Tympanostomy tubes for otitis media: quality-of-life improvement for children and parents

We measured quality of life issues for both children and their parents on the premise that parental quality of life should be an aspect of cost-effectiveness in otitis media treatment. The patients were less than 18 years of age and had had myringotomy with tube insertion at the head and neck surgery department of a large health maintenance organization. Quality of life for patients, parents, and caregivers was evaluated by telephone survey of parents or caregivers and by retrospective chart review of the number of pre- and postoperative healthcare visits and antibiotic usage. Chart review showed a significant postoperative reduction in the number of clinic visits and in use of antibiotic drugs after insertion of tympanostomy tubes. Improved postoperative hearing was noted, and tympanostomy tube insertion was shown to be safe. The chart-review cost analysis showed that tympanostomy tube insertion is a cost-effective treatment for otitis media in children, and the telephone survey results showed that it improves quality of life for children and their parents or other caregivers.     

Comparison of caregiver otitis media risk factor knowledge in suburban and urban primary care environments

OBJECTIVE: There are many risk factors for otitis media. Some of these, such as passive tobacco smoke exposure and childcare arrangements; have the potential to be modified. The purpose of this study is to assess caregiver knowledge deficits about risk factors associated with otitis media and their willingness to modify behaviors associated with those risks. RESEARCH DESIGN AND METHODS: This study is a prospective survey study investigating knowledge deficits of parents or guardians of children ages 6-36 months about the risk factors of otitis media. The patients were consecutively drawn from a suburban and an urban pediatric practice. Any difference in survey results between these two groups was also assessed. Participants completed a survey of 21 questions with content including demographic and OM risk factor data. RESULTS: A total of 401 caregivers completed surveys, with 213 from an urban pediatric practice and 188 from a suburban practice. There was a significant difference in the ethnic distributions of the two populations. The suburban population had a significantly greater family history of ear infections, number of ear infections in the past 12 months, and number of previous ventilation tubes placed. The urban population had a significantly greater number of smokers in the household and decreased knowledge about day care as a risk for OM. The urban population's question responses suggested a greater willingness to change day care arrangements to reduce the risk of otitis media. CONCLUSIONS: Both populations demonstrated knowledge deficits regarding risk factors associated with OM and both populations exhibited willingness to modify behaviors to reduce risk. These findings demonstrate that there are opportunities for improving education regarding OM risk factors and that this education could potentially reduce risk for OM and in turn reduce the incidence of OM in children.     

Knowledge, attitudes and practices with respect to risk factors for otitis media in a rural South Indian community

Objectives

(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.

Methods

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.

Results

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).

Conclusions

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.     

Analysis of risk factors for childhood persistent middle ear effusion

Although exposure to infectious agents and parental smoking are known to influence the overall risk of otitis media, these risk factors do not appear to be linked with the tendency to develop chronic otitis media with effusion (COME) instead of recurrent acute otitis media (RAOM). The genetic inflammatory response type of the child appears to influence the risk of persistent middle ear effusion in COME.Two different clinical presentations of childhood otitis media are encountered: RAOM; and COME, which is associated with persistent effusion in the middle ear. The objective of this study was to assess putative factors that may regulate the development of persistent middle ear effusion in COME.In total, 159 children with RAOM and their parents (n=304), and 55 children with COME and their parents (n=110) were evaluated. All the children with COME or RAOM were aged <4 years.There was no difference in the frequency of attendance at day care outside the home, number of siblings or parental smoking between children with RAOM and those with COME. The frequency of parental allergy and asthma was lower among children with COME than those with RAOM.     

Health-related quality of life in children with otitis media

BACKGROUND: Growing interest in health-related quality of life (HRQoL) in children with otitis media has brought the need to study the currently available HRQoL instruments with respect to their results and their applicability in clinical practice and research of otitis media. OBJECTIVE: To review existing literature on health-related quality of life research in children with otitis media with respect to: (1) the measured impact of otitis media on HRQoL; and (2) the applicability of HRQoL instruments used in research and clinical practice based on their characteristics and contents. METHODS: A search was performed in EMBASE (1988-November 2004) and on NLM Gateway (1966-November 2004) for studies assessing health-related quality of life or functional health status by means of disease-specific or generic questionnaires in children aged 0-18 years with chronic or recurrent otitis media with effusion or acute otitis media. The bibliographies of the selected articles were searched manually. RESULTS: Only 13 of the 141 retrieved articles retrieved fulfilled the criteria for inclusion. In these studies, physical suffering (pain, high fever, etc.), difficulties with hearing or speech, behavioural problems, or emotional distress were reported to be the most important problems experienced by children with otitis media. Almost all instruments applied in these studies measure functional health status instead of health-related quality of life. Data on validity and reliability of these instruments are incomplete. CONCLUSIONS: Recurrent or chronic otitis media is reported to have a substantial and negative effect on various domains of functional health status and health-related quality of life of children. The OM-6 appears to be the best available instrument to assess functional health status in children with OM in a research setting. However, the lack of true HRQoL instruments as well as incomplete data on their reliability and validity, limit both our current knowledge of HRQoL in OM and the application of current instruments in both research and clinical practice.     

Universal neonatal hearing screening--parental attitudes and concern

This study addresses parental attitudes and concern in relation to universal neonatal hearing screening by otoacoustic emissions (OAE) testing. The parents of 87 children who had participated during the first year of the universal neonatal hearing screening programme at University Hospital, Link?ping, Sweden were included in the study. These children were all tested during this period and later cared for at three well-baby clinics (part of their primary healthcare). A questionnaire was given to the parents during routine medical check-ups at the well-baby clinics when the infants were 5-6 months of age. Ninety-five per cent of parents stated that they had a positive attitude towards neonatal hearing screening, 1% were ambivalent and 4% were negative about it. The parents wanted early detection of hearing loss and the possibility of early intervention. It was also found that screening did not disturb the children. A few parents were anxious due to repeated testing of their children. The information provided in connection with the test was found to be sufficient by 77% of parents, whereas 11% of parents had negative comments about it (e.g. they wanted more information about the otoacoustic emissions technique). The general attitude among parents towards universal neonatal hearing screening was very positive in that they felt reassured by it. The risk of disturbing the parent-child relationship by early screening seems to be small, and could be further minimized by improved information and rapid and effective follow-up.     

Passive smoking after tympanostomy and risk of recurrent acute otitis media

OBJECTIVE: Exposure to environmental tobacco smoke has been reported to be a risk factor for childhood otitis media. The effect of parental smoking on the risk of otitis media after the insertion of tympanostomy tubes is unknown. We evaluated the effect of parental smoking on the risk of recurrent otitis media in children who had received tympanostomy tubes. METHODS: We enrolled 217 children aged 1-4 years who underwent insertion of tympanostomy tubes because of middle ear disease. The children were followed-up for 12 months. Otitis media episodes were recorded in patient diaries by primary care physicians. Parental smoking habits were assessed by a questionnaire at the start of the trial and after the 12 month follow-up had ended. The main outcome measure was risk of recurrent otitis media as defined by four or more otitis media episodes after tympanostomy. Altogether 198 children completed the follow-up. RESULTS: Maternal smoking was associated with a highly increased risk of recurrent acute otitis media (OR 4.15, 95% CI 1.45-11.9) after the insertion of tympanostomy tubes. CONCLUSION: Exposure to passive smoking is associated with four-fold risk of recurrent otitis media after tympanostomy. This finding should be used to encourage parents to stop smoking even after the insertion of tympanostomy tubes to their children.     

Analysis of risk factors for childhood persistent middle ear effusion

Conclusions

Although exposure to infectious agents and parental smoking are known to influence the overall risk of otitis media, these risk factors do not appear to be linked with the tendency to develop chronic otitis media with effusion (COME) instead of recurrent acute otitis media (RAOM). The genetic inflammatory response type of the child appears to influence the risk of persistent middle ear effusion in COME.

Objective

Two different clinical presentations of childhood otitis media are encountered: RAOM; and COME, which is associated with persistent effusion in the middle ear. The objective of this study was to assess putative factors that may regulate the development of persistent middle ear effusion in COME.

Material and methods

In total, 159 children with RAOM and their parents (n=304), and 55 children with COME and their parents (n=110) were evaluated. All the children with COME or RAOM were aged <4 years.

Results

There was no difference in the frequency of attendance at day care outside the home, number of siblings or parental smoking between children with RAOM and those with COME. The frequency of parental allergy and asthma was lower among children with COME than those with RAOM.     

A history of acute suppurative otitis media and allergic symptomatology in children with chronic secretory otitis media and controls

The parents of children with secretory otitis media and the parents of healthy children attending for routine school or community medical examinations have been questioned about previous acute otitis media, aural discharge, chronic nasal symptoms and allergic disorders. Eighty-nine pairs of children, matched for age and sex, were available for analysis. There was a significantly higher incidence of acute otitis media, aural discharge and chronic nasal symptoms in the secretory otitis group (P = less than 0.001). Amongst the allergic symptoms and disorders, the only significant differences demonstrated were for drug allergy, eye itching and eye running (P = less than 0.05). The results confirm that a relationship exists between acute otitis media and secretory otitis media and also support the conventional image of the child with secretory otitis as a mouth breather with nasal symptoms. They do not lend support to the view that allergy is an important factor in the pathogenesis of secretory otitis.     

Knowledge and care seeking practices for ear infections among parents of under five children in Kigali,Rwanda: a cross-sectional study

Background

Infections affecting the middle ear are a common childhood occurrence. Some cases may present with ear discharge through a tympanic membrane perforation which may heal spontaneously. However, up to 5% or more cases of those affected have persistent ear discharge. A number of barriers contribute towards delayed presentation at health facilities for treatment of ear infections. We conducted a study to evaluate parents’ and caregivers’ knowledge and care seeking practices for ear infections in children under five in Gasabo district in Kigali, Rwanda.

Methods

Parents/guardians (n = 810) were interviewed using a structured questionnaire to elicit their knowledge of ear infections in children under five and their attitude to seeking care for their children.

Results

The mean age of the respondents was 31.27 years (SD = 7.88, range 17–83). Considering an average of knowledge parameters which included causes, symptoms, prevention, treatment and consequences of ear infections, we found that 76.6% (622) of respondents were knowledgeable about ear infections. We defined a positive practice as seeking medical treatment (community health workers or health facility) and this was found in 89.1% (722) respondents. Correlating knowledge with choice of seeking treatment, respondents were 33% less likely to practice medical pluralism (OR = 0.33, CI 0.11–0.97, P = 0.043) if they were familiar with infections. Moreover, urban dweller were 1.7 times more likely to know ear infections compared to rural dwellers (OR = 1.70, CI 1.22–2.38, P = 0.002).

Conclusion

The majority of respondents had good knowledge and positive attitudes and practices about ear infection. However, medical pluralism was common. There is need to improve the community’s awareness and access to primary health care facilities for the care of ear infections especially in rural areas of Rwanda.

     

Otitis media referrals - the general practitioner perspective

OBJECTIVE: Otitis media management involves both primary and specialist health care. The present study used data on GP referrals to estimate the proportion of children with otitis media referred from primary to specialist care, study variation in referral pattern and factors that influence GP behaviour. METHODS: Data on general practitioners' view on collaborative aspects of specialist health care was collected in a cross-sectional questionnaire survey among all Norwegian GPs in 2004 (N=1633). The outcome of interest was referral routines for otitis media at first visit and at follow-up. RESULTS: Mean referral for otitis media was 22%, most commonly at follow-up visit. Twenty-seven percent of children with otitis media were sent to ENT departments and 73% to practicing otolaryngologists. Variation in referral pattern among GPs was moderate. GPs with specialty in general medicine had 6% fewer referrals. Separate analysis on referral to practicing otolaryngologists showed that GP work load and availability to practicing specialists increased referral, whereas availability to hospital services reduced the probability. CONCLUSION: In Norway, otitis media management mainly takes place in primary care. Completed specialty in general medicine reduces referrals and non-medical factors influence referral behaviour. We suggest that learning groups may contribute to update knowledge in primary care and fewer referrals to specialists.     

New vaccines offering a larger spectrum of protection against acute otitis media: Will parents be willing to have their children immunized?

Objectives

To examine parents’ knowledge, attitudes and beliefs regarding acute otitis media (AOM) and parents’ willingness to vaccinate their children with new vaccine offering larger spectrum of protection against AOM.

Methods

Telephone survey conducted in a stratified sample of household in 10 Canadian provinces using random-digit dialling methodology. Parents of children aged 6 months to 5 years were reached.

Results

502 parents participated. Mean age of the child was 3 years and 32% have had at least one AOM episode during the last 12 months. The great majority of parents agreed that recommended vaccines are important (94%) and useful (94%) for children's health. Parents felt that their knowledge on AOM was very (27%) or somewhat (54%) sufficient. Most parents (73%) thought that antibiotics use was always useful to treat an AOM and 54% estimated that vaccination is an effective mean of preventing AOM. Sixty-four percent (64%) of the surveyed parents were willing to vaccinate their child with a new vaccine offering larger spectrum of protection against AOM. A higher proportion of parents whose child had experienced an AOM were willing to have their children vaccinated. The strongest predictor of parental willingness to vaccinate was subjective norm, or the perception that the other parent of the child and the doctor will approve/recommend the vaccination behaviour.

Conclusions

When new vaccines are available, a key issue is the willingness of parents to adopt it. Health providers should be aware of their important role to inform parents and promote immunization.     

Otitis media and the new guidelines

Otitis media, including recurrent acute otitis media (AOM) and otitis media with effusion (OME), is one of the most common reasons for an illness-related visit to the primary care clinician. Until recently, antibacterial therapy was the standard treatment for most episodes of AOM and often for OME. However, in 1994, a clinical practice guideline on OME was developed by the Agency for Healthcare Policy and Research (now the Agency for Healthcare Research and Quality) and applied to normal children aged 1 to 3 years. The recommendations in the 1994 guideline were evidence based, widely discussed, and somewhat controversial but also acted as a starting point for some ideas about standardization of management of this very common disease. In 2004, revised clinical practice guidelines were published for OME that applied to children aged 2 months to 12 years and included children with developmental disabilities and underlying conditions that predispose them to OME. In addition, a new evidence-based clinical practice guideline for AOM was published in 2004. This guideline recognized that many episodes of AOM will resolve on their own without antimicrobial therapy, and on that basis, one of the recommendations for initial treatment of AOM in specified situations was watchful waiting without antibacterial therapy. This article briefly discusses the current knowledge about AOM and OME and then addresses the new AOM and OME guidelines point by point. It is important to remember that although important, these clinical practice guidelines are just guidelines and that actual management of the patient with otitis media depends on clinical judgement, the severity of the illness, other underlying medical conditions, ready access to adequate follow-up care, and other features, such as cultural differences. Surgical recommendations were not included in the AOM guidelines but were addressed in the OME guidelines. Further information about the efficacy and effectiveness of both sets of guidelines will likely include the results of prospective studies using the guidelines in both normal children and those with underlying medical conditions.     

Quality of life issues in chronic otitis media with effusion: parameters for future study.

This pilot project studied 61 children with chronic otitis media with effusion. The 12-month period prior to ventilation tube surgery was compared with the 12 months after surgery with respect to numbers of health care visits, the use of antibiotics, parental perceptions of hearing and speech problems, and other selected parameters. Significant decreases were found in total health care visits (mean decrease: 6.18 visits, P less than 0.001). Ear-related health care visits also decreased significantly (mean decrease = 10.93, P less than 0.001). Total health care visits correlated strongly with visits for ear problems both before and after surgery (r = 0.4474, P less than 0.001). Usage of antibiotics significantly decreased. Parental reports concerning the issues of secondary speech and hearing problems raised questions for additional study. In addition, the qualitative comments offered by parents suggest the breadth of impact of chronic otitis media with effusion in this patient population, and point the direction for future research.     

A different aspect of corrosive ingestion in children: socio-demographic characteristics and effect of family functioning

OBJECTIVE: Corrosive ingestion is thoroughly investigated in terms of its complications and treatment modalities but to date family functioning, behavior, attitude and knowledge of mothers of children who ingested corrosives has not been investigated and socio-demographic data has rarely been mentioned. Therefore a study was planned to investigate the socio-demographic data, family functioning, knowledge, behavior and attitude of mothers of children who ingested corrosive materials. METHODS: The mothers of 50 children who ingested corrosive materials and 60 controls were asked to answer a questionnaire which included socio-demographic data and questions about their attitude, behavior and knowledge of corrosive ingestion. The mothers were also asked to reply family assessment device (FAD) and parental attitude research instrument (PARI). RESULTS: The average ages of the children were 5.31+/-2.32 in the corrosive group with an M:F ratio of 1:1. The level of education of both mothers (p=0.000) and fathers (p=0.000) in the corrosive group were lower than that of the controls. There was no difference between the two groups in terms of number of working mothers (p=0.085). In the corrosive group the families used to have three or more children (42%) and the socioeconomic status of this group was lower than the controls (p=0.001). In the corrosive group these substances were purchased unlabeled (64%) and kept mainly in coke bottles. The affective involvement dimension of the FAD and the attitude of over-parenting and democratic attitude dimensions of the PARI tests were significantly different in the corrosive group among mothers from lower educational level whereas no difference was detected among mothers from higher educational level in this regard. CONCLUSION: It was found that both level of education of the parents and socioeconomic factors played important role in shaping the habits that might lead to corrosive ingestion in children. For the prevention of corrosive ingestion broad based strategies including education are required.     

Parental smoking and persistent otitis media with effusion in children.

A total of 163 children were entered into a case-control study to determine whether any causal relationship exists between otitis media with effusion (OME) requiring grommet insertion and parental smoking. One hundred children with persistent OME formed the case group and 63 children with normal ears formed the control group. The prevalence of parental smoking in each group was then compared. Information was collected by questionnaire and further details about the subjects with regard to surgery of the upper respiratory tract were also gathered. Analysis of findings in this study and previous reports has failed to demonstrate a significantly increased prevalence of smoking in at least one parent, amongst children with persistent otitis media with effusion requiring surgical intervention.     

Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya

BACKGROUND: Hearing-impaired children who are identified early and appropriately managed have improved outcomes in speech, language, cognitive and social development. Enhanced parental awareness of their child's hearing disability, behavioral, developmental and psychosocial limitations is essential to sustaining timely detection and appropriate intervention. Additionally, availability of services for diagnosis, treatment and habilitation would improve the demand for pedaudiological care in this community. OBJECTIVE: To describe level of parental awareness of childhood HI and the pattern of access to and utilization of ambulatory care services. SUBJECTS: Thirty-three parents of lower primary school-going children who failed audiometric screening from sampled schools in Kisumu district, western Kenya. MAIN OUTCOME MEASURES: First person to detect HI, age of child at first suspicion of HI, source of ambulatory health care and use of the health care facilities. RESULTS: The prevalence of HI was 2.48%. Most parents/guardians (69.7%) were aware of their child's hearing impairment. Of these, 63.6% were first to detect HI in the pupils, while 30.3% were detected by screen. Most children (57.2%) were first recognized with (HI) after age 2 years. The mean age at identification was 5.5 years. The median travel distance to the preferred health care facility was 2 km (IQR 1-2.5). Parents seldom sought or lacked help for their hearing-impaired children. Of 27.3% who asked for hearing assessment, 9.1% received some counsel on HI and 12.1% received medication, one (3%) was referred for audiological assessment and none used a hearing aid. Use of health facilities for maternal care was (65.7%) and immunization (62.9%). CONCLUSIONS: Despite adequate parental awareness of chronic childhood disability, health facilities were underutilized. This indicates the need to further stimulate and maintain a desirable level of uptake of services for diagnosis, treatment and habilitation of childhood HI, while sustaining delivery of effective and acceptable high quality paediatric care.     

Hyperacusis and otitis media in individuals with Williams syndrome

Williams syndrome is characterized by cardiac defects, varying degrees of physical and developmental delay, stellate eye pattern, possible elevated serum calcium level, and elfin/pixie facial features. A problem perhaps unique to these children is hyperacusis that can be severe enough to disrupt many routine daily activities. Parental questionnaires were used to determine the prevalence of hyperacusis and otitis media in individuals with Williams syndrome. Prevalences of 95% for hyperacusis and 61% for otitis media were found. This was significantly higher than in the general population. Despite the prevalence of hyperacusis, parents of these children were not counseled about management of the problem. The audiologist may become involved with Williams syndrome patients through hearing assessment and management, parental counseling, and research.     

Prevalence and risk factors of otitis media with effusion in Trabzon, a city in northeastern Turkey, with an emphasis on the recommendation of OME screening

This cross-sectional study was undertaken to assess the prevalence and risk factors for otitis media with effusion (OME) in Trabzon, a city in northeastern Turkey, and evaluate the need for screening for OME in the normal population. In kindergartens, daycare centers, public and private schools in the rural and central areas of Trabzon, 1,077 children aged between 5 and 12 years were examined. OME prevalence was 11.14% (120/1,077). Young age, attendance at kindergarten/daycare, low economical status, the mothers working status (housewife), history of snoring and acute otitis media, antibiotic use in the previous 3 months and active upper respiratory tract infection (URTI) were found to be the risk factors for OME. A history of hearing loss reported by the parents and teachers was found significant in the diagnosis of OME despite the low predictive value. When the parents suspected that their child had experienced hearing loss (in 36 cases), they did not refer them to a healthcare facility. To conclude, the approach to OME in developing countries should be more interventional as healthcare coverage is usually low and behavioral factors such as the demand for healthcare is poor.