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      Incidental lowering of otitis-media complaints in otitis-prone children during COVID-19 pandemic: not all evil comes to hurt

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          Abstract

          Given COVID-19 pandemic periodic outpatient assessment of otitis-prone children regularly followed at our tertiary outpatient clinic of upper respiratory tract infections was discontinued since 9 March. In order to avoid leaving the patients to themselves just during the winter months, which are the most critical ones for these children, we kept in touch with the families of 102 children (mean age 41.4 ± 14.0 months) who had had a follow-up visit scheduled during the lockdown, and compensated with telemedicine assessment. This incidentally leads to the unexpected but not at all negative finding that a consistent clinical improvement had been occurred in most (82.3%) of children. A statistically significant reduction in the mean number of documented acute otitis media episodes, otorrhea episodes, and systemic antibiotic treatments during the February–April 2020 period compared with February–April 2019 was attested. Clinical evaluation performed in 27.4% cases revealed normal middle ear findings in all but three (89.3%) children.

          Conclusion: Our data document a global improvement of otitis-prone children in Milan during the Italian lockdown, as a fortuitous and incidental positive effect of the national lockdown.

          What is Know:

          • During COVID-19 pandemic in Italy any non-urgent medical activity including periodic outpatient assessment of otitis-prone children was discontinued.

          • Otitis-prone children experience acute infectious exacerbations mainly in winter.

          What is New:

          • Most of children reached by means of a telemedicine assessment during lockdown experienced a subjective clinical improvement; clinical assessment at the end of the lockdown revealed normal otoscopic findings in most cases.

          • Exceptional circumstances during COVID-19 pandemic had a fortuitous positive effect on otitis-prone children’s clinical conditions.

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          Most cited references15

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          Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis.

          To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM).
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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.
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              Epidemiology, natural history, and risk factors: panel report from the Ninth International Research Conference on Otitis Media.

              The 2007 Recent Advances in Otitis Media Research Conference Panel Report provides an update on otitis media (OM) research published from 2003 to 2007. This report summarizes important trends in disease incidence and prevalence, describes established and newly identified risk factors for acute and chronic OM and OM with effusion, and conveys information on newly discovered genetic factors. In this report, researchers have described declining rates of OM diagnosis, antibiotic prescriptions, offices visits for OM, and middle ear surgery since the licensure and routine use of pneumococcal conjugate vaccine in infants. The panel report also recommends short and long term goals for current and future OM research. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Contributors
                sara.torretta@unimi.it
                Journal
                Eur J Pediatr
                Eur. J. Pediatr
                European Journal of Pediatrics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-6199
                1432-1076
                20 July 2020
                : 1-4
                Affiliations
                [1 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Department of Otolaryngology and Head and Neck Surgery, , Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ; Milan, Italy
                [2 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Clinical Sciences and Community Health, , University of Milan, ; Milan, Italy
                [3 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Biomedical Surgical Dental Science, , University of Milan, ; Milan, Italy
                [4 ]GRID grid.414818.0, ISNI 0000 0004 1757 8749, Pediatric Highly Intensive Care Unit, , Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, ; Milan, Italy
                [5 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Pathophysiology and Transplantation, , University of Milan, ; Milan, Italy
                Author notes

                Communicated by Peter de Winter

                Author information
                http://orcid.org/0000-0002-8461-6042
                Article
                3747
                10.1007/s00431-020-03747-9
                7370867
                32691131
                50e15e59-754d-45d1-a0a4-0b28bbf8722f
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 8 June 2020
                : 9 July 2020
                : 16 July 2020
                Categories
                Short Communication

                Pediatrics
                otitis media,children,otitis-prone,covid-19,infection
                Pediatrics
                otitis media, children, otitis-prone, covid-19, infection

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