Recurrent Acute Otitis Media: What Are the Options for Treatment and Prevention?

Abstract

Purpose of ReviewTo survey current strategies for treatment and prevention of recurrent acute otitis media (rAOM).Recent FindingsTreatment with systemic antibiotics is required in recurrent episodes of acute otitis media. A cautious attitude is recommended due to antibiotic resistance. Antibiotics also provide effective prophylaxis for rAOM. Topical treatment with ear drops is recommended in rAOM with otorrhea from tympanostomy tubes. Pneumococcal conjugated vaccines seem to have a moderate reductive effect on overall otitis media. The effect on rAOM is still unclear. Different administrations of immunoglobulins have not been effective against rAOM. Breastfeeding had a protective effect against rAOM. A recommendation against cigarette smoke exposure as a measure to prevent otitis seems warranted. An effect for adenoidectomy in children <2 years old with rAOM has been suggested. There is a strong genetic connection with rAOM. Probiotics and nasal spray with Streptococci might offer future opportunities as prophylaxis. Too little is known about complimentary treatments to give any recommendations.SummarySystemic antibiotics are still needed as treatment against episodes of AOM in rAOM children. There are several preventive measures that can be taken to reduce the burden of AOM but they all have a small-moderate effect. Systemic antibiotics provide effective prophylaxis in rAOM, but must be used with extreme caution due to the emerging antibiotic resistance.

Prevalence, risk factors and management strategies for otological problems in girls with Turner syndrome

“…Finally, antibiotic prophylaxis against otitis media is not routinely recommended in the general paediatric population, considering the small reduction in frequency when weighed against the financial cost and potential adverse effects of antibiotics . Nonetheless, a Cochrane review predicts larger benefits in high‐risk children .…”

Efficacy of a non-invasive middle ear aeration device in children with recurrent otitis media: A randomized controlled trial protocol

“…Influenza vaccinations have been proven interventions in reducing the incidence of AOM in children, especially during influenza season. However, there is only weak evidence that routine antibiotic treatment improves the course or prevents subsequent infections, indicating the need for an alternative solution to protect children from OM recurrence and complications [ 1 , 3 ]. The EP device has been shown in previous studies to be a safe and effective treatment for middle ear effusion.…”

“…While interventions include prophylactic antibiotics, tympanostomy tubes, and adenoidectomy, the mainstay initial treatment has been antibiotics [ 1 ]. However, there is only weak evidence that routine antibiotic treatment improves the course or prevents subsequent infections, indicating the need for an alternative solution to protect children from OM recurrence and complications [ 1 , 3 ].…”

Prospects for vitamin d in prevention of acute otitis media in children

“…Кроме того, в 20-30% случаев ОСО имеет тенденцию к рецидивирующему течению, вызывая значительные медицинские, социальные и экономические проблемы. Критерием постановки диагноза рецидивирующий средний отит (РСО) является 3 и более эпизода ОСО в течение 6 месяцев или 4 и более эпизода ОСО в течение 12 месяцев [12,13]. Например, в Великобритании около 30% детей с острым средним отитом в возрасте до 3 лет посещают педиатра каждый год и 97% получают антибактериальную терапию.…”

“…На сегодняшний день в мире существует несколько основных подходов для того, чтобы уменьшить число эпизодов ОСО. К ним относятся: расширение показаний к антибактериальной терапии (назначение антибиотиков на каждый эпизод рецидивирующего острого среднего отита), вакцинация от пневмококковой инфекции и гриппа, использование пробиотиков, пролонгированный прием препаратов ксилитола и сульфата цинка, хирургическое лечение (аденотомия или аденотонзиллотомия с одномоментным проведением миринготомии или тимпаностомии) [11][12][13]. При этом ни один из существующих подходив не дает гарантии 100% защиты ребенка от развития острого среднего отита.…”