Hearing aids for otitis media with effusion: Do children use them?

This study investigated what proportion of children referred for hearing aids actually receive them, and whether children use them | International Journal of Pediatric Otorhinolaryngology

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ENT surgeons may refer children with otitis media with effusion (OME) to audiology for consideration of hearing aids. They are an option for the treatment of OME, but are only effective if the child actually wears them.

During the study period, there were 202 referrals of children to audiology, of which 70 (34.7%) were for consideration of hearing aids for OME. Of these 70 referred children, 37 (52.9%) were not fitted with hearing aids due to normal audiometry (23), asymptomatic mild hearing loss (7), nonattendance (3), clinical decision to just monitor hearing (1), parental decline (2), and unrecorded reason (1). A total of 38 children (including direct access patients) were fitted with hearing aids for OME. Majority (36/38) of children issued aids used them, 16 all day, 7 only at school, 1 only at home, 3 only when needed, and 9 used them for an unspecified duration; 1 child’s use of hearing aids was unrecorded, and 1 child refused to use it. 21 were fitted bilaterally and 17 unilaterally. 37 were behind the ear aids and 1 a BAHA softband.

A third of referrals to paediatric audiology by ENT are for consideration of hearing aids for OME. Only about half of children referred to audiology for hearing aids for OME actually receive them, as by the time they see audiology the hearing loss has frequently resolved or is asymptomatic so that aiding is unwarranted. Once fitted, they appear to be well accepted. Hearing aids have fair utilization in children fitted with them for OME.

Full reference: Gan, R.W.C. et al. (2017) Hearing aids for otitis media with effusion: Do children use them? International Journal of Pediatric Otorhinolaryngology. Vol. 99 (August) pp. 117–119.

Novel antimicrobial shows promise for children with AOM

Investigators examined the efficacy and safety of a new formulation of amoxicillin-clavulanate to treat acute otitis media (AOM) in children | Contemporary Pediatrics

Children with acute otitis media (AOM) are routinely and successfully treated with antimicrobials, with data showing that the combination of amoxicillin-clavulanate (A/C) to treat AOM in children aged younger than 3 years is associated with more favorable outcomes than placebo.

Although effective, antimicrobial treatment is associated with the unwanted adverse effect of diarrhea that studies show can affect between 25% to 48% of children. Children who experience this common adverse effect may have to wait to return to daycare until it resolves, which in turn may delay parents’ return to work.

Finding a way to maintain the efficacy of antimicrobial treatment while reducing this unwanted adverse effect was the objective of recent study by Hoberman and colleagues. Based on evidence showing that the clavulanate component of the routinely administered antimicrobial treatment is responsible for diarrhea, the investigators examined the efficacy and safety of a novel formulation of the antimicrobial in which the total effective dose of clavulanate is reduced.

The open-label study found that reducing the total dose of clavulanate was associated with the desired reduction in diarrhea and diaper dermatitis without appearing to compromise efficacy; however, the lead author of the study, Alejandro Hoberman, MD, chief, Division of General Academic Pediatrics, professor of Pediatrics and Clinical and Translational Science, Children’s Hospital of Pittsburgh of UPMC, Pennsylvania, emphasized that these findings will have to be properly studied in a larger clinical trial.

Current management of necrotising otitis externa in the UK

This survey aims to report the experience of 221 otolaryngologists in this condition | Acta Oto-Laryngologica  

Introduction: Necrotising otitis externa (NOE) is a rare infection causing skull base osteomyelitis. The evidence regarding NOE consists mostly of case series. Hence, there is a limited evidence base to guide decision-making.

Materials and methods: Internet survey administered to the membership of the British Association of Otorhinolaryngology – Head and Neck Surgery (ENT UK).

Results: Respondents’ detailed replies on diagnosis, treatment and follow up are presented. One third of respondents reported increasing incidence of NOE. Over 80% diagnosed NOE based on pre-existing risk factors, severe pain, non-resolution of infection and CT scan. Most respondents managed NOE with intravenous antibiotics (90%) and blood sugar control (82%). There was less agreement in certain aspects of management including the role of surgery and the nature and duration of follow up.

Conclusions: Our survey provides a picture of NOE management in the UK. While there is consensus in some aspects of NOE management, other aspects attract widely differing answers. This may reflect the lack of strong evidence in the literature. Future work should aim to address this.

Full reference: Chawdhary, G. et al. (2017) Current management of necrotising otitis externa in the UK: survey of 221 UK otolaryngologists. Acta Oto-Laryngologica . Vol. 137 (no. 8) pp. 818-822.

Parental views on otitis media

This study aims to describe parental experiences and perspectives of caring for a child with otitis media | European Journal of Pediatrics

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We conducted a systematic review of qualitative studies on parental perspectives on caring for a child with otitis media. We searched electronic databases to July 2015. Seventeen studies involving 284 participants from six countries were included. We identified seven themes: diminishing competency (guilt over failure to identify symptoms, helpless and despairing, fear of complications, disempowered and dismissed); disrupting life schedules (disturbing sleep, interfering with work, burden on family); social isolation (stigma and judgement, sick consciousness); threatening normal development (delaying growth milestones, impairing interpersonal skills, impeding education); taking ownership (recognising symptoms, diagnostic closure, working the system, protecting against physical trauma, contingency planning); valuing support (needing respite, depending on community, clinician validation); and cherishing health (relief with treatment success, inspiring resilience).

Conclusion: The additional medical responsibilities and anxieties of parents caring for a child with otitis media, often discounted by clinicians, can be disempowering and disruptive. Chronicity can raise doubt about treatment efficacy and parental competency, and fears regarding their child’s development. Care that fosters parental confidence and addresses their concerns about the child’s development may improve treatment outcomes for children with otitis media.

Full reference: Chando, S. et al. (2016) Parental views on otitis media: systematic review of qualitative studies. European Journal of Pediatrics. 175: 1295. 

Why are ototopical aminoglycosides still first-line therapy for chronic suppurative otitis media?

This systematic review aimed to establish that quinolones are as effective as aminoglycosides when used to treat chronic suppurative otitis media | The Journal of Laryngology & Otology

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The review included good quality, randomised, controlled trials on human subjects, published in English, that compared topical aminoglycosides with topical quinolones for the treatment of chronic suppurative otitis media.

Nine trials met the criteria. Two studies showed a higher clinical cure rate in the quinolone group (93 per cent vs 71 per cent, p = 0.04, and 76 per cent vs 52 per cent, p = 0.009). Four studies showed no statistically significant difference in clinical outcome. A significant difference in microbiological clearance in favour of quinolones was shown in two studies (88 per cent vs 30 per cent, p < 0.001, and 88 per cent vs 30 per cent, p < 0.001).

Topical quinolones do not carry the same risk of ototoxicity as aminoglycosides. Furthermore, they are equal or more effective in treating chronic suppurative otitis media and when used as prophylaxis post-myringotomy. Topical quinolones should be considered a first-line treatment for these patients.

Full reference: Harris, A.S. et al. (2017) Why are ototopical aminoglycosides still first-line therapy for chronic suppurative otitis media? A systematic review and discussion of aminoglycosides versus quinolones. The Journal of Laryngology & Otology. Vol. 130, (no. 01) pp. 2-7

Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis

High rates of negative microbiologic test results highlight the potential role of empiric antimicrobial agents in management of malignant otitis externa (MOE) | Annals of Otology, Rhinology & Laryngology

Aims: This study investigates the clinical presentation, laboratory findings, and response to empiric treatment in a large group of patients admitted to a tertiary academic hospital in Tehran, Iran.

Methods and Materials: We recruited 224 patients diagnosed with MOE in a prospective observation from 2009 through 2015. All patients received a 2-agent antibacterial regimen at baseline (phase I). Patients with no improvement within 10 days and/or nonresponders to a second course of antibacterials were switched to antifungals (phase II). Response to treatment was observed and documented in both groups.

Results: All patients had physical symptoms for more than 12 weeks before admission. In total, 127 patients responded well to antibacterials. Eighty-seven out of 97 patients who were switched to antifungals had complete response to treatment; patients in the latter group had significantly higher A1C levels at baseline.

Conclusion: Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.

Full reference: Hasibi, M. et al. (2017) A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran. Annals of Otology, Rhinology & Laryngology. 126(7) pp. 561 – 567

Effectiveness of Tympanostomy Tubes for Otitis Media

Tympanostomy tube placement is the most common ambulatory surgery performed on children in the United States| Pediatrics

Objectives: The goal of this study was to synthesize evidence for the effectiveness of tympanostomy tubes in children with chronic otitis media with effusion and recurrent acute otitis media.

Results: Children with chronic otitis media with effusion treated with tympanostomy tubes compared with watchful waiting had a net decrease in mean hearing threshold of 9.1 dB (95% credible interval: −14.0 to −3.4) at 1 to 3 months and 0.0 (95% credible interval: −4.0 to 3.4) by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after placement of tympanostomy tubes. Associated adverse events are poorly defined and reported.

Conclusions: Tympanostomy tubes improve hearing at 1 to 3 months compared with watchful waiting, with no evidence of benefit by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after tympanostomy tube placement, but the evidence base is severely limited. The benefits of tympanostomy tubes must be weighed against a variety of associated adverse events.

Full reference: Steele, D.W. (2017) Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics. 139 (6) e20170125