Panel 7: otitis media:treatment and complications

Objective: We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources: PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods: All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions: Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice: Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention

Intranasal Drainage for Pediatric Nasal Abscesses

Nasal abscesses of the tip or soft tissues are uncommon in children. We describe an endonasal surgical approach for nasal abscesses based on our experience with 3 children at our tertiary care, academic children\u27s hospital. All presented with significant nasal pain out of proportion to the physical examination findings, along with edema, induration, and some intermittent bleeding and discharge of sebaceous and/or keratinous debris. Parenteral antibiotics were administered for an initial period of at least 24 hours in all cases, without any significant improvement in the patients\u27 symptoms. Computed tomography (CT) with intravenous contrast was diagnostic in all cases. Symptomatic relief was achieved immediately postoperatively. No child required a second drainage procedure, and all children had an uneventful recovery

Otoacoustic emission-based hearing screening of a Greek NICU population

The pressing need for early identification of hearing-disabled children has led to the development of several neonatal hearing screening programmes world-wide. Today otoacoustic emissions represent a widely used methodology for identification of neonatal hearing impairment. The purpose of the present study is to determine the sensitivity and specificity of click-evoked otoacoustic emissions (cEOAEs) in a Greek NICU population and compare the cEOAE data to the final hearing status of these children. A total of 438 ears of 223 neonates at high risk for hearing impairment were tested with both brainstem response audiometry (ABR) and cEOAEs. In 107 neonates the final hearing status was determined by using behavioural and playtone audiometry, at an age greater than 2 1/2 years. The sensitivity and specificity of the cEOAEs were found to be 90 and 92.4% when compared to ABR results and 90.9 and 91.1% when compared to the children’s hearing status, respectively. Click-EOAEs have been proved to be highly effective in determining whether or not hearing impairment really exists. Since conventional ABR does not meet the requirements for large scale screening programmes, the cEOAEs represent a reliable alternative. (C) 1999 Published by Elsevier Science Ireland Ltd. All rights reserved