-analysis Ventilation tubes after surgery for otitismedia with effusion or acute otitismedia and swimming: systematic review and meta-analysis Ventilation tubes after surgery for otitismedia with effusion or acute otitismedia and swimming: systematic review and meta-analysis Carbonell R, Ruiz-Garcia V Authors' objectives To determine whether swimming using ear (...) protection, swimming without ear protection and not swimming affects the risk of acute otitismedia (AOM) in children with ventilation tubes. Searching MEDLINE (from 1966 to June 2001), EMBASE (from 1980 to June 2001) and the Cochrane Library (to June 2001) were searched without language restriction. In addition, the reference lists from identified studies were checked. Experts were not contacted and grey literature was not sought. A brief summary of the search strategy was reported in the review. Study
Decongestants and antihistamines for acute otitismedia in children. Acute otitismedia (AOM) is a common and important source of morbidity in children, although most cases resolve spontaneously. While frequently recommended, decongestant and antihistamine therapy is of unclear benefit.To determine the efficacy of decongestant and antihistamine therapy in children with AOM on outcomes of AOM resolution, medication side effects, and complications of AOM.Comprehensive search of Cochrane's
Efficacy of a pneumococcal conjugate vaccine against acute otitismedia. Ear infections are a common cause of illness during the first two years of life. New conjugate vaccines may be able to prevent a substantial portion of cases of acute otitismedia caused by Streptococcus pneumoniae.We enrolled 1662 infants in a randomized, double-blind efficacy trial of a heptavalent pneumococcal polysaccharide conjugate vaccine in which the carrier protein is the nontoxic diphtheria-toxin analogue CRM197 (...) . The children received either the study vaccine or a hepatitis B vaccine as a control at 2, 4, 6, and 12 months of age. The clinical diagnosis of acute otitismedia was based on predefined criteria, and the bacteriologic diagnosis was based on a culture of middle-ear fluid obtained by myringotomy.Of the children who were enrolled, 95.1 percent completed the trial. With the pneumococcal vaccine, there were more local reactions than with the hepatitis B vaccine but fewer than with the combined whole-cell
Effect of early or delayed insertion of tympanostomy tubes for persistent otitismedia on developmental outcomes at the age of three years. A main indication for the insertion of tympanostomy tubes in infants and young children is persistent otitismedia with effusion, reflecting concern that this condition may cause lasting impairments of speech, language, cognitive, and psychosocial development. However, evidence of such relations is inconclusive, and evidence is lacking that the insertion (...) +/-7 vs. 86+/-7); the General Cognitive Index of McCarthy Scales of Children's Abilities (99+/-14 vs. 101+/-13); or on measures of receptive language, sentence length, grammatical complexity, parent-child stress, and behavior.In children younger than three years of age who have persistent otitismedia, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at the age of three years.
Effect of recolonisation with "interfering" alpha streptococci on recurrences of acute and secretory otitismedia in children: randomised placebo controlled trial. To study the effect of recolonisation with alpha streptococci with the ability to inhibit the growth of otopathogens ("interfering" activity) on the recurrence of acute otitismedia in susceptible children and the effect on the frequency of secretory otitis media.Double blind, randomised, placebo controlled study.Ear, nose (...) , and throat clinic with three doctors.130 children prone to otitismedia aged between 6 months and 6 years, 108 of whom were eligible and followed for 3 months.Recurrence of otitismedia during follow up and a normal tympanic membrane at the last valid visit.Children with no recurrences during the last month received phenoxymethylpenicillin (n=22), and those with a recurrence within 1 month received amoxicillin clavulanic acid (n=86), both twice daily for 10 days. These were followed by a streptococcal
Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitismedia. To compare immediate with delayed prescribing of antibiotics for acute otitis media.Open randomised controlled trial.General practices in south west England.315 children aged between 6 months and 10 years presenting with acute otitis media.Two treatment strategies, supported by standardised advice sheets-immediate antibiotics or delayed antibiotics (antibiotic prescription to be collected (...) mainly after first 24 hours, when symptoms were already resolving. For children who are not very unwell systemically, a wait and see approach seems feasible and acceptable to parents and should substantially reduce the use of antibiotics for acute otitismedia.
Management of acute otitismedia Management of acute otitismedia Management of acute otitismedia Agency for Healthcare Research and Quality (AHRQ) Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Agency for Healthcare Research and Quality (AHRQ). Management of acute otitismedia. Rockville: Agency for Healthcare Research and Quality (...) (AHRQ). Evidence Report/Technology Assessment No. 15. 2001 Authors' objectives The objective of this report is to analyze the evidence on the initial management of uncomplicated acute otitismedia (AOM) in children. Authors' conclusions There is a wide range of reported clinical failure rates in the first week in children with AOM who are not treated with antibiotics. The pooled estimates indicate that a majority of these children have clinical resolution within the first week after presentation
Management of acute otitismedia Management of acute otitismedia Management of acute otitismedia Marcy M, Takata G, Chan L S Shekelle P, Mason W, Wachsman L, Ernst R, Hay J W, Corley P M, Morphew T, Ramicone E, Nicholson C Authors' objectives To analyse the evidence on the initial management of uncomplicated acute otitismedia (AOM) in children, and to assess the following three questions. What is the natural history of AOM without antibiotic treatment? Are antibiotics effective in preventing (...) to establish differences in antibiotic efficacy. In addition, future studies should address the issue of bacterial resistance. Bibliographic details Marcy M, Takata G, Chan L S Shekelle P, Mason W, Wachsman L, Ernst R, Hay J W, Corley P M, Morphew T, Ramicone E, Nicholson C. Management of acute otitismedia. Rockville, MD, USA: Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment; 15. 2001 Original Paper URL Other publications of related interest Jadad AR, Moore RA, Carroll D