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      Otitis media

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          Abstract

          Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; ‘glue ear’) and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during ‘colds’, viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.

          Supplementary information

          The online version of this article (doi:10.1038/nrdp.2016.63) contains supplementary material, which is available to authorized users.

          Abstract

          Otitis media (OM) or middle ear inflammation is a spectrum of diseases. In this Primer, Schilder et al. provide an overview of OM epidemiology, its underlying pathophysiology, diagnosis, impact on children and their families and preventive and treatment options, as well as an outlook on the future.

          Supplementary information

          The online version of this article (doi:10.1038/nrdp.2016.63) contains supplementary material, which is available to authorized users.

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          Most cited references245

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          A scaled version of the General Health Questionnaire

          D P Goldberg, V F Hillier (1979)
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            Live attenuated versus inactivated influenza vaccine in infants and young children.

            Robert Belshe, Kathryn Edwards, Timo Vesikari … (2007)
            Universal vaccination of children 6 to 59 months of age with trivalent inactivated influenza vaccine has recently been recommended by U.S. advisory bodies. To evaluate alternative vaccine approaches, we compared the safety and efficacy of intranasally administered live attenuated influenza vaccine with those of inactivated vaccine in infants and young children. Children 6 to 59 months of age, without a recent episode of wheezing illness or severe asthma, were randomly assigned in a 1:1 ratio to receive either cold-adapted trivalent live attenuated influenza vaccine (a refrigeration-stable formulation of live attenuated intranasally administered influenza vaccine) or trivalent inactivated vaccine in a double-blind manner. Influenza-like illness was monitored with cultures throughout the 2004-2005 influenza season. Safety data were available for 8352 children, and 7852 children completed the study according to the protocol. There were 54.9% fewer cases of cultured-confirmed influenza in the group that received live attenuated vaccine than in the group that received inactivated vaccine (153 vs. 338 cases, P<0.001). The superior efficacy of live attenuated vaccine, as compared with inactivated vaccine, was observed for both antigenically well-matched and drifted viruses. Among previously unvaccinated children, wheezing within 42 days after the administration of dose 1 was more common with live attenuated vaccine than with inactivated vaccine, primarily among children 6 to 11 months of age; in this age group, 12 more episodes of wheezing were noted within 42 days after receipt of dose 1 among recipients of live attenuated vaccine (3.8%) than among recipients of inactivated vaccine (2.1%, P=0.076). Rates of hospitalization for any cause during the 180 days after vaccination were higher among the recipients of live attenuated vaccine who were 6 to 11 months of age (6.1%) than among the recipients of inactivated vaccine in this age group (2.6%, P=0.002). Among young children, live attenuated vaccine had significantly better efficacy than inactivated vaccine. An evaluation of the risks and benefits indicates that live attenuated vaccine should be a highly effective, safe vaccine for children 12 to 59 months of age who do not have a history of asthma or wheezing. (ClinicalTrials.gov number, NCT00128167 [ClinicalTrials.gov].). Copyright 2007 Massachusetts Medical Society.
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              Efficacy of a pneumococcal conjugate vaccine against acute otitis media.

              J Eskola, T Kilpi, A. Palmu … (2001)
              Ear infections are a common cause of illness during the first two years of life. New conjugate vaccines may be able to prevent a substantial portion of cases of acute otitis media caused by Streptococcus pneumoniae. We enrolled 1662 infants in a randomized, double-blind efficacy trial of a heptavalent pneumococcal polysaccharide conjugate vaccine in which the carrier protein is the nontoxic diphtheria-toxin analogue CRM197. The children received either the study vaccine or a hepatitis B vaccine as a control at 2, 4, 6, and 12 months of age. The clinical diagnosis of acute otitis media was based on predefined criteria, and the bacteriologic diagnosis was based on a culture of middle-ear fluid obtained by myringotomy. Of the children who were enrolled, 95.1 percent completed the trial. With the pneumococcal vaccine, there were more local reactions than with the hepatitis B vaccine but fewer than with the combined whole-cell diphtheria-tetanus-pertussis and Haemophilus influenzae type b vaccine that was administered simultaneously. There were 2596 episodes of acute otitis media during the follow-up period between 6.5 and 24 months of age. The vaccine reduced the number of episodes of acute otitis media from any cause by 6 percent (95 percent confidence interval, -4 to 16 percent [the negative number indicates a possible increase in the number of episodes]), culture-confirmed pneumococcal episodes by 34 percent (95 percent confidence interval, 21 to 45 percent), and the number of episodes due to the serotypes contained in the vaccine by 57 percent (95 percent confidence interval, 44 to 67 percent). The number of episodes attributed to serotypes that are cross-reactive with those in the vaccine was reduced by 51 percent, whereas the number of episodes due to all other serotypes increased by 33 percent. The heptavalent pneumococcal polysaccharide-CRM197 conjugate vaccine is safe and efficacious in the prevention of acute otitis media caused by the serotypes included in the vaccine.
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                Author and article information

                Contributors
                Anne G. M. Schilder: a.schilder@ucl.ac.uk
                Journal
                Journal ID (nlm-ta): Nat Rev Dis Primers
                Journal ID (iso-abbrev): Nat Rev Dis Primers
                Title: Nature Reviews. Disease Primers
                Publisher: Nature Publishing Group UK (London )
                ISSN (Electronic): 2056-676X
                Publication date (Electronic): 8 September 2016
                Publication date (Print): 2016
                Volume: 2
                Issue: 1
                Electronic Location Identifier: 16063
                Affiliations
                [1 ]GRID grid.83440.3b, ISNI 0000000121901201, evidENT, Ear Institute, University College London, Royal National Throat Nose and Ear Hospital, ; 330 Grays Inn Road, London, WC1X 8DA UK
                [2 ]GRID grid.176731.5, ISNI 0000 0001 1547 9964, Division of Pediatric Infectious Diseases, Department of Pediatrics, , University of Texas Medical Branch, ; Galveston, Texas USA
                [3 ]GRID grid.1022.1, ISNI 0000 0004 0437 5432, School of Medicine and Menzies Health Institute Queensland, Griffith University, ; Queensland Australia
                [4 ]GRID grid.262863.b, ISNI 0000 0001 0693 2202, Department of Otolaryngology, , SUNY Downstate Medical Center, ; Brooklyn, New York USA
                [5 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, University of Pittsburgh School of Medicine, ; Pittsburgh, Pennsylvania USA
                [6 ]GRID grid.5335.0, ISNI 0000000121885934, Department of Psychology, , University of Cambridge, ; Cambridge, UK
                [7 ]GRID grid.7692.a, ISNI 0000000090126352, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, ; Utrecht, The Netherlands
                Article
                Publisher ID: BFnrdp201663
                DOI: 10.1038/nrdp.2016.63
                PMC ID: 7097351
                PubMed ID: 27604644
                SO-VID: f06e41c8-045f-4a33-aa72-624113312404
                Copyright © © Macmillan Publishers Limited 2016
                License:

                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.

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                issue-copyright-statement © Springer Nature Limited 2016

                Keywords: inner ear,infection,vaccines
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                Keywords: inner ear, infection, vaccines

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