Clinical examination
Nicholas Summerton in Primary Care Diagnostics, 2018
Acute otitis media is responsible for at least 30 million patient visits per annum in the US (and at a cost exceeding 5 billion dollars). Furthermore, considerable energy has been devoted to examining the most effective treatment and in discussing the role of antibiotics. However, from my perspective as a primary care clinician, recognition rather that treatment is what I find most perplexing. I also suspect that I am not alone, and it has been suggested that, in general, primary care physicians are unsure about the diagnosis at least 40% of the time. Such uncertainty may result in increased use of antibiotics, antibiotic resistance and unnecessary referrals, and can also lead to other causes of fever or illness being misdiagnosed as acute otitis media. In a group of children with acute otitis media, 90% had fever, ear pain, crying and irritability (seeTable 6.6) but 72% of children unwell but without acute otitis media complained of exactly the same symptoms.22
Influenza Virus and CNS Infections
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
Influenza, commonly referred to as the flu, is an infectious disease caused by influenza virus, a group of single-stranded minus-sense RNA viruses, which affects birds and mammals. There are three types of influenza virus, influenza A, B, and C. Influenza virus A or B causes the flu syndrome, including chills, fever, headache, and sore throat and muscle pains. Although it is often confused with other influenzalike illnesses, especially the common cold, influenza is a more severe disease than the common cold. In adults, complications may follow the primary viral infection of the respiratory tract, such as bronchitis and pneumonia (Sessa et al. 2001). In children less than 5 years of age, the most common infective complication is acute otitis media (Tsolia et al. 2006). Influenza C infection is usually asymptomatic.
Infectious Disease: Upper Respiratory Infections and Otitis Media
Hilary McClafferty in Integrative Pediatrics, 2017
It has been estimated that the majority of children (~80%) experience at least one episode of otitis media by preschool age, with peak incidence occurring between 6–15 months. An estimated 10%–15% of cases become chronic. Due to concerns about antibiotic overuse, including: development of resistant organisms, lack of efficacy in addressing pain or preventing tympanic rupture, and high rate of spontaneous remission, many pediatric organizations, including the American Academy of Pediatrics, have adopted watchful waiting periods of 2–3 days, followed by re-examination prior to recommending or starting antibiotic treatment. Adverse effects from antibiotic treatment in children with otitis are common; of every 14 children treated, it has been shown that one will suffer an adverse event such as gastrointestinal upset, rash, or allergic reaction. It is currently recommended that antibiotics be reserved for children under age 2 years with bilateral infection, or with unilateral infection and tympanic membrane perforation. Management in other groups should focus on pain management, with ear recheck in 2–3 days (Venekamp et al. 2015).
Management of influenza – updated Swedish guidelines for antiviral treatment
Published in Infectious Diseases, 2023
Johan Westin, Emmi Andersson, Malin Bengnér, Anna Berggren, Mia Brytting, Erica Ginström Ernstad, Anna C. Nilsson, Martina Wahllöf, Gabriel Westman, Maria Furberg
Influenza is common among the youngest children but in most cases as a mild and spontaneously resolving infection. In a global perspective, influenza accounts for 3–7% of all lower respiratory tract infections and for 4% of deaths from lower respiratory tract infection in children under five years of age [30–32]. Primarily, infants and children with known risk factors may require hospital care. Nine to fourteen percent of those hospitalized require intensive care, and in the group of hospitalized children overall, up to a third is affected by pneumonia. Neurological symptoms such as febrile seizures and encephalopathy/encephalitis are also relatively common and seen in up to 10% of children requiring hospital care [4,33–36]. About 20–50% of all children under the age of six years develop otitis media.
The advantages of vestibular-evoked myogenic potentials induced by bone-conducted vibration in patients with otitis media
Published in Acta Oto-Laryngologica, 2022
Ying Cheng, Qing Zhang, Yuzhong Zhang, Zichen Chen, Weijun Ma, Min Xu
Clinical characteristics and parameters of a typical case with otitis media. (A) Endoscopic images showing evidence of otitis media (perforation of the tympanic membrane) in the left ear but not the right. Audiography revealed conductive deafness in the left ear, compared with the right ear. Left temporal bone computed tomography indicated granulation of the mastoid process, tympanic chamber, and tympanic sinus. (B) ACV-VEMPs could not be induced, while BCV-VEMPs were induced in both ears. The waveform was typical, and the repeatability was good. TM: tympanic membrane; PTA Left: average hearing threshold in the left ear; PTA Right: average hearing threshold in the right ear; ACS Left: air-conducted sound stimulation of the left ear; BCV Left: bone-conducted vibration stimulation of the left ear; BCV Right: bone-conducted vibration stimulation of the right ear.
Acute otitis media pneumococcal disease burden and nasopharyngeal colonization in children due to serotypes included and not included in current and new pneumococcal conjugate vaccines
Published in Expert Review of Vaccines, 2023
Michael Pichichero, Richard Malley, Ravinder Kaur, Robert Zagursky, Porter Anderson
Samson et al. [28] studied the prevalence of otitis media and NP carriage among 107 children from birth to 8 years of age in the K.V. Kuppam rural development area of Tamil Nadu of Southern India from 2009 to 2017. Diagnosis of otitis media was performed by an ENT. Of the 107 children, 23.4% experienced at least one episode of AOM in infancy. At the 8-year follow-up 14.0% (15/107) were diagnosed with otitis media. Based on NP swabs at AOM diagnosis, among the 15 with AOM, 4 were positive for S. pneumoniae (none were vaccinated) and 3 of them had PCV13 serotypes (4, 6A and 18C). 48.6% of the nasal swabs collected at the 8-year follow-up were positive for S. pneumoniae, demonstrating a high prevalence of carriage at 8 years of age. The main serotypes were NT (10.7%), 6A (8.9%), and 4 (7.1%). PCV coverage of the serotypes would have been 23% by PCV10GSK, 23% by PCV10SII, and 36% by PCV13 and PCV15, and 46% by PCV20.
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