Dissertations / Theses on the topic 'Acute otitis media'

Acute otitis media is the most common illness diagnosed during early childhood that can cause significant morbidity (Brook, 1994) and sometimes can cause irreversible sequelae such as a hearing defect and subsequent learning difficulties (Klein, 1994). The aims of the research presented here were to study some aspects of the middle ear defence mechanisms in both immune and non-immune rats following experimental otitis media (OM) with two pathogens nontypeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (M. catarrhalis). This study also aimed at developing a suitable technique for preparing immunohistochemical staining of middle ear sections (chapter 2). A previous study has shown that a regime where rats received an IPP immunisation combined with an IT boost was effective in enhancing clearance of a middle ear infection with the same strain of NTHi and also in the presence of a concomitant viral infection (Moore et al, 2001). Results of this study have shown that for NTHi infection a distinct cellular influx to the middle ear in the immune rats was accompanied by an enhanced bacterial clearance compared to the non-immunised rats (chapter 3). This cellular influx was responsible for the remarkable reduction in the bacterial number. The sharp decline in PMNs numbers in the NTHi immunised rats that followed complete bacterial clearance at 72h post infection (Table 3.1) indicate a more effectively controlled down regulation of this cell infiltrate than the non-immunised rats. For M. catarrhalis infection, there was no difference in cell infiltrate between immune and non-immune rats, but enhanced clearance of the bacteria were observed for the immune animals. The histopathological changes in the middle ear mucosa of rats with experimentally induced infection were studied to provide a better understanding about the distribution of the inflammatory cells and changes in the mucosa during the first 24h post challenge with NTHi and M. catarrhalis (Chapter 4). These changes have not been previously studied for the two pathogens at 24h post challenge in rats. Induced infections with the two pathogens were found to produce similar histopathological changes but more inflammatory infiltration was observed within the infected mucosa with NTHi than that seen with M. catarrhalis. The infections were characterized by increased thickness of the middle ear mucosa, Eustachian tube mucosa, periosteum and tympanic membrane. There was also an increase in the number and size of small blood vessels at all sites, and these small blood vessels seem to be the source of the inflammatory infiltration into the middle ear mucosa and middle ear cavity during the infection. These findings provided an essential background to the immunohistochemical study. The effect of mucosal immunisation on the distribution of CD4+T cells and CD8+T cells has not been investigated previously. Results of the present study (Chapter 5) show the pattern of distribution of these cells during the first 48h post infection with NTHi in the rat. The number of CD4+and CD8+T cells peaked at 24h post infection in the nonimmunised animal and were highest at 48h post-infection in the immunised rats. The difference in response in the immunised rats may represent regulation of the inflammatory response by the immune system. The inflammatory response regulation is indicated by the difference in cellular influx into the immune rats and the response in the immune rats that corresponds to enhanced bacterial clearance prior to a decrease in numbers of inflammatory cells once the bacteria was no longer detected (Chapter 3). This resolution of the inflammatory mass would reduce the opportunity for continued damage to local tissue. These changes are also supported by the reduction in the thickness of the middle ear mucosa of the immunised rats especially at 24h and 48h post-infection (Chapter 5). This study has shown that there are distinct differences in the rate of bacterial clearance and cellular changes in the middle ear mucosa and tympanic bulla in immunised rats during a middle ear infection. Future studies are still required to gain a better understanding of differences in the inflammatory response for both pathogens, NTHi and M. catarrhalis.

Acute otitis media ( AOM) is one of the most common indications for antibiotic use in children. We used the Régie de l'assurance maladie du Québec databases to better understand the prescribing patterns of physicians and to assess the effectiveness of different antibiotics in the treatment of AOM. We selected a cohort of 60,513 children aged < 6 years with a first episode of AOM between June 1999 and June 2002. Failure was defined as either a new dispensation of antibiotic or a hospitalization or outpatient visit for complications related to AOM in the following 30 days. The antibiotic most widely used was amoxicillin (42.8%). Failure occurred in 12,693 (21%) children. Overall, azithromycin was the only antibiotic that was less associated with failure when compared to amoxicillin (odds ratio 0.88; 95% confidence interval 0.82, 0.94). In the first 3 days of treatment, a 50% increased risk of failure was seen when macrolides were initially given. However, azithromycin was associated with a 20% decrease in the risk of failure occurring > 14 days after the beginning of treatment. Other risk factors associated with treatment failure were age < 24 months, antibiotics or hospitalization in the preceding month, and otitis-prone conditions. Considering the results of the effectiveness study, the importance of macrolides resistance among pneumococci, and because there is no single factor or combination of factors that predict with certainty which child will develop early or late failure, amoxicillin should remain the first-line drug of choice.

Abstract The purpose was to evaluate the microbiological mechanism of action of xylitol and to assess its use in clinical practice for preventing acute otitis media (AOM). To test whether the effect of xylitol on S. pneumoniae is inhibited by fructose, a total of 20 strains of S. pneumoniae were exposed to xylitol in the presence of fructose and other carbon sources. Addition of 5% xylitol to the media resulted in marked growth inhibition, an effect which was totally eliminated in the presence of 1%, 2.5% or 5% fructose but not in the presence of 1% or 5% glucose, 1% galactose or 1% sucrose. The inhibition of pneumococcal growth is probably mediated via a fructose phosphotransferase system in a similar manner to that seen in mutans streptococci. Sorbitol alone did not affect the growth of pneumococci, and thus sorbitol is unlikely to provide any clinical benefit in the prevention of AOM. To evaluate the effect of xylitol on the ultrastructure of S. pneumoniae and Haemophilus influenzae (H. influenzae) and on the pneumococcal phenotype, five strains of S. pneumoniae and one strain of H. influenzae were examined by electron microscopy after xylitol exposure. Xylitol damaged the ultrastructure of the pneumococci. Some of the bacteria were lysed and the cell wall of the remaining ones became more diffuse and the polysaccharide capsule was ragged. The resulting morphology was identical to that of the transparent pneumococcal phenotypic variant. The properties of the transparent variants of pneumococci could explain the clinical efficacy of xylitol in preventing AOM despite the lack of effect on the nasopharyngeal carriage of pneumococci. The cell wall of H. influenzae became slightly thicker, but the morphology remained otherwise unchanged. To evaluate the pharmacokinetics of xylitol locally in the nasopharynx, xylitol concentrations were measured in the saliva of 65 children by enzymatic assay after giving them xylitol chewing gum or syrup at doses equal to those used in clinical trials. Concentrations high enough to have an antimicrobial effect were attained, but the xylitol disappeared from the saliva within 15 minutes, which indicates that high peak concentrations may be more important for efficacy than the time for which the concentration exceeds the level needed for an antimicrobial effect. To find a more convenient dosing regime for xylitol prophylaxis, xylitol was administered to 1277 children only during an acute respiratory infection (ARI) in a randomised placebo-controlled trial. The occurrence of AOM during ARI was 34/166 (20.5%) in the xylitol mixture group as compared with 32/157 (20.4%) among the children receiving the control mixture. Among older children receiving control chewing gum, xylitol chewing gum or xylitol lozenges, AOM was experienced by 24/218 (11.0%), 31/220 (14.1%) and 34/219 (15.5%) respectively. None of the differences between the groups was statistically significant. Xylitol should be used continuously in AOM prophylaxis, as it proved ineffective when used only during URI.

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children in the United States. Previous trials evaluating an optional antibiotic prescription are limited and have significant limitations. None have evaluated an optional prescription in the urgent care setting. We conducted a randomized, controlled trial in an urban emergency department in which children aged 6 months to 12 years diagnosed with AOM were randomly assigned a "wait-and-see prescription" (WASP) or a "standard treatment prescription" (STP). Structured phone interviews were conducted 4-6, 11-14, and 30-40 days after enrollment to determine the proportion of each group that filled the antibiotic prescription and outcomes related to the clinical course. Substantially more parents in the WASP group (N=138) did not fill the antibiotic prescription compared to the STP group (N=145) (62% vs. 13%; P<0.001). There were no statistically significant differences between the groups in the frequency of subsequent fever, otalgia or unscheduled visits for medical care. Within the WASP group, both fever (OR = 4.0, 95% confidence interval, 1.7-9.5) and otalgia (OR = 4.5, 95% confidence interval, 1.7-11.5) were associated with filling the prescription. The WASP approach substantially reduced unnecessary use of antibiotics in children and is a reasonable alternative to routine use of antimicrobials for treatment of AOM.

Otitis Media is one of the most common childhood diseases. Recurrent acute otitis media RAOM is characterized by repeated episodes of inflammation of the middle ear in conjunction with middle ear fluid, and often with an inflamed or bulging eardrum. Defective clearance by the Eustachian tube results in mucus build-up and is characteristic of otitis media with effusion (OME). Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory syncytial virus, and rhinovirus are the most common contributors to otitis media pathogenesis. In New Zealand, OME has been implicated with conductive hearing loss in childhood and has been shown to significantly impact on speech and language development. New Zealand Māori and Polynesian children have displayed significantly higher hearing test failure rates than European-Caucasian children. The collectins, Surfactant Protein (SP)-A and -D are encoded by three genes (SP-A1, SP-A2, and SP-D) and are host defense proteins present in the middle ear and Eustachian tube. Single nucleotide polymorphisms (SNPs) in SP-A1 and SP-A2 have been associated with increased or decreased susceptibility to otitis media, meningococcal disease, and range of respiratory diseases. Using allele-specific primers and real-time PCR with SYBR Green I melting curve analysis, four groups of individuals were genotyped for eleven SP-A1, SP-A2, and SP-D SNPs: European-Caucasian individuals with RAOM/OME; New Zealand Māori/Polynesian individuals with RAOM/OME; individuals with meningococcal disease; and a control group. The computer program, Haploview, was employed to perform χ2 analyses and identify statistically significant associations of alleles/haplotypes with RAOM/OME or meningococcal disease. In the European-Caucasian population, two SP-A1 alleles, one SP-A2 allele, and four haplotypes (CGAGC, 1A3, 1A9, and 1A10) were found to be associated with increased risk of RAOM/OME (P lt; 0.05). Conversely, haplotypes 6A2 and 1A2 were found to be protective against susceptibility to RAOM/OME (P lt; 0.05). In New Zealand Māori and Polynesian individuals, two SP-A1 alleles, three SP-A2 alleles, one SP-D allele, and four haplotypes (6A8, 6A10, 1A3, and 1A10) were found to be associated with increased risk of RAOM/OME (P lt; 0.05). An additional four haplotypes (6A2, 1A0, 1A2, and TA) were determined to be protective against susceptibility to RAOM/OME (P lt; 0.05). However, protective SPA1/SPA2/SPD haplotype 6A2-1A0-TA was significantly under-represented in the New Zealand Māori and Polynesian population (P lt; 0.05). A single allele and haplotype were associated with increased risk of meningococcal disease (P lt; 0.05). The findings of this study confirm that specific genetic variants of SP-A and SP-D are associated with either increased or decreased risk of developing RAOM and/or OME. Furthermore, it was demonstrated that New Zealand Māori and Polynesian individuals appear to exhibit more haplotypes susceptible to RAOM/OME. This may provide a partial explanation for the higher RAOM/OME-related failure rates of hearing tests in New Zealand Māori and Polynesian children. However, there are numerous socio-economic and environmental factors that also contribute to otitis media pathogenesis which were not considered in this study. The effects of the SP-A1, SP-A2, and SP-D alleles and haplotypes on the bacterial/viral binding efficiencies of SP-A and SP-D need to be investigated by further research, using a large population, to confirm the association with susceptibility or resistance with RAOM/OME.

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM). Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics. Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Abstract The purpose of this study was to evaluate the effect of antibiotic treatment and surgery on acute otitis media (AOM), and to evaluate quality of life (QoL) among children with AOM and their parents. To evaluate the effectiveness of antibiotics, a total of 82 children with AOM were randomized for antibiotic or placebo treatment for 7 days. The duration of middle ear effusion was measured by daily tympanometry screenings at home over 2 weeks. Duration was also measured at clinical visits, including at entry, after 3 days, after 7 days, and then weekly until both ears were healthy according to pneumatic otoscopy or otomicroscopy, or for a maximum of 2 months. Among the group receiving antibiotics, middle ear effusion disappeared 2.0 weeks earlier than among those receiving placebo (P<0.02). On day 14, 69% of children in the antibiotic group and 38% in the placebo group had normal tympanometry findings (P=0.02). On day 60, 5% of children in the antibiotic group and 24% in the placebo group had persistent middle ear effusion (P=0.01). The effect of surgery was assessed by randomly assigning 300 children with recurrent AOM, aged 10 months to 2 years, into 3 groups: 1. to receive ventilation tubes (VTs), 2. to receive VTs and adenoidectomy and 3. non-surgery. Follow-up of children occurred at clinical visits every 4 months for a 1-year period. If children suffered from upper respiratory symptoms or their parents suspected AOM during this period they were encouraged to receive additional follow-up care. Intervention was considered unsuccessful if a child had 2 AOM episodes in 2 months, 3 episodes in 6 months or persistent effusion lasting for 2 months. Intervention failed in 34% of children in the non-surgery group, 21% in the VT group (P=0.04 compared to non-surgery) and 16% in the group with VT and adenoidectomy (P=0.004 compared to non-surgery). QoL was assessed among 159 children participating in the study on the effect of surgery in children with recurrent AOM. We used disease-specific (Otitis Media-6) and generic instruments (Child Health Questionnaire-50) to measure QoL among children with AOM and their parents, and the effect of surgery on QoL. Children with AOM and their parents had a significantly poorer QoL than healthy children. QoL improved significantly at 1-year follow-up, but it did not reach the level observed in healthy children. Surgery did not have any additional impact on QoL
Tiivistelmä Työn tavoitteena oli tutkia antibiootin ja kirurgian vaikutusta äkilliseen välikorvatulehdukseen sekä tutkia välikorvatulehduksia sairastavien lasten ja heidän vanhempiensa elämänlaatua. 82 äkillistä välikorvatulehdusta sairastavaa lasta satunnaistettiin saamaan joko antibiootti- tai lumelääkettä. Välikorvaeritteen poistumista seurattiin kotona päivittäisillä tympanometriamittauksilla kahden viikon ajan. Seurantakäynnit olivat yhden, kolmen ja seitsemän päivän kuluttua sekä viikoittain, kunnes korvat oli todettu terveiksi pneumaattisella otoskoopilla tai korvamikroskoopilla tai kahden kuukauden seuranta-aika päättyi. Välikorvaerite poistui kaksi viikkoa aikaisemmin antibiootti- kuin lumelääkkeellä (P<0.02). Tympanometria normalisoitui kahden viikon kuluttua 69 %:lla antibioottiryhmästä ja 38 %:lla lumelääkeryhmästä (P=0.02). 60 päivän kuluttua välikorvaeritettä oli 5 %:lla antibioottiryhmästä ja 24 %:lla lumelääkeryhmästä (P=0.02). Kirurgian vaikuttavuutta toistuviin äkillisiin välikorvatulehduksiin tutkittiin satunnaistamalla 300 10–24 kk:n ikäistä lasta saamaan ilmastointiputket tai sekä ilmastointiputket että kitarisanpoisto tai ei kumpaakaan. Seurantakäynnit olivat neljän kuukauden välein vuoden ajan tai aina kun lapset sairastuivat ylähengitystietulehdukseen tai vanhemmat epäilivät välikorvatulehdusta. Interventio katsottiin epäonnistuneeksi (äkillisiä välikorvatulehduksia 2 / 2 kk, 3 / 6 kk tai jatkuva erite 2 kk) 34 %:lla ilman kirurgiaa hoidetuista lapsista, 21 %:lla ilmastointiputkiryhmän lapsista (P=0.04 verrattuna ilman kirurgiaa hoidettuihin) ja 16 %:lla lapsista, joille tehtiin sekä kitarisan poisto että asetettiin ilmastointiputket (P=0.004 verrattuna ilman kirurgiaa hoidettuihin). Elämänlaadun, äkillisen välikorvatulehduksen sekä siihen liittyvän kirurgian välistä yhteyttä selvitettiin 159 lapsella, jotka osallistuivat kirurgian vaikuttavuutta selvittävään tutkimukseen. Elämänlaatua mitattiin sekä tautikohtaisilla (Otitis Media-6) että yleistä elämänlaatua (Child Health Questionnaire-50) mittaavilla kyselylomakkeilla. Äkillistä välikorvatulehdusta sairastavilla lapsilla ja heidän vanhemmillaan oli merkittävästi huonompi elämänlaatu kuin terveillä. Elämänlaatu parani merkittävästi vuoden seuranta-aikana, mutta ei saavuttanut terveiden tasoa. Kirurgia ei tuonut mitään lisähyötyä elämänlaatuun

Este estudo teve como objetivo verificar a liberação de xilitol em saliva artificial ao longo do tempo após aplicação de verniz contendo 10% e 20% do açúcar. Para tal, 15 blocos de dentes bovinos foram divididos em três grupos (Grupo 1- recebeu verniz a 10%; Grupo 2 - recebeu verniz a 20% e Grupo 3 - recebeu verniz sem xilitol). Na seqüência, cada bloco foi imerso em tubo de microcentrífuga contendo 500 µL de saliva artificial. Foram coletadas e analisadas as amostras salivares em diferentes tempos após a aplicação do verniz (1h, 8h, 12h, 16h, 24h, 48h e 72h). Comparando-se os valores de concentração de xilitol em mg/L nos grupos G1 e G2, pode-se observar que houve diferença estatisticamente significante entre os grupos (ANOVA, F=32,68, p=0,0004) e tempos (ANOVA, F=2465,53, p=0,0000). Foi observada interação entre as variáveis grupo e tempo (ANOVA, F=1486,25, p=0,0000). Notou-se uma liberação significativamente maior no Grupo G2 nos tempos de 1 h (168,96 mg/L) e 8 h (164,22 mg/L), quando comparados com o Grupo G1 (1 h=63,42 mg/L e 8 h=69,52 mg/L), conforme detectado pelo teste de Tukey (p=0,0002). No entanto, nos tempos de 12 h, 16 h, 24 h, 48 h e 72 h, a liberação do açúcar foi significativamente maior no Grupo 1 (56,92 mg/L; 49,70 mg/L; 49,40 mg/L; 55,52 mg/L; 32,66 mg/L, respectivamente) em relação ao Grupo 2 (29,90 mg/L; 18,52 mg/L; 19,76 mg/L; 24,20 mg/L; 12,72 mg/L, respectivamente), conforme detectado pelo teste de Tukey (p=0,0002). Portanto, o verniz contendo 10% de xilitol liberou maiores concentrações do açúcar em períodos de tempo mais longos, denotando-se em uma liberação mais lenta e homogênea deste verniz.
The aim of this study was to test xylitol release in artificial saliva along time after application of varnishes containing 10% and 20% xylitol. For this purpose, 15 block of bovine teeth were divided into three groups (Group 1-varnish 10%; Group 2-varnish 20%; Group 3-control). In sequence, each block was immersed in a microcentrifuge tube containing 500 µL of artificial saliva. Saliva samples were collected and analyzed for xylitol in different times after varnishes application (1h, 8h, 12h, 16h, 24h, 48h e 72h). Data were analyzed by 2-way ANOVA and Tukey?s test (p<0.05). An interaction between group and time was observed (ANOVA, F=1,486.25, p=0.0000). Xylitol release was significantly higher for Group G2 in times 1 h (168.96 mg/l) and 8 h (164.22 mg/l) when compared with Group G1 (1h=63.42 mg/l e 8h=69.52 mg/l). However, for the other periods, the sugar release was significantly higher in Group 1(56.92 mg/l; 49.70 mg/l; 49.40 mg/l; 55.52mg/l and 32.66 mg/l, respectively, for 12 h, 16 h, 24 h, 48 h and 72 h) when compared to Group G2 (29.90 mg/l; 18.52 mg/l; 19.76 mg/l; 24.20 mg/l and 12.72 mg/l, respectively). In conclusion, the varnish containing 10% xylitol released sugar more slowly and for longer periods, characterizing a more homogeneous release.

Thesis (M.A.)--Northern Kentucky University, 2008.
Made available through ProQuest. Publication number: AAT 1450592. ProQuest document ID: 1495953201. Includes bibliographical references (p. 30-32)

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução e objetivos: A otite média aguda (OMA) é uma infeção muito comum em idade pediátrica, sendo precedida por colonização bacteriana da nasofaringe (NF). Algumas crianças têm infeções recorrentes, nas quais podem estar envolvidos diferentes microrganismos ou combinações dos mesmos, bem como a formação de biofilmes. Uma das formas de estudar a etiologia da OMA é através da timpanocentese, procedimento não utilizado por rotina em Portugal. A otorreia pode complicar a OMA (OMA com otorreia, OMAO), permitindo um acesso mais fácil à amostra biológica. O objetivo deste estudo foi analisar a etiologia da OMA e da OMA recorrente (OMAR) na era das vacinas conjugadas pneumocócicas e avaliar se a presença de várias espécies bacterianas é mais comum em crianças com OMAR. Materiais e métodos: Entre dezembro de 2013 e abril de 2016, foram colhidas simultaneamente secreções nasofaríngeas e otorreia de crianças em idade pré-escolar com diagnóstico de OMA, com otorreia com duração inferior a 3 dias e presença de febre e/ou irritabilidade e/ou otalgia. OMAR foi definida como 3 ou mais episódios de OMA nos últimos 6 meses ou 4 ou mais no último ano. Após extração de DNA, as amostras foram submetidas a qPCR de gene único para Streptococcus pneumoniae (Sp) (lytA), Haemophilus influenzae (Hi) (hdp), Moraxella catarrhalis (Mc) (ompJ), Staphylococcus aureus (Sa) (nuc) e Streptococcus do grupo A (SGA) (ntpC). Resultados: Das 151 crianças incluídas no estudo, 85 (56%) eram rapazes e a idade média era de 31 meses (2-81). Sp foi detetado em 71 (47%) casos, Hi em 82 (54%), Mc em 45 (30%), Sa em 32 (21%) e SGA em 37 (25%). Verificou-se uma maior probabilidade de detetar Sp (p=0,024) e Hi (p=0,007) na otorreia das crianças com OMAR, relativamente às crianças com OMA. Das 27 crianças com OMAR, 23 (85%) tinham 2 ou mais bactérias presentes na otorreia; das 124 sem OMAR, 64 (52%) tinham 2 ou mais bactérias (p=0,001). Conclusões: As bactérias mais frequentemente detetadas na otorreia foram Hi e Sp. Crianças com OMAR tinham com maior frequência múltiplas espécies bacterianas, o que pode, em parte, explicar a maior dificuldade de tratamento e a menor efetividade das vacinas pneumocócicas conjugadas nessas crianças.
Introduction and aims: Acute otitis media (AOM) is one of the most frequent infections in the paediatric age and is preceded by nasopharyngeal (NP) bacterial colonisation. Some children suffer from recurrent infections, which might involve different bacterial species or combinations of them, as well as biofilm formation. One way of assessing its etiology is by tympanocentesis, a procedure not routinely performed in Portugal. AOM may be complicated by otorrhea (acute otitis media with otorrhea, AOMO), allowing an easier access to biological samples. The aim of this study was to analyse the aetiology of AOM and recurrent AOM (RAOM) in the pneumococcal conjugate vaccines era and evaluate if the presence of several bacterial species was more common in children with RAOM. Material and methods: From December 2013 to April 2016, NP and otorrhea samples were simultaneously collected from preschool-aged children with AOM with otorrhea lasting less than 3 days and presence of fever and/or irritability and/or otalgia. RAOM was defined as 3 or more episodes of AOM in the last 6 months or 4 or more in the past year. After DNA extraction, the samples were subjected to single gene qPCR for Streptococcus pneumoniae (Sp) (lytA), Haemophilus influenzae (Hi) (hdp), Moraxella catarrhalis (Mc) (ompJ), Staphylococcus aureus (Sa) (nuc) and Group A Streptococcus (GAS) (ntpC). Results: Of the 151 children included in the study, 85 (56%) were male and the mean age was 31 months (2-81). Sp was detected in 71 (47%) samples, Hi in 82 (54%), Mc in 45 (30%), Sa in 32 (21%) and GAS in 37 (25%). There was a higher probability of finding Sp (p=0.024) and Hi (p=0.007) in the otorrhea of children with RAOM, compared to children with AOM. Of the 27 children with RAOM, 23 (85%) had 2 or more bacteria present in the otorrhea; of the 124 children without RAOM, 64 (52%) had ≥2 bacteria (p=0.001). Conclusion: The bacteria most frequently detected in otorrhea were Hi and Sp. Children with RAOM had more often multiple bacterial species, which might, in part, explain the difficulties in treating these infections and contribute for the lower effectiveness of pneumococcal conjugate vaccines in these children.

碩士
高雄醫學大學
藥學研究所碩士在職專班
93
Abstract Objectives: To determine the impact of antibiotic prescribing at initial visit on the probability and frequency of acute otitis media (AOM)-related return visit. Methods: This study was a retrospective cohort. Total 89,370 patients were continuously enrolled this study from the National Health Insurance Database, period between March 1, 2001 to December 31, 2003. On the basis of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-Code). Sample selection were claimed ICD-9 (381.0, 381.00, 381.01, 381.4, 382.00, 382.01, 382.4, 382.9) for AOM. We constructed the decision tree to compare two strategies, first-line (from the NHI reimbursement and erythromycin) and second-line (Augmentin, cefuroxime, cefaclor, cefpodoxime, ceftriaxone) antibiotics treated, by estimating the return visit of patients. Initial visit: absence of AOM-related visit 90 days prior to visit, return visit: AOM-related visit that occurs within 60 days after an initial visit. Data was analysis statistical by using univariate and multivariate analysis. Results : There were totally about 75.31% of the enrolled patients being prescribed antibiotics, 67.70% of them accepted first-line antibiotics, 41.6% of the subjects in first-line antibiotics treated group experienced a return visit and the ratio among those treated with second-line was 52.9%, Obviously, the ratio of requiring a first return visit was observed to be lower in treating with first-line antibiotics. Besides, the mean return visit number required for the first-line was 0.84 and second-line was 1.22 in average. During the return visit, for those initially treated with first-line, 85.7% of them would stay in same group and 14.3% of them will be changed to second-line. Among second-line group, 78.1% of them would stay in same group and 21.9% of them will be changed to first-line. By the way, for first-line group: the cost of antibiotics only was NT$ 80.33, if combined with other drugs: NT$186.58 and if all the medical expense were included: NT$729.89. In contract to second-line group: antibiotics only cost: NT$174.33, combining drug cost: NT$300.09 and total cost: NT$891.57. The first-line antibiotic therapy also showed more preferable result in the cost. Conclusion: Base on the results collected from AOM patients enrolled in this study, the first-line antibiotics can meet the purpose of prevention and also be cost saving.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Contexto: Apesar do decréscimo na incidência com o aparecimento dos antibióticos, a mastoidites aguda é uma complicação frequente da otite media aguda em crianças. Não há consenso no que diz respeito ao tratamento da mastoidite aguda em crianças, o que resulta em diferenças na sua abordagem de hospital para hospital.Objetivos: O principal objetivo do trabalho foi compreender a melhor abordagem da mastoidite aguda em crianças, de acordo com os resultados da bibliografia disponível.Métodos: Foi feita uma revisão sistemática através da base de dados PubMed.Resultados: Nesta revisão foram incluídos sete estudos, com um total de 259 doentes. As taxas de cura com tratamento antibiótico exclusive e cirurgia foram de 93.65% e 97.96%, respetivamente.Conclusão: A mastoidectomia é o tratamento definitivo para a patologia em estudo. No entanto, esta revisão sugere que uma abordagem conservadora (tratamento com antibiótico ou miringotomia) tem uma taxa de sucesso superior a 90% como tratamento de primeira linha, sem as complicações expectáveis de uma cirurgia agressiva, apoiando uma abordagem step-based da mastoidite aguda .
Background: Despite its declining incidence in the post-antibiotic era, acute mastoiditis is a common complication of acute otitis media in children. There is some controversy regarding the management of acute mastoiditis in children, resulting in different approaches according to each center.Objectives: The main goal of our work was to highlight the best management of acute mastoiditis in children according to reported treatment outcomes.Method: A systematic review was conducted using PubMed database.Results: Seven studies were included in this review, with a total of 259 patients. Cure rates with antibiotic treatment and surgery were 93.65% and 97.96%, respectively.Conclusion: Mastoidectomy is the most definitive treatment available. However, this review suggests that a conservative approach (antibiotic therapy or myringotomy) has a success rate of more than 90% as first-line treatment, without the expected complications of surgery, supporting a step-based management of acute mastoiditis .

Introduction: Les instillations nasales de solution saline isotonique (INSS) chez les enfants sont recommandées par les pédiatres et des oto-rhino-laryngologistes de notre institution dans le but de prévenir les otites moyennes aigues à répétition (OMAr). Cependant, aucune étude dans la littérature ne vient corroborer ou infirmer cette pratique. Objectifs: Déterminer l’efficacité des INSS dans la prévention des OMAr. Méthode: Projet pilote d’un essai clinique randomisé. Les enfants diagnostiqués avec des OMAr étaient éligibles. Les patients recrutés ont été randomisés en 2 groupes. Seul le groupe traitement procède aux INSS. L’issue primaire est l’incidence d’OMAr pendant une période de 3 mois. Résultats: Vingt-neuf patients satisfaisant les critères d’inclusion et d’exclusion ont consenti à participer. Le taux d’OMAr était inférieur dans le groupe traitement (p=0.03, chi-carré) Conclusion: Les INSS semblent efficaces dans la prévention des OMAr. Une étude multicentrique est indiquée pour vérifier la validité externe et confirmer la sécurité.
Introduction: Normal saline nasal cavity irrigations (NSNI) are commonly recommended by pediatricians and otolaryngologists to prevent recurrent acute otitis media (rAOM). However, no published scientific study corroborates or invalidates this practice. Goal: To determine the efficacy of NSNI to prevent rAOM. Method: Pilot randomized controlled clinical trial. All consecutive patients with a diagnosis of rAOM were eligible. Recruited patients were randomized in 2 groups. Only patients in the treatment group proceeded with NSNI. The primary outcome of the study was the incidence of rAOM observed during a 3 month period. Results: Twenty-nine patients met the inclusion and exclusion criteria and agreed to participate. There was a statistically significant lower incidence of rAOM in the treatment group (p=0.003, Fisher exact). Conclusion: Our results suggest that NSNI could effectively prevent rAOM. A larger scale randomized multicentre study is feasible, and it must be done in order to verify for external validity and to properly assess safety issues.