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      The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children


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          Background and objectives: Based on our previous single-center study on optimization of treatment of chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) in children using a noninvasive system approach to lower the necessity of antibiotics, analgesic use, and surgical interventions, we proceeded to perform a multicenter investigation in an outpatient setting. The purpose of the previous prospective study in 2013–2015 was to compare outcomes in the treatment of COME and AH using the noninvasive multimodal integrative method (IM) versus conventional treatment practice (COM). Materials and Methods: In this paper, we retrospectively analyze the data of patients treated with the integrative method between 2017 and 2020 in a multicenter setting and compared the outcomes with data from 2013–2015 in order to evaluate generalizability. In both periods, all eligible and willing participants were included and treated with the IM protocol under real-life conditions. The treatment involved pneumatization exercises, education, an antiallergic diet, nasal hygiene, useful constitutional therapy, and thermal interventions (P.E.A.N.U.T.). A total of 48 versus 28 patients, aged 1–8, were assessed, presenting with COME and AH, with moderate to severe hearing impairment at entry. Results: The significant improvement found in both audiometric measures (intact hearing) and tympanometric measures (normal A-type curve) was similar in both datasets with respect to conventional treatment. The new data confirms that the P.E.A.N.U.T. method results in a significant reduction of antibiotics, analgesic use, and surgical interventions. Conclusion: In this multicenter trial, we confirm the effectiveness of the noninvasive system approach for the treatment of COME in lowering the need for antibiotics and analgesic use and elective surgery. This could be especially important with respect to a generally observed increase in antibiotic resistance. The method is easy to perform in different clinical settings and is effective, safe, and well-tolerated.

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          Most cited references40

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            Berberis Vulgaris and Berberine: An Update Review.

            Berberine is an isoquinoline alkaloid present in several plants, including Coptis sp. and Berberis sp. Berberine is a customary component in Chinese medicine, and is characterized by a diversity of pharmacological effects. An extensive search in electronic databases (PubMed, Scopus, Ovid, Wiley, ProQuest, ISI, and Science Direct) were used to identify the pharmacological and clinical studies on Berberis vulgaris and berberine, during 2008 to 2015, using 'berberine' and 'Berberis vulgaris' as search words. We found more than 1200 new article studying the properties and clinical uses of berberine and B. vulgaris, for treating tumor, diabetes, cardiovascular disease, hyperlipidemia, inflammation, bacterial and viral infections, cerebral ischemia trauma, mental disease, Alzheimer disease, osteoporosis, and so on. In this article, we have updated the pharmacological effects of B. vulgaris and its active constituent, berberine. Copyright © 2016 John Wiley & Sons, Ltd.
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              Natural history of untreated otitis media.

              Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media (AOM) and otitis media with effusion (OME). Systematic literature review and meta-analysis. Source articles were identified by MEDLINE search through August 2002 plus manual crosschecks of bibliographies and published meta-analyses. Data were abstracted independently by two investigators and combined with random effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity analysis was performed. Sixty-three articles met inclusion criteria. AOM symptoms improved within 24 hours without antibiotics in 61% of children (95% CI, 50-72%), rising to 80% by 2 to 3 days (95% CI, 69-90%). Suppurative complications were comparable if antibiotics were withheld (0.12%) or provided (0.24%). Children entered recurrent AOM trials with a mean rate of 5.5 or more annual episodes but averaged only 2.8 annual episodes while on placebo (95% CI, 2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI, 50-68%) and 74% resolution by 3 months (95% CI, 68-80%). OME of unknown duration had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6 months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6 months and 33% resolution by 1 year. The natural history of otitis media is very favorable. Combined estimates of spontaneous resolution provide a benchmark against which to judge new or established interventions. The need for surgery in children with recurrent AOM or chronic OME should be balanced against the likelihood of timely spontaneous resolution and the potential risk of learning, language, or other adverse sequelae from persistent middle ear effusion. Further research is needed to identify prognostic factors that can target children unlikely to improve spontaneously for earlier intervention.

                Author and article information

                Role: Academic Editor
                Antibiotics (Basel)
                Antibiotics (Basel)
                30 January 2021
                February 2021
                : 10
                : 2
                [1 ]Department of IM, Faculty of Health Sciences, University of Pécs, 7623 Pécs, Hungary
                [2 ]Doctoral School, Faculty of Health Sciences, University of Pécs, 7623 Pécs, Hungary
                [3 ]Department of Otolaryngology, Szt. Borbála Hospital, 2800 Tatabánya, Hungary; doktormarodi@ 123456gmail.com
                [4 ]Department of Neonatology, University Children’s Hospital Tubingen, 72016 Tubingen, Germany; j.vagedes@ 123456arcim-institute.de
                [5 ]ARCIM Institute (Academic Research in Complementary and Integrative Medicine), 70794 Filderstadt, Germany
                [6 ]Cello Health Insight, Advanced Analytics Manager, London EC1M 7AP, UK; szekelyb.ppke@ 123456gmail.com
                [7 ]Department of Otolaryngology, Balassa János Hospital, 7100 Szekszárd, Hungary; mistvan19@ 123456yahoo.com (I.M.); moricz.peter@ 123456tmkorhaz.hu (P.M.)
                [8 ]Doctoral School, Faculty of Medicine, University of Pécs, 7622 Pécs, Hungary
                [9 ]Outpatient Clinic, 8000 Székesfehérvár, Hungary; dr.adel.bedo@ 123456gmail.com (A.B.); fvera@ 123456datatrans.hu (V.F.)
                [10 ]Department of Otorhinolaryngology and Head-Neck Surgery, Clinical Center, University of Pécs, 7621 Pécs, Hungary; dr.somogyvari.k@ 123456gmail.com
                Author notes
                [* ]Correspondence: henrik.szoke@ 123456etk.pte.hu ; Tel.: +36-204729459
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).


                adenoid hypertrophy,analgesics,antibiotics,children,chronic otitis media with effusion,integrative therapy,surgical interventions


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