How to Treat Otitis Media
Mild cases, characterised by pinkness or infection of the eardrum, often resolve spontaneously and need only analgesia and observation. They are normally viral. A bulging, inflamed eardrum indicates bacterial otitis media usually due to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Bran-hamella) catarrhalis, Streptococcus pyogenes (Group A) or Staphylococcus aureus. Amoxicillin or co-amoxiclav is satisfactory, but the clinical benefit of antibiotic therapy is very small when tested in controlled trials. Chemotherapy has not removed the need for myringotomy when pain is very severe, and also for later cases, as sterilised pus may not be completely absorbed and may leave adhesions that impair hearing. Chronic infection presents a similar problem to that of chronic sinus infection, above.
Haemophilus influenzae is a small gram-negative bacterium whose natural host is the human upper respiratory tract, in which it can cause mucosal infections, otitis, sinusitis, and meningitis, particularly in young children. Its genome consists of a single circular chromosome 1.83 million base pairs long, which is relatively small compared with the genome of its cousin, E. coli, which exceeds 4.3 million base pairs. Its small genome and the therapeutic interest of this bacterium as a target made H. influenzae the candidate of choice for the first complete automated genome sequencing project, carried out in 1995 at TIGR (The Institute of Genome Research), in the United States.
3 Pain is frequently referred from one segment to another. Thus, a patient with a carcinoma of the tongue (lingual nerve) frequently complains bitterly of earache (auriculotemporal nerve). The classical description of such a case is an old gentleman sitting in out-patients spitting blood and with a piece of cotton wool in his ear.
A 3-year-old boy is brought to your office by his mother for evaluation of fever, loss of appetite, and emesis. The symptoms have been present for 2 days the fever is only temporarily relieved with antipyretics. You perform a physical examination and diagnose otitis media. What is your most likely physical finding on otoscopic examination (A) Otitis media (B) Serous otitis (D) Otitis externa 13. A 15-year-old member of the high school marching band comes to your office for evaluation of hearing loss. He had multiple ear infections as an infant and toddler, and had to have myringotomy tubes inserted in his ears. Additionally, he suffers from many allergies. His hearing is diminished in the right ear. When you place a vibrating tuning fork on the top of his head, the sound lateralizes to the right ear. The name of this test is
Several semisynthetic derivatives of erythromycin A, including clarithromycin (22), di-rithromycin (23), flurithromycin (24), and roxithromycin (25), have been successfully developed and are currently in clinical use. These semisynthetic newer macrolides are used for the following indications community acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute bacterial sinusitis, tonsillitis pharyngitis, otitis media, skin and soft-tissue infections, and ophthalmologic infections. They possess good antibacterial activity against the common respiratory pathogens such as Streptococcus pyogenes, Streptococcus pneumoniae, H. influenzae, and M catarrhalis as well as atypical bacteria such as L. pneumophila, M. pneumoniae, and C. pneumoniae. In addition to these derivatives of erythromycin A, an oleandomycin (26) analog called triacetyloleandomycin (27) has also been developed for limited clinical use.
19.2 A 40-year-old male presents with severe unilateral ear pain for the past 3 days. He swims laps daily at the YMCA for exercise. Which of the following are you most likely to find on examination 19.2 C. This patient has symptoms suggestive of swimmer's ear, otitis externa, probably caused by P. aeruginosa. The most common examination finding consistent with this is an inflamed external auditory canal. Other findings might be pain with movement of the external ear and exudates in the auditory canal.
Otitis Media Otitis media is the most frequent illness diagnosis made in pediatric practice for children younger than 15 years old. By 1 year, 60 of children will have been diagnosed with otitis media, and by 3 years of age, 80 of children will have had at least one episode (66). In a survey by the Centers for Disease Control and Prevention in 1990, otitis media was the primary diagnosis at 24.5 million visits to the doctor (67). Paradise et al. examined the records of more than 2200 Pittsburgh area infants and found antimicrobial therapy for otitis media was prescribed on average for 41 days of the first year and 48 days of the second year (68). Despite the frequency with which otitis media is diagnosed and the vast amount of antibiotics prescribed for it, there is a striking lack of data on the extent of pain associated with otitis media and the appropriate treatment of that pain. Otalgia is a frequent presenting symptom associated with otitis media. There are many...
Otitis media, 365 million Gastroenteritis, 10 million Necrotizing entercolitis, 3 billion Gastroenteritis, 291.3 million Respiratory syncytial virus, 225 million Insulin-dependent diabetes, 10 to 125 million Otitis media, 660 million Food vouchers for breastfeeding mothers vs. medical costs for gastroenteritis and otitis media in formula-fed infants Office visits, drug prescriptions, hos-pitalizations of breastfed vs. nonbreastfed infants Office visits, drug prescriptions, hos-pitalizations of breastfed vs. nonbreastfed infants
Most, but not all, AT homozygotes express clinically significant, but nonprogressive, humeral and cellular immune defects. These can include one or more of the following thymic hypoplasia, low numbers of circulating T cells, functional impairment of T-cell-mediated immunity, abnormally high levels of IgM, oligo-clonal expansions, and or selective deficiencies of IgA, IgE, IgG2, and IgG4 (8-10). Opportunistic infections are rare however, otitis media and sinus infections are frequent. The risk of lower respiratory infections (pneumonia and bronchitis) increases with age, and the combination of immunodeficiency and progressive loss of cerebellar function makes aspiration pneumonia the leading cause of death in AT patients, whose median life expectancy was estimated in a recent survey to be 30 years (11).
Although there have been dramatic changes in attitude and practice in the treatment of children's pain in the hospital, pain management in outpatient settings is treated essentially the way it was 20 years ago. It is quite remarkable that many common illnesses and procedures universally acknowledged to be associated with significant discomfort and anxiety have received minimal research attention. In this chapter, some of the more common pain problems (minor procedures and acute illnesses) encountered in office practice are reviewed, and suggestions for pain relief based on the limited literature are offered. The following areas are addressed (1) pain associated with immunization, the most common painful procedure in office practice (2) pain associated with common illnesses, specifically otitis media, pharyngitis, and viral mouth infections and (3) chronic and recurrent pains, which require an alternative paradigm than acute pain. Through the uniform use of relatively simple...
If ear pain, discharge, or inflammation is present, move the auricle up and down, press the tragus, and press firmly just behind the ear. Movement of the auricle and tragus (the tug test ) is painful in acute otitis externa (inflammation of the ear canal), but not in otitis media (inflammation of the middle ear). Tenderness behind the ear may be present in otitis media. In acute otitis externa, shown below, the canal is often swollen, narrowed, moist, pale, and tender. It may be reddened.
A substantial proportion of bacterial infections occurring in CLL patients involve the respiratory tract and are caused by S. pneumoniae and H. influenzae (40). The propensity for these infections relates to several factors including decreased production of secretory and serum immu-noglobulins, impaired complement binding to organisms, and deficiencies in neutrophils and CD4+ lymphocytes. The most common respiratory infections are acute and chronic sinusitis, otitis media, and pneumonia. In the past most pneumonias were caused by S. pneumoniae, but with current chemotherapeutic regimens, the spectrum of pathogens includes Gram-negative bacilli, Nocardia species, Legionella species, and P. carinii. In a study from the 1980s, the estimated frequency of pneumococcal bacteremia was 10.8 episodes 1000 patients (54). The lung was the site of origin of 75 of cases and even when treated with appropriate antibiotics, the fatality rate was 20 . The increasing proportion of penicillin-resistant...
There are few published studies of herbal medicine as a pediatric therapy, despite the general popularity of herbal remedies (9) and the likelihood that many are given to children in the home. The only two existing studies that were randomized, double-blinded controlled trials were conducted by Sarrell and colleagues to evaluate a naturopathic herbal extract (NHE) for ear pain associated with acute otitis media (AOM) (55,56). Although well designed, both studies excluded children younger than 5 years of age despite AOM being the most common complaint in ages 2-3 years. Sarrell et al. excluded these children because younger children are not able to report pain clearly and accurately. Despite these limitations, it is striking that naturopathic extract was as effective as anesthetic drops in reducing ear pain, and that antibiotics had no additional analgesic effect. Notably, there were no adverse effects reported in either study. The naturopathic extract evaluated by Sarrell and...
History of Present Illness Johnny B. is a 15-year-old high school student who comes to the office complaining of an earache that has persisted for the last 3 days. His mother says Johnny's forehead felt hot at home, but she did not have a thermometer to check his temperature. He has a decreased appetite and a runny nose with clear to yellow drainage. He has been sneezing but not coughing. Some of his classmates are sick with similar symptoms.
O.basilicum (Albahaca) is one of many plants used in Guatemala to treat gastrointestinal disorders such as colic, stomach pains, intestinal parasites, flatulence, and loss of appetite. It is also used as an anti-emetic agent (Caceres et al., 1990). Among the Caribs, a small ethnic group of Afro-Caribbean origin, in Guatemala a decoction of O.micranthum (Albahaca) leaves is used orally for coughs and phlegm, stomach pains, intestinal parasites and skin diseases (locally). The juice is used directly for ear pain (Gir n et al., 1991).
Antibiotics are medications that are prescribed for people with bacterial infections. When you were a child and had an ear infection, your parents probably gave you spoonfuls of the pink medicine (Figure E11.1), and now when you have a sinus infection your doctor prescribes other antibiotics. These infections are easily treated and require fairly little inconvenience besides a trip to the doctor and pharmacy. Unfortunately, the days of easily treatable bacterial infections may soon be over because the bacteria that cause many diseases including tuberculosis, malaria, ear infections, and gonorrhea have become resistant to the antibiotics developed to cure them.
The mastoid antrum is a small cavity in the posterior part of the petrous temporal bone connected to the epitympanic recess of the middle ear by way of the narrow aditus. Its importance is twofold it is in communication with the mastoid air cells (hence the portal through which infection may spread to these spaces from the middle ear) and it is intimately related posteriorly to the sigmoid sinus and the cerebellum, both of which may be involved from a middle ear infection.