Treatment of Early Recurrences of Acute Purulent Otitis Media; Value of Myringotomy

Abstract

The present investigation was carried out in order to study the efficacy of oral antibiotics (A) versus oral antibiotics plus acute myringotomy (B) in the treatment of early recurrences of acute purulent otitis media. Seventy-nine children with early recurrences (arisen within 4 weeks of a primary episode) were randomly allocated to one of the two treatment groups (A or B). Eleven of 41 (26.8%) children in group A, and 12/38 (31.6%) in group B had healed at 4 weeks (p greater than 0.1). Seventeen children of both groups had secretory otitis media at 4 weeks and new relapses had occurred in 13 children in group A and 9 in group B. No difference between the groups was noted regarding the number of otitis episodes during the next 5 months. Thus, acute myringotomy could not be proven to affect the clinical course of an early recurrence of acute purulent otitis media as compared with that after treatment with oral antibiotics alone.

Comparison of study designs for acute otitis media trials

“…There are conflicting data as to whether the tympanocentesis procedure itself is a confounding factor in AOM study designs because it may provide therapeutic benefit for children with AOM [15,18,[199][200][201][202]. A therapeutic benefit from tympanocentesis is plausible, given that drainage of loculated, infected pus generally improves outcomes at other sites of infection.…”

Controversies in the Medical Management of Persistent and Recurrent Acute Otitis Media Recommendations of a Clinical Advisory Committee

“…11 Children in day care centers are at higher risk for recurrent AOM. 9 • 11 • 13 Between 1981 and1988, the percentage of children in day care centers increased from 11% to 21% (p < .001) and the percentage of infants in day care centers increased from 2.2% to 5.0% (p < .007). 11 Day care entry at or before 2 months of age, attendance of 30 or more hours per week, and settings with more than 2 children younger than 2 years of age and a total of 5 or more children are risk factors for AOM.…”

“…1 Evacuation (drainage) of the middle ear effusion can be beneficial in breaking the cycle of persistent and recurrent AOM. 44 The information provided by the culture and susceptibility report may be valuable for treating persistent and recurrent AOM. If a bacterial pathogen is reported, selecting an appropriate antibiotic will reduce the likelihood of further treatment failure; if no bacterial pathogen is isolated, the patient will not require further antibiotic treatment.…”