Skip to main content
SpringerLink
Log in

New Concepts in the Pathophysiology and Management of Middle Ear Disease in Childhood

  • Section 4: Keynote Presentations
  • Published:
Drugs Aims and scope Submit manuscript

Summary

Middle ear disease encompasses acute otitis media, recurrent otitis media, and otitis media with effusion. For many children, middle ear disease occurs early in life, is chronic and recurrent and can impair language development and/or school performance. Risk factors for recurrent otitis media include early disease onset, bottle feeding, daycare attendance, exposure to cigarette smoke and immunological defects or immaturity.

Antimicrobial therapy in acute otitis media is associated with earlier resolution and a reduction in the frequency of persistent disease and suppurative complications. An antimicrobial agent should be selected according to its activity, tolerability and concentrations achieved in the middle ear. At present, amoxicillin remains the drug of choice for acute otitis media. Antimicrobial prophylaxis is also effective, but only for the duration of therapy.

Future challenges for the management of middle ear disease include the treatment of penicillin-resistant Streptococcus pneumoniae, effective prevention of relapses, and the development of a vaccine for S. pneumoniae that has the appropriate serotypes and is immunogenic in young children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Teele DW, Klein JO, Chase C, et al. Otitis media in infancy and intellectual ability, school achievement, speech, and language at 7 years. J Infect Dis 1990; 162: 685–94.

    Article  PubMed  CAS  Google Scholar 

  2. Friel-Patti S, Finitzo-Hieber T, Conti G, et al. Language delay in infants associated with middle ear disease and mild fluctuating hearing impairment. Pediatr Infect Dis J 1982; 1: 104–9.

    Article  CAS  Google Scholar 

  3. Teele DW, Klein JO, Rosner B, et al. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989; 160: 83–94.

    Article  PubMed  CAS  Google Scholar 

  4. Fria TJ, Cantekin ET, Eichler JA. Hearing acuity of children with otitis media with effusion. Arch Otolaryngol Head Neck Surg 1985; 111: 10–6.

    Article  CAS  Google Scholar 

  5. Teele DW, Klein JO, Rosner BA, et al. Otitis media with effusion during the first three years of life and development of speech and language. Pediatr 1984; 74: 282–7.

    CAS  Google Scholar 

  6. Friel Patti S, Finitzo T. Language learning in a prospective study of otitis media with effusion in the first two years of life. J Speech Hear Res 1990; 33: 188–94.

    PubMed  CAS  Google Scholar 

  7. Wright PF, Sell SH, McConnell KB, et al. Impact of recurrent otitis media on middle ear function, hearing, and language. J Pediatr 1988; 113: 571–7.

    Google Scholar 

  8. Shurin PA, Pelton SI, Donner A, et al. Persistence of middle ear effusion after acute otitis media in children. N Engl J Med 1979; 300: 1121–3.

    Article  PubMed  CAS  Google Scholar 

  9. Wald ER, Dashefsky B, Byers C, et al. Frequency and severity of infections in day care. J Pediatr 1988; 112: 540.

    Article  PubMed  CAS  Google Scholar 

  10. Wald ER, Guerra N, Byers C, et al. Frequency and severity of infection in daycare. J Pediatr 1988; 112: 540.

    Article  PubMed  CAS  Google Scholar 

  11. Etzel RA, Pattishall EN, Haley NJ, et al. Passive smoking and middle ear effusion among children in daycare. Pediatrics 1992; 91: 867–72.

    Google Scholar 

  12. Prellner K, Kalm O, Hartsen G, et al. Pneumococcal serum antibody concentrations during the first three years of life: a study of otitis-prone and non-otitis-prone children. J Pediatr Otolaryngol 1989; 17: 267–79.

    Article  CAS  Google Scholar 

  13. Barnett ED, Klein JO, Pelton SI, et al. Otitis media in children born to human immunodeficiency virus-infected mothers. Pediatr Infect Dis J 1992; 11: 360–4.

    Article  PubMed  CAS  Google Scholar 

  14. Rudberg RD. Acute otitis media: comparative therapeutic results of sulfonamide and penicillin administered in various forms. Acta Otolaryngol (Stockh) 1954; 113: 1–79.

    CAS  Google Scholar 

  15. Slapak L, Hornik P, Slapakova MD. Incidence of complications of acute otitis media in children [abstract]. 6th International Symposium on Recent Advances in Otitis Media; 1995 Jun 4–8; Fort Lauderdale, 25

  16. Marchant CD, Carlin SA, Johnson CE, et al. Measuring the comparative efficacy of antibacterial agents for acute otitis media: the ‘Pollyanna phenomenon’? J Pediatr 1992; 120 (1): 72–7.

    Article  PubMed  CAS  Google Scholar 

  17. Klein JO. Microbiologic efficacy of antibacterial drugs for acute otitis media. Pediatr Infect Dis J 1993; 12: 973–5.

    Article  PubMed  CAS  Google Scholar 

  18. Pichichero ME, Pichichero CL. Persistent acute otitis media: II. Antimicrobial treatment. Pediatr Infect Dis J 1995; 14: 183–8.

    Article  PubMed  CAS  Google Scholar 

  19. Teele DW, Wendell PM, Pelton SI, et al. Prophylaxis in early infancy for infants at risk for otitis media. In: Lim, Bluestone, Klein, et al., editors. Recent advances in otitis media: Proceedings of the 5th International Symposium. Fort Lauderdale, FL, 1991: 276

  20. Casselbrant ML, Kaieida PH, Rockette HE, et al. Efficacy of antimicrobial prophylaxis and of tympanostomy tube insertion for prevention of recurrent acute otitis media: results of a randomized clinical trial. Pediatr Infect Dis J 1992; 11: 278–86.

    Article  PubMed  CAS  Google Scholar 

  21. Paradise JL. Treatment guidelines for otitis media: the need for breadth and flexibility. Pediatr Infect Dis J 1995; 14: 429–35.

    Article  PubMed  CAS  Google Scholar 

  22. Gehanno P, Lenoir G, Berche P. In vivo correlates for Streptococcus pneumoniae penicillin resistance in acute otitis media? Antimicrob Agents Chemother 1995; 39 (1): 271–2.

    Article  PubMed  CAS  Google Scholar 

  23. Barnett ED, Klein JO, Teele DW, et al. Short course therapy for acute otitis media: single dose ceftriaxone [abstract]. 6th International Symposium on Recent Advances in Otitis Media; 1995 Jun 4–8; Fort Lauderdale, 119

  24. Teele DW, Klein JO, Bratton L, et al. Use of pneumococcal vaccine for prevention of recurrent acute otitis media in infants in Boston: The Greater Boston Collaborative Otitis Media Study Group. Rev Infect Dis 1981; Suppl. 3: S113–8

    Article  PubMed  Google Scholar 

  25. Shurin PA, Rehmus JM, Johnson CE, et al. Bacterial polysaccharide immune globulin for prophylaxis of acute otitis media in high-risk children? J Pediatr 1993; 123 (5): 801–10.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Maxwell Finland Laboratory for Infectious Diseases, Boston City Hospital /Boston University School of Medicine, 774 Albany Street, Room 512, Boston, Massachusetts, 02118, USA

    Stephen I. Pelton (Professor of Pediatrics)

Authors
  1. Stephen I. Pelton
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pelton, S.I. New Concepts in the Pathophysiology and Management of Middle Ear Disease in Childhood. Drugs 52 (Suppl 2), 62–67 (1996). https://doi.org/10.2165/00003495-199600522-00013

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199600522-00013

Keywords

Search

Navigation