Grand Rounds Archive - Otology/Neurotology Grand Rounds Archive Otology/Neurotology Acute Otitis Media:A Public Health Perspective [3/18/99] Autoimmune Inner Ear Disease [4/8/93] Barotrauma of the Middle and Inner Ear [3/23/95] Bell's Palsy [7/20/95] Unusual Cerebellopontine Angle Neoplasms [11/4/93] Pediatric Cholesteatoma [10/7/93] Chordomas of the Skull Base [10/1/92] Congenital Aural Atresia [11/2/95] Congenital Inner Ear Malformations [11/11/93] Diving Medicine [01/13/00] Eustachian Tube Function and Dysfunction [7/11/96] Traumatic Injuries to the Facial Nerve [10/12/91] Facial Reanimation of the Chronically Paralyzed Face [9/29/94] Therapeutic Options for Treatment of Glomus Tumors [10/26/91] http://www.bcm.edu/oto/grand/otology.html (1 of 2) [5.11.2005 10:38:17] Grand Rounds Archive - Otology/Neurotology Considerations in the Evaluation of the Hearing Impaired Child [3/11/93] Update on Hearing Aids [6/3/93] Herpes Zoster Oticus [8/21/97] Neurotologic Manifestations Of HIV Infection [3/24/94] Infectious Intracranial Complications of Suppurative Ear Disease [3/18/93] Lateral Sinus Thrombosis [5/7/92] Acute Mastoiditis [2/3/94] Surgical Management Of Meniere's Syndrome [4/14/94] Myringoplasty and Tympanoplasty [2/16/95] Osteodystrophies of the Middle Ear and Temporal Bone [2/8/95] Ototoxicity [8/20/92] Ototoxicity [4/25/96] Otitis Externa [10/12/95] Pathology And Pathogenesis Of Otitis Media [4/21/94] The Diagnosis and Management of Perilymphatic Fistulas [10/21/93] Lesions of the Petrous Apex [8/4/94] Complications of Stapedectomy [11/11/99] Issues in Stapedectomy [2/6/92] Sudden Sensorineural Hearing Loss [3/5/92] Sudden Sensorineural Hearing Loss [11/18/93] Temporal Bone Fractures [4/2/92] Temporal Bone Gunshot Wounds: Evaluation and Management [8/5/93] Subjective Tinnitus [03/12/98] Tuberculous Otitis Media [11/22/92] Tympanostomy Tubes [2/23/95] Vestibular Adaptation and Rehabilitation [5/21/92] Vestibular Neuritis [7/14/94] Laryngology | Neoplasms | Pediatric | Plastics | Rhinology | Others | Main | Home ©2001, The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine One Baylor Plaza, NA102, Houston, TX 77030 [email protected] URL: http://www.bcm.tmc.edu/oto (Modified: 12/12/01) http://www.bcm.edu/oto/grand/otology.html (2 of 2) [5.11.2005 10:38:17] From the Grand Rounds Archive at Baylor Grand Rounds Archives **** DISCLAIMER **** The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at The Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature. Acute Otitis Media: A Public Health Perspective Derek Drummond, M.D. March 18, 1999 Case Presentation J.D., a previously healthy girl, presented to her pediatrician at 6 http://www.bcm.edu/oto/grand/031899.html (1 of 6) [5.11.2005 10:38:33] From the Grand Rounds Archive at Baylor months of age with a 3-day history of increasing irritability and fevers. History revealed that she had upper respiratory tract symptoms for 3 days that included nasal congestion, rhinorrhea, dry cough, decreased appetite and low-grade fevers. The parents became concerned the night before presentation when she became very irritable, appeared to be in pain, and vomited once after bottle-feeding. The girl was seen pulling on her ears and was inconsolable prior to arrival at the pediatrician's office. She had no previous medical problems and was not taking any medication other than acetaminophen. Physical exam demonstrated a 6-month old girl who was crying in her mother's arms. She was alert but not cooperative. She had a temperature of 101.5 F. Examination of the ears revealed a right tympanic membrane that was bulging, erythematous, and didn't move with pneumotoscopy. The nasal mucosa was congested and the patient was mouth breathing. The remainder of the physical exam was unremarkable. She was diagnosed with acute otitis media and prescribed a 10-day course of amoxicillin at 40mg/kg/day. Within 24 hours, her symptoms were improving and she began to feed normally. Follow-up at 2 weeks revealed bilateral middle-ear effusions in a happy, asymptomatic child. The MEE would resolve spontaneously over the next 3 months. Bibliography Berman S. Otitis media in developing countries. Pediatrics 1995; 96:126-131. Berman S, Byrns PJ, Bondy J, Smith PJ, Lezotte D. Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population. Pediatrics 1996;100:585- 592. Bluestone CD. Otitis media. In: Behrman RE, Vaughan RE, Nelson WE, editors. Nelson http://www.bcm.edu/oto/grand/031899.html (2 of 6) [5.11.2005 10:38:33] From the Grand Rounds Archive at Baylor Textbook of Pediatrics, 13th edition. Philadelphia: W.B. Saunders; 1987. pp. 880. Bluestone CD, Klein JO. Otitis media, atelectasis, and eustachian tube dysfunction. In: Bluestone CD, Stool SE, editors. Pediatric Otolaryngology, 3rd edition. Philadelphia: W.B. Saunders;1996. pp. 388-582. Bluestone CD, Stephenson JS, Martin LM. Ten-year review of otitis media pathogens. Pediatr Infect Dis J 1992;11:S7-S11. Blumer JL. Pharmacokinetics and pharmacodynamics of new and old antimicrobial agents for acute otitis media. Pediatr Infect Dis J 1998;17:1070-1075. Bottenfield GW, Burch DJ, Hedrick JA, Schaten R, Rowinski CA, Davies JT. Safety and tolerability of a new formulation (90 mg/kg/day divided every 12 h) of amoxicillin/clavulanate (Augmentin) in the empiric treatment of pediatric acute otitis media caused by drug-resistant Streptococcus pneumoniae. Pediatr Infect Dis J 1998;17:963-968. Boulesteix J, Dubreuil C, de La Roque F, Trinh A, Scheimberg A. Effects of cefixime or co- amoxiclav treatment on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children with acute otitis media: J Antimicrob Chemother 1998;41:253-258. Branthaver B, Greiner DL, Eichelberger R Determination of cost-effective treatment of acute otitis media from HMO records. Am J Health Syst Pharm 1997;54:2736-2740. Brown DH. Education of medical practitioners in otitis media management. J Otolaryngol 1998; 2749-52. Canafax DM, Yuan Z, Chonmaitree T, Deka K, Russlie HQ, Giebink GS. Amoxicillin middle ear fluid penetration and pharmacokinetics in children with acute otitis media. Pediatr Infect Dis J 1998;17:149-156. Casselbrant ML, Mandel EM, Kurs-Lasky M, Rockette HE, Bluestone CE. Otitis media in a population of black American and white American infants, 0-2 years of age. Int J Pediatr Otorhinolaryngol 1995;33:1-16. Clements DA, Langdon L, Bland C, Walter E. Influenza A vaccine decreases the incidence of otitis media in 6- to 30-month-old children in day care. Arch Pediatr Adolesc Med 1995;149:1113-1117. Craig WA. Antimicrobial resistance issues of the future. Diagn Microbiol Infect Dis 1996;25:213- 217. Culpepper L, From J. Routine antimicrobial treatment of otitis media: Is it necessary? JAMA 1997;278:1643-1645. David CB, Hamrick HJ, Schwartz RJ. Follow-up after otitis media. N Engl J Med 1982;307:252. http://www.bcm.edu/oto/grand/031899.html (3 of 6) [5.11.2005 10:38:33] From the Grand Rounds Archive at Baylor DeMaria TF, Prior RB, Briggs BR, Lim DJ, Birck HG. Endotoxin in middle-ear effusions from patients with chronic otitis media with effusion. J Clin Microbiol 1984;20:15-17. Dowell SF, Schwartz B. Resistant pneumococci: protecting patients through judicious use of antibiotics. Am Fam Phys 1997;55:1647-1654, 1657-1658. Gates G.A. Acute otitis media and otitis media with effusion. In: Cummings CE, Harker LE, editors. Otolaryngology, Head and Neck Surgery, 2nd edition. St. Louis: Mosby;1993. pp. 2808- 2822. Gates G.A. Workshop on effects of otitis media on the child: socioeconomic impact of otitis media. Pediatrics 1983;71:639-652. Gehanno P, N'Guyen L, Derriennic M, Pichon F, Goehrs JM, Berche P. Pathogens isolated during treatment failures in otitis. Pediatr Infect Dis J 1998;17:885-890. Giebink GS. Vaccination against middle-ear bacterial and viral pathogens. Ann N Y Acad Sci 1997; 830:330-352. Heikkinen T, Ruuskanen O. New prospects in the prevention of otitis media. Ann Med 1996;28:23-30. Hoekelman RA. Infectious illness during the first year of life. Pediatrics 1977;59:119-121. Kaleida PH., Casselbrant ML, Rocket HE, Paradise JL, Bluestone CD, Blatter MM, Reisinger KS, Wald ER, Supance JS. Amoxicillin or myringotomy or both for acute otitis media. Results of a randomized clinical trial. Pediatrics 1991;87:466-474. Klein JO. Clinical implications of antibiotic resistance for management of acute otitis media. Pediatr Infect Dis J 1998;17:1084-1089. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, Wincott JL, Sitar DS, Klassen TP, et al. Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. JAMA 1998;279:1736-1742. Klein JO, Teele DW, Masson R, Menyuk P, Rosner BA. Otitis media with effusion during the first three years of life and the development of speech and language. In: Lim DJ, Bluestone CD, Klein JO, Nelson DJ, editors. Recent Advances in Otitis Media With Effusion. Philapelphia, PA: BC Decker;1983. pp. 332-333. Ling D, McCoy RH, Levinson ED. The incidence of middle ear disease and its educational implications among Baffin Island Eskimo children. Can J Public Health 1969;60:385-390. Lister PD, Pong A, Chartrand SA, Sanders CC. Rationale behind high-dose amoxicillin therapy for acute otitis media due to penicillin-nonsusceptible pneumococci: support from in vitro http://www.bcm.edu/oto/grand/031899.html (4 of 6) [5.11.2005 10:38:33] From the Grand Rounds Archive at Baylor pharmacodynamic studies. Antimicrob Agents Chemother 1997;41:1926-1932. Lynn GE, Benitez JT. Temporal bone preservation in a 2600-year-old Egyptian mummy. Science 1974;183:200-202. Makela PH, Karma P, Leinonen MK. Pneumococcal vaccine and otitis media in infancy. Bull Eur Physiopathol Respir 1983;19:235-238. Mandel EM, Casselbrant ML, Rockette HE, Bluestone CD, Kurs-Lasky M. Efficacy of 20- versus 10-day antimicrobial treatment for acute otitis media. Pediatrics 1995;96:5-13. Nelson WL, Kennedy DL, Lao CS, Kuritsky JN. Outpatient systemic anti-infective use by children in the United States, 1977 to 1986. Pediatr Infect Dis J. 1988;7:505-509. Paradise JL: Controversies: Treatment of acute otitis media. JAMA 1998;279:1784-1785. Paradise JL. Managing otitis media: a time for change. Pediatrics 1995;96:712-715. Pean Y, Goldstein FW, Guerrier ML. Highlights of the French antimicrobial resistance surveillance project. French Study Group. Diagn Microbiol Infect Dis 1996;25:191-194. Population Estimates Program, Population Division, U.S. Bureau of the Census, Washington, DC Contact: Statistical Information Staff, Population Division, U.S. Bureau of the Census, 301-457- 2422 Internet Release date: March 17, 1998. www.census.gov/population/estimates/county/co-97- 1/97C1_48.txt Rathbun TA, Mallin R. Middle ear disease in a prehistoric Iranian population. Bull N Y Acad Med 1977;53:901-905. Rosenfeld RM. An evidence-based approach to treating otitis media. Pediatr Clin North Am 1996;43:1165-1181. Rosenfeld RM, Vertrees JE, Carr J, Cipolle RJ, Uden DL, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: meta-analysis of 5400 children from thirty-three randomized trials. J Pediatr 1994;124:355-367. Saainen UM. Prolonged breast feeding as prophylaxis for recurrent otitis media. Acta Paediatr Scand 1982;71:567-571. Schaefer O. Otitis media and bottle-feeding. An epidemiological study of infant feeding habits and incidence of recurrent and chronic middle ear disease in Canadian Eskimos. Can J Public Health 1971;62:478-489. Scheaffer RL, Mendelhall W, Ott L. Simple Random Sampling. In: Scheaffer RL, Mendelhall W, Ott L, editors. Elementary Survey Sampling, 5th edition. Wadsworth Publishing: Belmont, California, 1996. pp.79-124. http://www.bcm.edu/oto/grand/031899.html (5 of 6) [5.11.2005 10:38:33] From the Grand Rounds Archive at Baylor Schappert, SM. Office visits for otitis media, United States 1975-1990. Vital and Health Statistics of The Centers for Disease Control / National Center for Health Statistics. 1992;214:1. Schwartz RH, Rodriguez WJ, Hayden GF, Grundfast KM. The reevaluation visit for acute otitis media. J Fam Pract 1987;24:145-148. Teele DW, Kleine JO, Rosner B. et al. Middle ear disease and the practice of pediatrics. Burden during the first five years of life. JAMA 1983; 249:1026-1029. Teele DW, Kleine JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective cohort study. J Infect Dis 1989;160:83-94. Timmermans FJ, Gerson S. Chronic granulomatous otitis media in bottle-fed Inuit children. Can Med Assoc J 1980;122:545-547. White LL, Holimon TD, Tepedino JT, Portner TS, Wan JY, Thompson JW. Antimicrobials prescribed for otitis media in a pediatric Medicaid population. Am J Health Syst Pharm 1996;53:2963-2969. Click here to view the slides from this presentation Return to the Grand Rounds Archive Index Return to BCM Otolaryngology Home Page ® Copyright, 1995-9. All Rights Reserved. Baylor College of Medicine. The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences. http://www.bcm.edu/oto/grand/031899.html (6 of 6) [5.11.2005 10:38:33] Acute Otitis Media Slide 1 of 62 http://www.bcm.edu/oto/grand/03-18-99/sld001.htm [5.11.2005 10:39:23] http://www.bcm.edu/oto/grand/4893.html Grand Rounds Archives **** DISCLAIMER **** The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at The Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature. AUTOIMMUNE INNER EAR DISEASE Douglas D. Backous,, MD April 8, 1993 The role of immunity in sensorineural hearing loss was first suggested in 1958 by Lenhart. Kikuchi, in 1959, wrote of "sympathetic otitis" whereby surgery on one ear affected hearing in the other. He proposed an autoimmune phenomena as the etiology. In 1961 Beickert, and two years later, Terrayama presented data supporting autoimmunity in experimental guinea pig cochleas. McCabe described 18 patients with bilateral asymmetric hearing loss progressing over weeks to months which responded to steroid therapy. His 1979 paper asserted the importance of a high index of suspicion in these patients since, if diagnosed early, they could be treated and their hearing preserved. Humoral and cell mediated immunity, the lymphocyte-macrophage system, and the complement cascade work in homeostatic harmony to provide immune protection to the host. B cells are produced in the bone http://www.bcm.edu/oto/grand/4893.html (1 of 5) [5.11.2005 10:39:37]