The clinical course of acute otitis media in high-risk Australian Aboriginal children: a longitudinal study

BACKGROUND: It is unclear why some children with acute otitis media (AOM) have poor outcomes. Our aim was to describe the clinical course of AOM and the associated bacterial nasopharyngeal colonisation in a high-risk population of Australian Aboriginal children. METHODS: We examined Aboriginal children younger than eight years who had a clinical diagnosis of AOM. Pneumatic otoscopy and video-otoscopy of the tympanic membrane (TM) and tympanometry was done every weekday if possible. We followed children for either two weeks (AOM without perforation), or three weeks (AOM with perforation), or for longer periods if the infection persisted. Nasopharyngeal swabs were taken at study entry and then weekly. RESULTS: We enrolled 31 children and conducted a total of 219 assessments. Most children had bulging of the TM or recent middle ear discharge at diagnosis. Persistent signs of suppurative OM (without ear pain) were present in most children 7 days (23/30, 77%), and 14 days (20/26, 77%) later. Episodes of AOM did not usually have a sudden onset or short duration. Six of the 14 children with fresh discharge in their ear canal had an intact or functionally intact TM. Perforation size generally remained very small (<2% of the TM). Healing followed by re-perforation was common. Ninety-three nasophyngeal swabs were taken. Most swabs cultured Streptococcus pneumoniae (82%), Haemophilus influenzae (71%), and Moraxella catarrhalis (95%); 63% of swabs cultured all three pathogens. CONCLUSION: In this high-risk population, AOM was generally painless and persistent. These infections were associated with persistent bacterial colonisation of the nasopharynx and any benefits of antibiotics were modest at best. Systematic follow up with careful examination and review of treatment are required and clinical resolution cannot be assumed

Efficacy and feasibility of teledermatology for paediatric medical education

We evaluated a teledermatology consultation service in the education of medical trainees. The selection of cases for consultation was at the discretion of the trainees, who could contact the study team for advice about obtaining photographs and submitting the case to a web-based system. Asynchronous structured feedback was provided to trainees by an academic paediatric dermatology consultant using a web-based interface. Efficacy was evaluated by examining the trainees' self-reported competency in clinical dermatology skills before and after teleconsultation. A total of 44 trainees (31 residents and 13 medical students) completed 50 consultations. Trainees reported significant improvement (mean improvement 22%, P < 0.002) in competency in five of the six areas assessed. In addition, 88% of trainees were very satisfied with the teaching methodology (≥5 on a 7-point scale) and 86% were very likely to apply the information in their future practice (≥5 on a 7-point scale). We believe that teledermatology has great potential in the education of medical trainees

Diagnosing otitis media - Otoscopy and cerumen removal

Proper performance of pneumatic otoscopy is critical to the accurate diagnosis of acute otitis media and otitis media with effusion. To provide optimal care for children, clinicians should master the techniques required for accurate determination of the presence or absence of these frequently occurring conditions. Copyright © 2010 Massachusetts Medical Society