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      Pediatric Ear, Nose, and Throat Emergencies

      review-article
      Author(s): , MD a , * , , MD b
      Publication date (Electronic):
      Journal: Pediatric Clinics of North America
      Publisher: Elsevier Inc.

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          Abstract

          Acute otitis media is the most common infection for which antibiotics are prescribed in children, resulting in more than 20 million antibiotic prescriptions annually. New practice guidelines published by the American Academy of Pediatrics and the American Academy of Family Physicians call for the judicious use of antibiotics in view of increasing antibiotic resistance and the unclear necessity of the use of antibiotics in children with uncomplicated acute otitis media. This article reviews those guidelines, several other common ear, nose, and throat entities, including sinusitis and dental emergencies, and current strategies in diagnosis and treatment.

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          Diagnosis and management of acute otitis media.

          (2004)
          This evidence-based clinical practice guideline provides recommendations to primary care clinicians for the management of children from 2 months through 12 years of age with uncomplicated acute otitis media (AOM). The American Academy of Pediatrics and American Academy of Family Physicians convened a committee composed of primary care physicians and experts in the fields of otolaryngology, epidemiology, and infectious disease. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to AOM. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations. The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific definition of AOM. It addresses pain management, initial observation versus antibacterial treatment, appropriate choices of antibacterials, and preventive measures. Decisions were made based on a systematic grading of the quality of evidence and strength of recommendations, as well as expert consensus when definitive data were not available. The practice guideline underwent comprehensive peer review before formal approval by the partnering organizations. This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem.
          Article 0 comments Cited 151 times – based on 0 reviews     Review now
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            Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media.

            Gina C. Gould, Jonathan Little, I Williamson … (2001)
            To compare immediate with delayed prescribing of antibiotics for acute otitis media. Open randomised controlled trial. General practices in south west England. 315 children aged between 6 months and 10 years presenting with acute otitis media. Two treatment strategies, supported by standardised advice sheets-immediate antibiotics or delayed antibiotics (antibiotic prescription to be collected at parents' discretion after 72 hours if child still not improving). Symptom resolution, absence from school or nursery, paracetamol consumption. On average, symptoms resolved after 3 days. Children prescribed antibiotics immediately had shorter illness (-1.1 days (95% confidence interval -0.54 to -1.48)), fewer nights disturbed (-0.72 (-0.30 to -1.13)), and slightly less paracetamol consumption (-0.52 spoons/day (-0.26 to -0.79)). There was no difference in school absence or pain or distress scores since benefits of antibiotics occurred mainly after the first 24 hours-when distress was less severe. Parents of 36/150 of the children given delayed prescriptions used antibiotics, and 77% were very satisfied. Fewer children in the delayed group had diarrhoea (14/150 (9%) v 25/135 (19%), chi(2)=5.2, P=0.02). Fewer parents in the delayed group believed in the effectiveness of antibiotics and in the need to see the doctor with future episodes. Immediate antibiotic prescription provided symptomatic benefit mainly after first 24 hours, when symptoms were already resolving. For children who are not very unwell systemically, a wait and see approach seems feasible and acceptable to parents and should substantially reduce the use of antibiotics for acute otitis media.
            Article 0 comments Cited 69 times – based on 0 reviews     Review now
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              Replantation of 400 avulsed permanent incisors. 1. Diagnosis of healing complications.

              Kathryn H Jacobsen, J Andreasen, M Borum … (1995)
              A material of 322 patients with 400 avulsed and replanted permanent teeth were followed prospectively in the period from 1965 to 1988 (mean observation period = 5.1 yrs). The age of the patients at the time of replantation ranged from 5 to 52 yrs (mean = 13.7 yrs and median = 11.0 yrs). Standardized patient records were used through the entire period in order to obtain valid data concerning the extent of injury and treatment provided. At the follow-up period, pulpal and periodontal healing were monitored by clinical examination, mobility testing and standardized radiographic controls. Thirty-two of the replanted teeth (8%) showed pulpal healing. When related to teeth with incomplete root formation, where pulpal revascularization was anticipated (n = 94) the frequency of pulpal healing was 34%. Periodontal ligament healing (i.e. with no evidence of external root resorption) was found in 96 teeth (24%). Gingival healing was found in 371 teeth (93%). During the observation period, 119 teeth (30%) were extracted. Tooth loss was slightly more frequent in teeth with incomplete root formation at the time of replantation than in teeth with completed root formation.
              Article 0 comments Cited 46 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Morgen Bernius
                Journal
                Journal ID (nlm-ta): Pediatr Clin North Am
                Journal ID (iso-abbrev): Pediatr. Clin. North Am
                Title: Pediatric Clinics of North America
                Publisher: Elsevier Inc.
                ISSN (Print): 0031-3955
                ISSN (Electronic): 1557-8240
                Publication date PMC-release: 29 March 2006
                Publication date (Print): April 2006
                Publication date (Electronic): 29 March 2006
                Volume: 53
                Issue: 2
                Pages: 195-214
                Affiliations
                [a ]Department of Surgery, Division of Emergency Medicine, University of Maryland School of Medicine, 110 Sout Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA
                [b ]Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Maryland Hospital for Children, 22 South Greene Street, Baltimore, MD 21201, USA
                Author notes
                [* ]Corresponding author morgen2131@ 123456aol.com
                Article
                Publisher ID: S0031-3955(05)00161-6
                DOI: 10.1016/j.pcl.2005.10.002
                PMC ID: 7126702
                PubMed ID: 16574522
                SO-VID: 62d2a0c5-93c9-4074-8f8d-1c1ca9984509
                Copyright statement: Copyright © 2006 Elsevier Inc. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                ScienceOpen disciplines: Pediatrics

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