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      Aspectos clinicoepidemiológicos de las patologías ambulatorias del oído frecuentes en adultos Translated title: Outpatient clinical-epidemiological aspects of diseases of the ear common in adults

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          Abstract

          RESUMEN Introducción y objetivo: La patología otorrinolaringología tiene una alta incidencia en afecciones agudas como crónicas en la consulta externa de ORL, pese a esto, no existen datos estadísticos exactos, confiables y estandarizados sobre el perfil epidemiológico de las patologías otológicas ambulatorias en nuestro medio. El objetivo de este estudio fue describir las características clínicas, epidemiológicas, de tratamiento y seguimiento propios de las tres patologías otológicas ambulatorias diagnosticadas frecuentemente en la consulta otorrinolaringológica en nuestra región. Método: Se realizó un estudio observacional retrospectivo, en 312 pacientes con patologías otológicas, las variables estudiadas fueron procesadas a través del programa estadístico IBM-SPSS®, aplicando una técnica estadística descriptiva. Resultados: Los tres diagnósticos más frecuentes en consulta externa fueron: otitis media crónica en el 60.6 %, predomino en mujeres con el 44 %; 12.8 % presbiacusia, en la cual no hubo distinción de sexo y 12.17 % otomicosis afectando a mujeres en el 65.7 %. Tuvieron una mayor prevalencia en mayores de 51 años, procedentes del área urbana, sin ninguna formación profesional, manifestándose como hipoacusia, otorrea, otalgia y prurito ótico, referidas de manera aislada o en combinación. Se evidenció que la otomicroscopía, impedanciometría y audiometría tonal liminal fueron las principales técnicas otológicas realizadas para el diagnóstico. El tratamiento farmacológico en procesos infecciosos fue ciprofloxacino oral y ótico, fluconazol oral asociado clotrimazol o clioquinol ótico, se observó la prescripción de loratadina en el 91.5 % de los pacientes con OMC, 40 % en los pacientes con presbiacusia y un 73.6 % en pacientes con otomicosis. Las principales complicaciones clínicas se encontraron en pacientes con OMC tras una segunda evaluación, las cuales fueron parálisis facial 2.1 %y colesteatoma adquirido asociado a otomastoiditis crónica en el 0.96 %. Discusión: La prevalencia y afectación en cuanto al sexo por OMC, presbiacusia y otomicosis discrepa con lo obtenido en otras investigaciones aunque su prevalencia con respecto a la edad se asemeja a lo reportado por otros investigadores Las técnicas complementarias de diagnóstico y el tratamiento se alinean a lo descrito en la literatura, pese a esto, se identificó la prescripción de antihistamínico las cual no fue fundamentada en el expediente clínico, se observó que el uso de antibióticos tópico en combinación por vía oral no fue del todo eficaz para evitar reagudizaciones. Conclusiones: Los diagnósticos más frecuentes fueron OMC, presbiacusia y otomicosis, prevalecieron en mujeres entre la quinta década de vida. El tratamiento diagnóstico y terapéutico de las patologías ambulatorias de etiología infecciosa coincide con la literatura, salvo la prescripción de antihistamínicos la cual fue común en el grupo poblacional, así mismo se identificó que el uso significativo de antibióticos orales, más allá de la terapia tópica, no es del todo eficaz para evitar recidivas y complicaciones.

          Translated abstract

          ABSTRACT Introduction and objective: Otorhinolaryngology pathology has a high incidence in acute and chronic conditions in the ENT outpatient clinic, despite this; there are no accurate, reliable and standardized statistical data on the epidemiological profile of ambulatory otology pathologies in our setting. The objective of this study was to describe the clinical, epidemiological, treatment and follow-up characteristics of the three outpatient otological pathologies frequently diagnosed in the otorhinolaryngological consultation in our region. Method: A retrospective observational study was carried out in 312 patients with otological pathologies; the variables studied were processed through the IBM-SPSS® statistical program, applying a descriptive statistical technique. Results: The three most frequent outpatient diagnoses were: chronic otitis media in 60.6 %, predominated in women with 44 %; 12.8 % presbycusis, in which there was no sex distinction and 12.17 % otomycosis affecting women in 65.7 %. They had a higher prevalence in people older than 51 years, from the urban area, without any professional training, manifesting as hearing loss, otorrhea, otalgia and otic pruritus, referred in isolation or in combination. It was evident that otomicroscopy, impedanciometry and liminal tone audiometry were the main otological techniques performed for the diagnosis. Pharmacological treatment in infectious processes was oral and otic ciprofloxacin, oral fluconazole associated clotrimazole or clioquinol otic, the prescription of loratadine was observed in 91.5 % of patients with OMC, 40 % in patients with presbycusis and 73.6 % in patients with otomycosis. The main clinical complications were found in patients with OMC after a second evaluation, which were facial paralysis 2.1 % and acquired cholesteatoma associated with chronic otomastoiditis in 0.96 %. Discussion: The prevalence and involvement in terms of sex due to OMC, presbycusis and otomycosis disagrees with that obtained in other investigations although its prevalence with respect to age is similar to that reported by other researchers. Complementary diagnostic and treatment techniques are aligned with that described in the literature, despite this; the prescription of antihistamine was identified. Which was not based on the clinical record, it was observed that the use of topical antibiotics in combination orally was not entirely effective in avoiding flare-ups. Conclusions: The most frequent diagnoses were OMC, presbycusis and otomicosis they prevailed in women between the fifth decade of life. The diagnostic and therapeutic treatment of ambulatory pathologies of infectious etiology coincides with the literature, except for the prescription of antihistamines, which was common in the population group, and it was also identified that the significant use of oral antibiotics, beyond topical therapy, It is not entirely effective in preventing recurrences and complications.

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          Antihistamines and/or decongestants for otitis media with effusion (OME) in children.

          This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2006.Otitis media with effusion (OME) is common and may cause hearing loss with associated developmental delay. Treatment remains controversial. The effectiveness of antihistamines, decongestants and antihistamine/decongestant combinations in promoting the resolution of effusions has been assessed by randomized controlled trials. The objective of this review was to determine whether antihistamine, decongestant or combination therapy is effective in treating children who present with OME. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 1 February 2011, following a previous search in 2006. Randomized controlled trials (RCTs) using antihistamines, decongestants or antihistamine/decongestant combinations as treatment for OME in children. We excluded trials that randomized on the basis of acute otitis media (AOM) even though OME was also studied in follow up. Two authors independently extracted data from the published reports using standardized data extraction forms and methods. The two authors assessed the methodological quality of the included studies independently. We expressed dichotomous results as a risk ratio with 95% confidence intervals using a fixed-effect model when homogeneous and a random-effects model when heterogeneous. Nearly all outcomes analyzed were homogeneous. We discussed continuous results qualitatively. We conducted statistical analysis using RevMan 5.1 software. Sixteen studies (1880 participants) were included in the review. No statistical or clinical benefit was found for any of the interventions or outcomes studied. However, treated study subjects experienced 11% more side effects than untreated subjects (number needed to treat to harm = 9). The pooled data demonstrate no benefit and some harm from the use of antihistamines or decongestants alone or in combination in the management of OME, therefore we recommend against their use.
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            Topical antibiotics for chronic suppurative otitis media

            Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection (involving more than one micro‐organism) of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Topical antibiotics, the most common treatment for CSOM, act to kill or inhibit the growth of micro‐organisms that may be responsible for the infection. Antibiotics can be used alone or in addition to other treatments for CSOM, such as antiseptics or ear cleaning (aural toileting). To assess the effects of topical antibiotics (without steroids) for people with CSOM. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 April 2019. We included randomised controlled trials (RCTs) with at least a one‐week follow‐up involving participants (adults and children) who had chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks. The interventions were any single, or combination of, topical antibiotic agent(s) of any class, applied directly into the ear canal as ear drops, powders or irrigations, or as part of an aural toileting procedure. The two main comparisons were topical antibiotic compared to a) placebo or no intervention and b) another topical antibiotic (e.g. topical antibiotic A versus topical antibiotic B). Within each comparison we separated studies where both groups of participants had received topical antibiotic a) alone or with aural toileting and b) on top of background treatment (such as systemic antibiotics). We used the standard Cochrane methodological procedures. We used GRADE to assess the certainty of the evidence for each outcome. Our primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at between one week and up to two weeks, two weeks to up to four weeks and after four weeks; health‐related quality of life using a validated instrument; ear pain (otalgia) or discomfort or local irritation. Secondary outcomes included hearing, serious complications and ototoxicity measured in several ways. We included 17 studies with a total of 2198 participants. Twelve studies reported the sample size in terms of participants (not ears); these had a total of 1797 participants. The remaining five studies reported both the number of participants and ears, representing 401 participants, or 510 ears. A: Topical antibiotics versus placebo or no treatment (with aural toilet in both arms and no other background treatment) One small study compared a topical antibiotic (ciprofloxacin) with placebo (saline). All participants received aural toilet. Although ciprofloxacin was better than saline in terms of resolution of discharge at one to two weeks: 84% versus 12% (risk ratio (RR) 6.74, 95% confidence interval (CI) 1.82 to 24.99; 35 participants, very low‐certainty evidence), the very low certainty of the evidence means that it is very uncertain whether or not one intervention is better or worse than the other. The study authors reported that "no medical side‐effects and worsening of audiological measurements related to this topical medication were detected" (very low‐certainty evidence). B: Topical antibiotics versus placebo or no treatment (with use of oral antibiotics in both arms) Four studies compared topical ciprofloxacin to no treatment (three studies; 190 participants) or topical ceftizoxime to no treatment (one study; 248 participants). In each study all participants received the same antibiotic systemically (oral ciprofloxacin, injected ceftizoxime). In at least one study all participants received aural toilet. Useable data were only available from the first three studies; ciprofloxacin was better than no treatment, resolution of discharge occurring in 88.2% versus 60% at one to two weeks (RR 1.47, 95% CI 1.20 to 1.80; 2 studies, 150 participants; low‐certainty evidence). None of the studies reported ear pain or discomfort/local irritation. C: Comparisons of different topical antibiotics The certainty of evidence for all outcomes in these comparisons is very low. Quinolones versus aminoglycosides Seven studies compared an aminoglycoside (gentamicin, neomycin or tobramycin) with ciprofloxacin (734 participants) or ofloxacin (214 participants). Whilst resolution of discharge at one to two weeks was higher in the quinolones group the very low certainty of the evidence means that it is very uncertain whether or not one intervention is better or worse than the other (RR 1.95, 95% CI 0.88 to 4.29; 6 studies, 694 participants). One study measured ear pain and reported no difference between the groups. Quinolones versus aminoglycosides/polymyxin B combination ± gramicidin We identified three studies but data on our primary outcome were only available in one study. Comparing ciprofloxacin to a neomycin/polymyxin B/gramicidin combination, for an unknown treatment duration (likely four weeks), ciprofloxacin was better (RR 1.12, 95% CI 1.03 to 1.22, 186 participants). A "few" patients experienced local irritation upon the first instillation of topical treatment (numbers/groups not stated). Others Other studies examined topical gentamicin versus a trimethoprim/sulphacetamide/polymixin B combination (91 participants) and rifampicin versus chloramphenicol (160 participants). Limited data were available and the findings were very uncertain. We are uncertain about the effectiveness of topical antibiotics in improving resolution of ear discharge in patients with CSOM because of the limited amount of low‐quality evidence available. However, amongst this uncertainty there is some evidence to suggest that the use of topical antibiotics may be effective when compared to placebo, or when used in addition to a systemic antibiotic. There is also uncertainty about the relative effectiveness of different types of antibiotics; it is not possible to determine with any certainty whether or not quinolones are better or worse than aminoglycosides. These two groups of compounds have different adverse effect profiles, but there is insufficient evidence from the included studies to make any comment about these. In general, adverse effects were poorly reported. Topical antibiotics for people with chronic suppurative otitis media What is the aim of this review? The aim of this Cochrane Review was to find out if topical antibiotics are effective in treating chronic suppurative otitis media and whether one type of topical antibiotic treatment is more effective than any other. We collected and analysed all relevant studies to answer this question. Key messages There is a lot of uncertainty as to whether or not topical antibiotics improve the resolution of ear discharge in patients with chronic suppurative otitis media (CSOM). However, among this uncertainty there is some evidence to suggest that the use of topical antibiotics may be effective when compared to placebo, or when used in addition to a systemic antibiotic (oral or injected). There is also lots of uncertainty about which type of topical antibiotic is the most effective. Overall, the certainty of the evidence was very low. What was studied in the review? Chronic suppurative otitis media, sometimes referred to as chronic otitis media (COM), is a long‐term (chronic) swelling and infection of the middle ear, with ear discharge (otorrhoea) through a perforated tympanic membrane (eardrum). The main symptoms of CSOM are ear discharge and hearing loss. Topical antibiotics (administered into the ear canal as ear drops, ointments, sprays or creams) are the most commonly used treatment for CSOM. Topical antibiotics kill or stop the growth of the micro‐organisms that may be responsible for the infection. Topical antibiotics can be used on their own or added to other treatments for CSOM, such as antiseptics or ear cleaning (aural toileting) or systemic antibiotics (antibiotics taken either by mouth or by an injection into a muscle or vein). It was important in this review to examine whether there were any adverse effects from using topical antibiotics as they can cause irritation of the skin within the outer ear, which may cause discomfort, pain or itching. This review also examined whether different types of antibiotics were more effective at treating CSOM than others, as some antibiotics (such as aminoglycosides) may have the potential to be toxic to the inner ear (ototoxicity), with potential to cause irreparable hearing loss (sensorineural), dizziness or ringing in the ear (tinnitus). What are the main results of the review? We found 17 studies examining at least 2126 participants, but it was difficult to determine precisely how many participants were included as a number of studies did not clearly report the number. A number of different types of antibiotics and combinations of antibiotics were used. Comparison of topical antibiotics to placebo or no treatment One study compared topical antibiotics to a saline (salt water) ear wash. The topical antibiotics appeared to be more effective than the saline ear wash when assessed one to two weeks after treatment, but this study was too small to provide any certainty of the findings (very low‐certainty evidence). Comparison of topical antibiotics in addition to systemic (oral or injected) antibiotics Four studies compared treatment with topical antibiotic (ciprofloxacin) drops in addition to a systemic (oral or injected) antibiotic. Treatment marginally favoured the combined topical and oral antibiotics compared to oral antibiotics only for resolution of discharge at one to two weeks and two to four weeks. These studies were too small to provide any certainty of the findings (low‐certainty evidence). Comparisons of different topical antibiotics There were 12 studies that examined the effectiveness of different types of antibiotics. The certainty of the evidence for all outcomes in these comparisons is very low. Two studies did not report the number of included participants, or reported only the number of ears treated, so the total number of participants could not be calculated. Due to the low certainty of evidence it is not known which type of topical antibiotic is the most effective. How up to date is this review? The evidence is up to date to April 2019.
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              Análisis epidemiológico de la patología otorrinolaringológica ambulatoria en el Hospital San Juan de Dios

              Introducción: La patología otorrinolaringológica presenta una alta incidencia. Objetivo: Conocerla frecuencia de consultas permite crear programas de formación continua adecuados. Material y método: Estudio retrospectivo. Análisis de las hojas de atención de policlfnico ambulatorio durante el año 2006 en el Hospital San Juan de Dios. Resultados: La patología más frecuente es la otológica, que corresponde a 50% de las consultas. Individualmente, la patología más común es la otitis media crónica, seguida de la patología adenoamigdalina y la rinitis. Conclusiones: Ha habido un desplazamiento de la patología infecciosa hacia la patología crónica inflamatoria.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                March 2021
                : 12
                : 1
                : 19-33
                Affiliations
                [1] Managua orgnameUniversidad Católica Redemptoris Mater orgdiv1Facultad de Ciencias Médicas Nicaragua
                Article
                S2444-79862021000100003 S2444-7986(21)01200100003
                10.14201/orl.23063
                95937054-0102-4cdd-bae2-fd0b2af207fb

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 14 June 2020
                : 11 April 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 15
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                SciELO Spain

                Categories
                Artículo original

                OMC y otomicosis en adultos,Epidemiology and clinic of ambulatory ear pathologies,OMC and otomycosis in adults,Use of antihistamines,Terapia prologada con antibióticos orales y tópicos,Prolonged therapy with oral and topical antibiotics,Uso de antihistamínicos,Epidemiologia y clínica de las patologías ambulatorias del oído

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