Otitis Media

The review found no convincing evidence for the effectiveness of any therapeutic or preventive homeopathic treatment for the treatment of childhood and adolescent ailments. The authors' cautious conclusions were appropriate given the evidence presented and are likely to be reliable. Authors' objectives To evaluate the effectiveness of therapeutic or preventive homeopathy treatment for childhood and adolescent ailments. Searching MEDLINE, EMBASE, AMED, CINAHL, Cochrane Central Register of Controlled Trials (2005), British Homeopathic Library, ClinicalTrials.gov and UK National Research Register were searched from inception to January 2006 without language restrictions. Search terms were reported. Handsearching of conference proceedings and five relevant medical journals were also conducted. Bibliographies of all retrieved articles were scanned. Experts in the field were contacted for additional studies. Study selection Double-blind placebo-controlled randomised clinical trials (RCTs) of any homeopathic intervention for the prevention or treatment of childhood and adolescent ailments were eligible for inclusion. The age range of participants was 0 to 19 years based on the World Health Organisation classification. The included studies reported a wide variety of homeopathic remedies using different regimens, potencies and duration (details reported in review). A number of the included studies also reported usage of concomitant treatments. Participants in the included studies were aged from six months to 15 years. The proportion of males, when reported, ranged from 41% to 90%. Patient conditions included adenoid vegetation, attention-deficit/hyperactivity disorder (ADHD), asthma, acute otitis media, conjunctivitis, diarrhoea, postoperative pain agitation syndrome, upper respiratory tract infection and warts. Assessment of outcomes included use of the Conners' Global Index-Parent (CGI-P), Conners' Parent Symptom Questionnaire and parent diaries. Outcomes varied between studies and included need for adenoidectomy, size of adenoid vegetation, intensity, frequency and duration of asthma attacks, symptom scores and number of days with diarrhoea. Two reviewers independently selected studies for inclusion. Decisions were discussed and validated by a third reviewer. Disagreements were resolved through discussion. Assessment of study quality Validity was assessed and scored using the Jadad scale, which considered the reporting and handling of randomisation, blinding and handling of withdrawals. The maximum possible score was 5 points. Two reviewers independently assessed validity. Data extraction Data on each outcome and adverse events were extracted using a standard form. Two reviewers independently extracted data, which were discussed and validated by a third reviewer. Disagreements were resolved through discussion. Methods of synthesis The studies were combined in a narrative synthesis grouped by patient conditions. Each study was described in the text and additional descriptive information was presented in tables. Results of the review

Streptococcus pneumoniae is one of the leading bacterial pathogens causing invasive disease and noninvasive infections at both extremes of life: in children younger than 5 years and in elderly persons of 65 years or more. Pneumococcal infections result in substantial morbidity and mortality among children under 5 years of age; it is estimated that 1,600,000 deaths occur per year in that age range alone, mostly in developing countries, thus representing a serious public health problem around the globe. Infections caused by S. pneumoniae are considered by the World Health Organization (WHO) as the number one vaccine-preventable cause of death in children younger than 5 years of age. In 2000, the first heptavalent conjugated pneumococcal vaccine (PCV7) was licensed in the United States, differing from the already available non-conjugated polysaccharide pneumococcal vaccine in its ability to induce a protective immune response in children under 2 years of age. Initial efficacy studies in the United States with PCV7 revealed a 97.4% efficacy against invasive pneumococcal disease (IPD) caused by vaccine serotypes (4, 9V, 14, 19F, 23F, 18C and 6B). PCV7 was introduced into the National Immunization Program (NIP) of various countries starting in year 2000 and, after 11 years of use, the data confirm that PCV7 introduction resulted in a major reduction of S. pneumoniae IPD, non-bacteremic pneumonia, otitis media medical visits, the need for tympanic tubes, the number of cases of otorrhea and of various antimicrobial resistant strains in children <5 years of age. Additionally, reductions in S. pneumoniae infections have been observed in unvaccinated children above 5 years of age and adults including individuals older than 65 years of age (herd effect). Effectiveness has been observed in countries using a 4-dose regimen (3 infant doses followed by a booster during the second year of life) but also in countries with modified reduced doses (2 infant doses and a booster during the second year of life or after 3 infant doses with no booster).

Young children with Pierre Robin sequence are at considerable risk to develop delayed or disordered communication development. This study investigated the effectiveness of early communication intervention with four young children with Pierre Robin sequence, aged 5 to 28 months. The Proportional Change Index (Wolery, 1983) was used to determine the amount of child progress that took place during the intervention period. The results indicated that regular early communication intervention sessions over an extended period of time produced positive results, especially for expressive language abilities. The presence of a slight hearing loss due to otitis media, seemed to have influenced the effectiveness of early communication intervention. One subject displayed an associated disorder and evidenced the slowest rate of development for receptive and expressive language abilities as well as a limited phonetic repertoire for consonants. All but one subject had limited phonetic repertoires pos...

(a) To study knowledge, attitudes and practices with respect to risk factors of otitis media in a rural South Indian Community where the prevalence of otitis media is high. (b) To discover the association between parental education, socioeconomic status (SES) and family type (nuclear or joint) with knowledge, attitudes and practices regarding risk factors for otitis media.Using a cluster sampling design, the caregivers of 150 children attending daycare were interviewed to note knowledge, attitudes and practices with respect to risk factors for otitis media. Data on level of education of the caregiver, house type (an indicator of SES) and type of family structure were noted. A questionnaire was administered to collect all the relevant data. Statistical analysis of the data obtained was performed to note frequencies. Correlations between sociodemographic parameters and knowledge, attitudes and practices were studied using Chi-square test of proportions.Over 50% of the population showed knowledge deficits with regard to the various risk factors for otitis media. Caregivers from nuclear families were slightly less knowledgeable regarding lack of immunization and household smoke as risk factors for the disease. There was no correlation between any of the sociodemographic factors and attitudes. However, educated mothers were more likely than illiterate mothers to clean their children's ears of wax on a regular basis with the belief that it would prevent ear disease (p = 0.05). Treatment practices in the community were more or less uniform in that earache was either disregarded (26.4%) or treated with home remedies (67.2%) by most caregivers, while a doctor's opinion was often sought for ear discharge (50%). Parents of higher SES were more likely to use home remedies than those of lower SES (p = 0.008).Sociodemographic factors as well as poor knowledge and attitudes and unhealthy practices with respect to risk factors of otitis media contribute to the high prevalence of otitis media in this rural South Indian community. Health education regarding risk factors and provision of accessible health care is essential to reduce the disease burden.

Tympanosclerosis is a sequel of chronic otitis media characterized by the deposition of calcareous plaques following hyaline degeneration in the fibrous layer of the tympanic membrane and inside middle ear mucosa. It usually results from prior middle ear infections. In this study, results of treatment and clinical findings of the patients with tympanosclerosis are presented. Our objective is to determine the changes in middle ear caused by tympanosclerosis and intervene in the more problematic zone and find out the more useful treatment protocol for patients. Preoperative features, middle ear findings detected during surgery and postoperative hearing levels of the patients who were operated in our clinic between January 1996 and June 2006 due to tympanosclerosis were evaluated. Surgical treatment was performed on a total of 37 patients including 25 females and 12 males between ages of 11 and 71. Preoperative tympanic membranes perforations were presented at a rate of 91% and average airway bone gap was 37.8 dB. Bilateral involvement was present in 59%. Conductive-type hearing loss was present at a rate of 81%, whereas mixed-type hearing existed at a rate of 19%. Sclerotic plaques were most commonly localized in the attic with a rate of 72%. Post-op outcome was found to be 27% in the patients with air bone gap between 0-20 dB. The best hearing result belonged to type 1 patients. Cases in which stapes footplate was fixated had the worst result in terms of hearing. Teflon piston was only applied in one patient. Our tympanoplasty success was found to be 67%. The most common treatment method of tympanosclerosis is surgery. Stapedectomy is recommended in surgery instead of mobilization techniques. However, there is often recurrence and there is no curative treatment. Therefore rehabilitation with hearing device can be preferred as an adjunct. In the recent experimental studies, good results with topical or systemic agents have also been promising.

Miyazis, omurgalı canlıların dokularında sinek larvalarının yerleşmesiyle oluşan infektif bir durumdur. Bu sunuda orta kulak miyazı ve etken sineklerin türlerinin belirlenmesi amaçlanmıştır. Laboratuara % 10 formaldehit ve serum fizyolojik içerisinde gönderilen larvalar stereo-mikroskop (Olympus 10X) ile incelenmiştir. Canlı larvaların bir kısmı erişkin hale getirilerek larva evresindeki ve erişkin haldeki özelliklerinden yararlanılarak tanımlanmıştır. Larvaların ve erişkin hale getirilen sineğin Sarcophaga sp. olduğu belirlenmiştir. Her iki hastada da orta kulak miyazına neden olan sinek türünün Sarcophaga sp. olduğu saptanmıştır.

Surface associated pneumococcal proteins ␣-enolase (Eno), immunoglobulin A1 protease (Iga), streptococcal lipoprotein rotamase A (SlrA), and putative proteinase maturation protein A (PpmA) have potential as candidates for future protein-based anti-pneumococcal vaccines. The immunogenicity of these proteins were studied in a cohort of 329 children during their first two years of life. During the first recorded episode of otitis media, acute and convalescent phase sera were available from 151 children. Concentrations of antibodies against Eno, Iga, SlrA and PpmA were measured by EIA and detected in 99% (300/302), 95% (288/302), 95% (288/302), and 83% (251/302) of the sera, respectively. There were no statistically significant differences between the groups of children with and without a history of pneumococcal contact or with respect to the type of pneumococcal contact. Despite a mean overall decrease in the antibody titers in the convalescent sera following AOM, several children were able to respond with a more than twofold increase in antibody titer in response to AOM. The majority of the children with increased antibody concentrations appeared in the groups, which were colonized with pneumococci at the time of serum collection, but were recorded as having no prior contact with pneumococci. In conclusion, SlrA, PpmA, Eno and Iga are immunogenic proteins that elicit antibody responses early in life. No significant correlation between antibody titers to these proteins and pneumococcal carriage or infection was found. Presumably, this results from the presence of cross-reactive epitopes on commensal bacteria.

Human milk provides infants with antimicrobial, anti-inflammatory, and immunomodulatory agents that contribute to optimal immune system function. The act of breastfeeding allows important bacterial and hormonal interactions between the mother and baby and impacts the mouth, tongue, swallow, and eustachian tubes. Previous meta-analyses have shown that lack of breastfeeding and less intensive patterns of breastfeeding are associated with increased risk of acute otitis media, one of the most common infections of childhood. A review of epidemiologic studies indicates that the introduction of infant formula in the first 6 months of life is associated with increased incidence of acute otitis media in early-childhood. More recent research raises the issues of how long this increased risk persists, and whether lack of breastfeeding is associated with diagnosis of otitis media with effusion. However, many studies suffer from lack of study of younger populations and imprecise definitions of i...

This study was designed to investigate the efficacy of a decongestantantihistamine preparation in combination with antibiotic treatment of acute otitis media. The effectiveness of a new Dimetapp ® (DIM) preparation was assessed in comparison with each of its components (brompheniramine maleate [BPM] and phenylephrine hydrochloride [PEH]) as well as a placebo (PL) vehicle in the treatment of acute otitis media. In a randomized double blind study, 98 children were treated in the emergency department or outpatient medical clinics at Children's Hospital of Michigan with amoxicillin and either DIM, BPM, PEH, or PL. They were evaluated at two weeks by clinical examination, pneumatoscopy, and tympanometry. Fifty-eight patients (59%) continued to have evidence of fluid in the middle ear. These patients were continued on the test medications for another two weeks and then reevaluated. There were significant differences between the treatment groups (DIM, BPM, and PEH) and the control PL group; the patients receiving Dimetapp ® or placebo fared better than those receiving BPM or PEH. However, there was no difference in the overall response between Dimetapp ® and placebo. Antihistamine-decongestant therapy does not appear to be necessary in the treatment of acute otitis media in children. [Bhambhani

Objectives/Hypothesis: Heterotopic masses of neuroglial tissue involving non-midline structures, specifically, the middle ear region, are exceptional. The pathogenesis of these lesions and, in particular, their relation to encephaloceles, is uncertain. Study Design and Methods: H&E-stained sections from 15 lesions diagnosed as neuroglial heterotopias or encephaloceles involving the middle ear region were reviewed. Radiographic or operative evidence of a central nervous system (CNS) relation and clinical factors possibly related to pathogenesis were analyzed. Results: All 15 lesions (from six men and nine women; mean age, 49 y; range, 16 -67 y), regardless of their relation to the CNS, were composed of varying proportions of neurons and glia with associated chronic inflammatory cells and reactive gliosis. No significant ependymal or choroid plexus component was present. Operative findings revealed that two lesions had definite CNS connections and two were unrelated to the CNS; this relation could not be determined in the remaining cases. Seven of 10 patients for whom clinical information was available had a history of chronic otitis media or mastoiditis or both; four of these seven patients also had a history of previous trauma or surgery. Three patients, including both patients whose lesions had no demonstrable CNS attachment, had no predisposing factors. Conclusions: Most neuroglial heterotopias of the middle ear are probably acquired encephaloceles. These lesions occur in older patients than do their midline counterparts. Determination of the relation of these lesions to adjacent CNS structures must be done radiographically or using operative findings, because histology alone cannot be reliably used to render an accurate diagnosis.

Statements of commitment to change are advocated both to promote and to assess continuing education interventions. Howevel; most studies of commitment to change have used self-reported outcomes, and self-reports may significantly overestimate actual performance. As part of an educational randomized controlled trial, this study documented changes that family physicians committed to make in their prescribing and then used third-party data to examine actual changes.

Aicardi syndrome is an X-linked-dominant condition characterized by infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae. We reviewed the Aicardi Syndrome Foundation's compilation of family-based, self-reported questionnaires for the year 2000. Information was obtained from 77 females with Aicardi syndrome regarding developmental milestones, seizure frequency, seizure classification, antiepileptic drug use, and medical problems. Patient ages ranged from 1 to 25 years (mean ‫؍‬ 7.2 years). All patients were significantly developmentally delayed with milestones ranging from 2 to 36 months. Of the patients, 91% attained milestones no higher than 12 months. Seizures were reported in 92% of patients and occurred daily in 67%. Infantile spasms were the most common seizure type observed in 17%, although a variety of other seizure types were also reported. Multiple antiepileptic drugs were used in these patients with 73% of patients taking two or more antiepileptic drugs. Five patients had a vagal nerve stimulator implanted, and one patient underwent a hemispherectomy. The most common medical problems cited included scoliosis, constipation, gastroesophageal reflux, aspiration pneumonia, and otitis media, but overall health was perceived to be good. Our review demonstrates the spectrum of developmental disabilities, epilepsy severity, and prognosis in a large group of Aicardi patients. © 2002 by Elsevier Science Inc. All rights reserved.

The ototoxieity of antibiotics given either systemically or topically has been recently recognized. However, the ototoxicity of topically applied alcohols and other solvents used as vehicles for drugs has not been well recognized. One of the most common solvents, propylene glycol, was chosen for this study, and this agent in various concentrations was instilled into the middle ear of guinea pigs and chinchillas for various periods of time. Its effect on the function of the cochlea was studied as well as the histopathologic changes in the temporal bones. Deterioration of the cochlear microphonics and the endocochlear direct current potential was found. A 10 per cent solution applied for six days caused a reduction in the cochlear microphonics. Fifty per cent or stronger solution always caused a reduction in the cochlear microphonics. The deterioration in the cochlear microphonics persisted one month. Dose related changes in the endocochlear potential were noted. Morphologic changes were severe and included granulation tissue in the middle ear and destruction and ossification of the auditory bulla and bony cochlea. Propylene glycol should not be used in the ear that has a perforation of the tympanic membrane.

Objective: The purpose of this study was to investigate the association between deep dental overbite and eustachian tube dysfunction (ETD). Design: Casecontrol study Setting: Tertiary care pediatric otolaryngology outpatient clinic at the Children's Hospital, Boston, Massachusetts. Patients: 105 patients between the ages of 2 and 6 years. Study Measurements: Dental overbite, overjet, and occlusal relationships were measured by an observer who was unaware of ETD status. ETD was defined as having ventilation tubes in place or having the recommendation for ventilation tube placement by an attending pediatric otolaryngologist. In addition, demographic information and medical and social histories were prospectively recorded. Results: In a multivariate logistic regression model, children with deep bites were 2.8 times more likely to have ETD than those without deep bites (P ‫؍‬ .03). Other independent risk factors for ETD identified in this model were family history of otitis media (OM) and age less than 3 years. Conclusions: Children with deep dental overbites are at a significantly increased risk for developing ETD.

Objective: Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aeitological factors for children diagnosed with APD compared to those for whom APD was excluded. Methods: Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors. Results: 32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership. Conclusions: Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable. #

Increasing numbers of young children spend extended portions of their days in group care settings. However, little attention has been given to the acoustical properties of these settings and how these may affect development, particularly speech and language development. This article provides a review of how classroom acoustics are measured, what researchers have found, and why poor classroom acoustics are of concern, particularly for infants and toddlers. It concludes with recommendations for improving classroom acoustics and verbal communication in the classroom.

Background: Although the epidemiology of otitis media is well-known in industrialized countries, the extent of otitis media in developing Asian countries, especially in south East Asia is not well studied. Methods: To define the burden of otitis media and its sequelae in children 6-15 years of age, we enrolled elementary and junior high school children in 6 areas in rural and urban Indonesia. Randomly selected schools and classrooms were selected. All children were administered a questionnaire and had ear examinations, pneumatic otoscopy and screening audiometry. Children with any abnormality on examination or with a relevant history underwent diagnostic audiometry and tympanometry, if indicated. Results: Of the 7005 children studied, 116 had chronic suppurative otitis media (CSOM), 30 had acute otitis media and 26 had otitis media with effusion. 2.7% of rural children had CSOM compared with 0.7% of urban children (P < 0.0001). The rates per 1000 of CSOM in rural Bali and Bandung were significantly higher (75 and 25, respectively) than in the rest of Indonesia (P < 0.05). In rural Bali, the rate per 1000 children of inactive CSOM was 63 in 6-to 9-year-old children, compared with 37 in children aged 13-15 years. Concomitantly, the rates of tympanosclerosis were 7 and 26/1000, respectively, in these age groups. Conclusions: In Indonesia, the prevalence of CSOM is relatively high with most disease occurring in rural areas. The high rates in rural Bali with early progression to tympanosclerosis suggest a significant burden of potentially vaccine preventable illness.

Objective: Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures. Study Design: This study was a retrospective case review. Setting: Tertiary referral center with hospital-setting surgery and outpatient ambulatory patient visits. Patients: One hundred twenty patients who underwent over-under tympanoplasty were included in this study. Average follow-up was 1.8 years. Intervention: Over-under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included. Main Outcome Measures: Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy. Results: All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB. Conclusion: Over-under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.

Acute respiratory infections accounts for 20–40% of outpatient and 12–35% of inpatient attendance in a general hospital. Upper respiratory tract infections including nasopharyngitis, pharyngitis, tonsillitis and otitis media constitute 87.5% of the total episodes of respiratory infections. The vast majority of acute upper respiratory tract infections are caused by viruses. Common cold is caused by viruses in most circumstances and does not require antimicrobial agent unless it is complicated by acute otitis media with effusion, tonsillitis, sinusitis, and lower respiratory tract infection. Sinusitis is commonly associated with common cold. Most instances of rhinosinusitis are viral and therefore, resolve spontaneously without antimicrobial therapy. The most common bacterial agents causing sinusitis areS. pneumoniae, H. influenzae, M. catarrhalis,S. aureus andS. pyogenes. Amoxycillin is antibacterial of choice. The alternative drugs are cefaclor or cephalexin. The latter becomes first line if sinusitis is recurrent or chronic. Acute pharyngitis is commonly caused by viruses and does not need antibiotics. About 15% of the episodes may be due to Group A beta hemolytic streptococcus (GABS). Early initiation of antibiotics in pharyngitis due to GABS can prevent complications such as acute rheumatic fever. The drug of choice is penicillin for 10–14 days. The alternative medications include oral cephalosporins (cefaclor, cephalexin), amoxicillin or macrolides.

Complications of cholesteatoma can be of a different nature from those of other otitis media. This review aims to undertake an analysis of current literature regarding management of the complications of cholesteatoma. Despite a significant decline in the incidence of complications secondary to cholesteatoma in developed countries it is still a considerable problem in the developing countries. Among intratemporal complications, facial nerve paralysis and labrynthine fistula and among intracranial complications, meningitis, brain abscess and lateral sinus thrombosis are most common. In cases of facial nerve paralysis, decompression with complete disease eradication is considered to be the mainstay of treatment and usefulness of an epineural incision and the range of the decompression are still debatable. Labyrinthine fistula is commonly managed by a single staged matrix removal, followed by closure of the fistula. Partial labrynthectomy in difficult cases is gaining favor among surgeo...

Six lop rabbits were presented with clinical signs of otitis media or externa. The presence of disease was confirmed by computerized tomography examination, with two rabbits suffering from bilateral disease. The rabbits were anaesthetized and underwent surgery of the affected bulla. Rabbits with bilateral disease had a minimum of 2 weeks between procedures. A single vertical incision was made over the base of the vertical canal, which was bluntly dissected free from surrounding tissue. The ventral portion of the vertical canal was removed and a lateral bulla osteotomy was performed. The mucosa at the base of the dorsal vertical canal was apposed and the aural cartilage sutured to form a blindending pouch open at the pretragic incisure. Histopathological samples taken from the dorsal margin of the vertical canal yielded subtle and non-specific changes in the six samples submitted. All rabbits were discharged within 48 hours of surgery. The cosmetic outcome was excellent with animals retaining visually normal aural anatomy. The partial ear canal ablation/lateral bulla osteotomy procedure is quick and has a good cosmetic result when performed in rabbits.

This study is based on 25 well documented reports of cases which responded well to treatment with Petroleum. Materia medica data were compared with results in contemporary clinical practice. Many patients had characteristic skin problems; children often had recurrent or chronic upper respiratory tract problems. The most prominent mental feature is a quiet, withdrawn or stubborn disposition. The mental symptoms may be difficult to recognise. Detailed documentation in daily practice can be helpful for preserving data of the effect of a medicine; confirmation of statements given in materia medica; improving understanding of homeopathic medicines and differentiating the indications for medicines. Homeopathy (2008) 97, 83-88.

BACKGROUND AND OBJECTIVES: Most osteopaths are trained in pediatric care, and osteopathic manipulative treatment (OMT) is available for many pediatric conditions. The objective of this systematic review was to critically evaluate the effectiveness of OMT as a treatment of pediatric conditions. METHODS: Eleven databases were searched from their respective inceptions to November 2012. Only randomized clinical trials (RCTs) were included, if they tested OMT against any type of control in pediatric patients. Study quality was critically appraised by using the Cochrane criteria.

Allergic rhinitis (AR), rhinosinusitis, and otitis media are among the most common health problems encountered in general practice. Although frequently trivialized, they affect the quality of life, represent a significant socioeconomic burden, and are associated with some serious complications. In addition, allergic rhinitis, rhinosinusitis, and otitis media are often considered as comorbidities.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, or stock options, expert testimony, grants, or patents received or pending, or royalties) that conflict with material presented in this report.

Background and Objectives. Although serious complications of otitis media (OM) such as brain abscess are rare, sequelae of OM such as tympanic membrane perforation and atelectatic tympanic membrane are quite common. Inner ear sequelae can cause hearing loss and speech and language problems. The objectives of this article are to provide a state-of-the-art review on recent articles on complications and sequelae of OM in different anatomic locations, from the tympanic membrane to intracranial sites, as well as hearing loss and speech and language development.

Adenoids are strategically located for mediating local and regional immune functions as they are exposed to antigens from both the outside air and the alimentary tract. Recurrent or chronic respiratory infections can induce histomorphological and functional changes in the adenoidal immunological barrier, sometimes making surgical treatment necessary. Our aim in this review is to summarize the crucial points about not only the immunological histopathology of adenoidal tissue, especially in patients with adenoid hypertrophy, but also the most common and useful diagnostic techniques and surgical options. Clin.

The conventional antibiotic treatment of acute otitis media (AOM) faces a number of problems, including antibiotic resistance. Homeopathy has been shown to be capable of treating AOM successfully. As AOM has a high rate of spontaneous resolution, a trial to prove any treatment-effect has to demonstrate very fast resolution of symptoms. The purpose of this study was to find out how many children with AOM are relieved of pain within 12 h after the beginning of homeopathic treatment, making additional measures unnecessary. Two hundred and thirty children with AOM received a first individualized homeopathic medicine in the paediatric office. If pain-reduction was not sufficient after 6 h, a second (different) homeopathic medicine was given. After a further 6 h, children who had not reached pain control were started on antibiotics. Pain control was achieved in 39% of the patients after 6 h, another 33% after 12 h. This resolution rate is 2.4 times faster than in placebo controls. There w...

Objective: To detect the most common causes of vertigo in children. Methods: Fifty-four children (20 boys and 34 girls) aged 3-16 years, who presented with vertigo attacks during a 3-year period, were studied. A detailed medical history for vestibular symptoms and migraine was obtained from our patients or their parents. All patients underwent otolaryngologic, ophthalmologic and neurologic clinical evaluation. A detailed laboratory examination, including serologic tests for viral infections, was also obtained. Additionally, a complete audiological and neurotologic evaluation was performed. Computed tomography (CT) scans and magnetic resonance imaging (MRI) were obtained in selected cases. Results: Viral infections, benign paroxysmal vertigo of childhood and migraine were the most common causes of vertigo accounting for approximately 65% of our patients. Otitis media, head trauma, benign paroxysmal positional vertigo, Meniere's disease and brain tumor were less common causes of vertigo.

Acute Otitis Media (AOM), a viral or bacterial infection of the ear, is the most common childhood infection for which antibiotics are prescribed in the United States. In 2001, the Southern California Evidence-based Practice Center conducted a systematic review of the evidence comparing treatments of AOM. This review updates the 2001 review findings on diagnosis and treatment of uncomplicated AOM, assesses the evidence for treatment of recurrent AOM, and assesses the impact of the heptavalent pneumococcal conjugate (PCV7) vaccine on the microbiology of AOM. Searches of PubMed® and the Cochrane databases were conducted from January 1998 to July 2010 using the same search strategies used for the 2001 report, with the addition of terms not considered in the 2001 review. The Web of Science was also searched for citations of the 2001 report and its peer-reviewed publications. After review by two investigators against pre-determined inclusion/exclusion criteria, we included existing system...