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M. E. Pichichero - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era.
Pediatrics, 2017Co-Authors: Ravinder Kaur, Matthew C. Morris, M. E. PichicheroAbstract:OBJECTIVES: To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era. METHODS: Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006–June 2016). All clinical diagnoses of AOM were confirmed by Tympanocentesis and bacterial culture of middle ear fluid. RESULTS: By 1 year of age, 23% of the children experienced ≥1 episode of AOM; by 3 years of age, 60% had ≥1 episodes of AOM, and 24% had ≥3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (Tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of Streptococcus pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis causing AOM had dynamic changes during the past decade. CONCLUSIONS: We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.
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Correlation of nasopharyngeal cultures prior to and at onset of acute otitis media with middle ear fluid cultures
BMC infectious diseases, 2014Co-Authors: Ravinder Kaur, Katerina Czup, Janet Casey, M. E. PichicheroAbstract:We sought to determine if nasopharyngeal (NP) cultures taken at times of healthy visits or at onset of acute otitis media (AOM) could predict the otopathogen mix and antibiotic-susceptibility of middle ear isolates as determined by middle ear fluid (MEF) cultures obtained by Tympanocentesis. During a 7-year-prospective study of 619 children from Jun 2006-Aug 2013, NP cultures were obtained from 6-30 month olds at healthy visits and NP and MEF (by Tympanocentesis) at onset of AOM episodes. 2601 NP and 530 MEF samples were collected. During healthy visits, S. pneumoniae (Spn) was isolated from 656 (31.7%) NP cultures compared to 253 (12.2%) for Nontypeable Haemophilus influenzae (NTHi) and 723 (34.9%) for Moraxella catarrhalis (Mcat). At onset of AOM 256 (48.3%) of 530 NP samples were culture positive for Spn, 223 (42%) for NTHi and 251 (47.4%) for Mcat, alone or in combinations. At 530 AOM visits, Spn was isolated from 152 (28.7%) of MEF compared to 196 (37.0%) for NTHi and 104 (19.6%) for Mcat. NP cultures collected at onset of AOM but not when children were healthy had predictive value for epidemiologic antibiotic susceptibility pattern assessments. NP cultures at onset of AOM more closely correlate with otopathogen mix than NP cultures at healthy visits using MEF culture as the gold standard, but the correlation was too low to allow NP cultures to be recommended as a substitute for MEF culture. For epidemiology purposes, antibiotic susceptibility of MEF isolates can be predicted by NP culture results when samples are collected at onset of AOM.
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Reducing the frequency of acute otitis media by individualized care.
The Pediatric infectious disease journal, 2013Co-Authors: M. E. Pichichero, Janet R. Casey, Anthony AlmudevarAbstract:We sought to determine if use of more stringent diagnostic criteria for acute otitis media (AOM) than currently advocated by the American Academy of Pediatrics, Tympanocentesis and pathogen-specific antibiotic treatment (individualized care) would result in reducing the incidence of recurrent AOM and consequent tympanostomy tube surgery. A 5-year longitudinal, prospective study in Rochester, NY, was conducted from July 2006 to July 2011 involving 254 individualized care children. When this individualized care group developed symptoms of AOM, strict diagnostic criteria were applied and a Tympanocentesis was performed. Pathogen resistance to empiric high-dose amoxicillin/clavulanate (80 mg/kg of amoxicillin component) caused a change in antibiotic to an optimized choice. Legacy controls (n = 208) were diagnosed with the same diagnostic criteria by the same physicians as the individualized care group and received the same empiric amoxicillin/clavulanate (80 mg/kg of amoxicillin component) but no Tympanocentesis or change in antibiotic. Community control children (n = 1020) were diagnosed according to current American Academy of Pediatrics guidelines and treated with high-dose amoxicillin (80 mg/kg) without Tympanocentesis as guideline recommended. 5.9% of children of the individualized care group compared with 14.4% of Legacy controls and 27.3% of community controls became otitis prone, defined as 3 episodes of AOM within a 6-month time span or 4 AOM episodes within a 12-month time span (P < 0.0001). 2.4% of the individualized care group compared with 6.3% of Legacy controls, and 14.8% of community controls received tympanostomy tubes (P < 0.0001). Individualized care of AOM significantly reduces the frequency of AOM and tympanostomy tube surgery. Use of strict diagnostic criteria for AOM and empiric antibiotic treatment using evidence-based knowledge of circulating otopathogens and their antimicrobial susceptibility profile also produces improved outcomes.
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Comparison of study designs for acute otitis media trials.
International journal of pediatric otorhinolaryngology, 2008Co-Authors: M. E. Pichichero, Janet R. CaseyAbstract:A framework for evaluating the efficacy of antibiotics in development as well as those currently approved for acute otitis media (AOM) is needed. Review strengths and limitations of various antibiotic trial designs and their outcome measures. A review of 157 published trials involving 36,710 subjects for the treatment of AOM. AOM trials have three designs: (1) clinical, clinical diagnosis and assessment of outcomes; (2) single Tympanocentesis, microbiologic diagnosis (by middle ear fluid culture) and clinical assessment of outcomes; and (3) double Tympanocentesis, microbiologic diagnosis and microbiologic outcome assessment. Identifiable strengths and limitations of each design are reviewed. Case definitions for entry of children in trials of AOM vary widely. The lack of stringent diagnostic criteria in a clinical design allows for inclusion of a significant proportion of children with a non-bacterial etiology (i.e., viral AOM or otitis media with effusion). Tympanocentesis increases diagnostic accuracy at study entry; however, the procedure is confounding because of its potentially therapeutic benefit and the procedure is not performed in a uniform manner. A second Tympanocentesis allows a high sensitivity to detect microbiologic eradication, but it does not correlate with clinical outcomes in half of the cases. The timing of outcome assessment also varies widely among trials. Improved clinical diagnosis criteria for AOM are needed to enhance specificity; emphasis on a bulging tympanic membrane has the best evidence base. Tympanocentesis within study designs has merits. At study entry it assures diagnostic accuracy but may alter outcomes and it is useful to document microbiologic outcomes but lacks specificity for clinical outcomes. For all designs, test of cure assessment 2-7 days after completion of therapy seems most appropriate.
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The use of Tympanocentesis in the diagnosis and management of acute otitis media
Current Infectious Disease Reports, 2006Co-Authors: M. E. Pichichero, Tracy WrightAbstract:Acute otitis media (AOM), when associated with a bulging or full tympanic membrane, has a bacterial etiology in more than 90% of cases. Not infrequently, the organisms present express resistance mechanisms to commonly prescribed antibiotic therapy. Tympanocentesis is a procedure advocated by several national guidelines for use in selected patients not clinically responding to antimicrobial treatment. In this paper we discuss the use of Tympanocentesis as a tool to track pathogen shifts and to guide antibiotic selection. We detail the indications for Tympanocentesis, compare guidelines endorsing the procedure, and describe how to implement a technique for use in the primary care setting. The pros and cons of using Tympanocentesis in clinical trial designs are also presented.
Eugene Leibovitz - One of the best experts on this subject based on the ideXlab platform.
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Acute otitis media in infants younger than two months of age: Epidemiologic and microbiologic characteristics in the era of pneumococcal conjugate vaccines.
International journal of pediatric otorhinolaryngology, 2019Co-Authors: Oren Ziv, David Greenberg, Mordechai Kraus, Racheli Holcberg, Anat Bahat Dinur, Sofia Kordeluk, Daniel M. Kaplan, Hadar Naidorf Rosenblatt, Shalom Ben-shimol, Eugene LeibovitzAbstract:Abstract Objectives To evaluate the epidemiology, microbiology, Streptococcus pneumoniae serotypes distribution and serious bacterial infections (SBIs) occurrence in infants Methods The medical records of all hospitalized infants with AOM who underwent Tympanocentesis during 2005–2014 were reviewed. Results Of the 303 infants with AOM who were diagnosed by an ENT specialist, 182 underwent Tympanocentesis, 92 during 2005–2009 (prevaccine period) and 90 during 2010–2014 (postvaccine period). Streptococcus pneumoniae and nontypeable Hemophilus influenzae were isolated in 46/92 (50%) and 37/92 (40.2%) patients during 2005–2009 and decreased to 27/90 (30%) and 21/90 (23.3%). Respectively, during 2010–2014 (P = 0.006 and P = 0.001). The proportion of culture-negative patients increased from 18/92 (19.6%) during 2005–2009 to 32/90 (35.6%) during 2010–2014 (P = 0.02). There were only 6 (3.3%) patients Conclusions The overall number of AOM cases needing Tympanocentesis seen at the PER and the proportion of S. pneumoniae and nontypeable H. influenzae-AOM decreased while the proportion of culture-negative AOM increased following the introduction of PCVs. SBIs associated with AOM were frequent and were represented mostly by urinary tract infections caused by pathogens unrelated to the etiologic agents of AOM.
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Epidemiologic and Microbiologic Characteristics of Culture-positive Spontaneous Otorrhea in Children With Acute Otitis Media
The Pediatric infectious disease journal, 2009Co-Authors: Eugene Leibovitz, Merav Serebro, Noga Givon-lavi, David Greenberg, Arnon Broides, Alberto Leiberman, Ron DaganAbstract:Objectives We aimed to describe the epidemiologic and microbiologic characteristics of acute otitis media (AOM) with spontaneous otorrhea in children and compare it with AOM with intact tympanic membrane in children who underwent Tympanocentesis. Patients and methods All infants and young children aged Results Of 12,617 AOM patients from whom a middle ear fluid was obtained, 5247 (42%) culture-positive patients were enrolled; spontaneous otorrhea was observed in 822 (15%) patients. Patients with spontaneous otorrhea were older than patients with AOM who underwent Tympanocentesis (15.8 +/- 8.2 vs. 9.7 +/- 6.7 months, respectively, P or =1 previous AOM episode (OR: 3.2, 95% CI: 2.6-4.0, P 1 previous Tympanocentesis (OR: 1.4, 95% CI: 1.4-1.7, P = 0.001), and infection with S. pyogenes (OR: 8.2, 95% CI: 5.4-12.3, P Conclusions AOM presenting as spontaneous otorrhea in patients less than 3 years of age is characterized by older age, previous repeated tympanocenteses, > or =1 previous AOM episodes, lack of recent antibiotic treatment, and infection with S. pyogene.
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rates of tympanic membrane closure in double Tympanocentesis studies
Pediatric Infectious Disease Journal, 2008Co-Authors: Youval Slovik, Alberto Leiberman, Ron Dagan, Simon Raiz, Moshe Puterman, Eugene LeibovitzAbstract:Background: Data on the outcome of tympanic membrane (TM) closure after Tympanocentesis in acute otitis media (AOM) patients is limited. Objectives: To analyze the dynamics of TM perforation closure after 1 or 2 Tympanocentesis procedures performed at diagnosis and during AOM treatment. Patients and Methods: Study population included 113 children enrolled in 4 double-Tympanocentesis studies. Only the files of patients whose first and second examination were performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid (MEF) was cultured on day 1 and days 4-6, the latter only in initially culture-positive patients. Patients were also examined on days 11-14 and followed until days 22-28. Results: Ninety-three (82%) patients underwent Tympanocentesis on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28, respectively. One hundred seventy-three ears underwent Tympanocentesis on day 1 and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One hundred fifty-three (88%) Tympanocentesis procedures performed at enrollment were closed on days 4-6. No differences were recorded in the closure rates as function of patient age, previous AOM history, MEF culture positivity, pathogens isolated at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. Conclusions: TM perforation closed in most cases within a few days regardless of patient and disease characteristics, and 2 consecutive Tympanocentesis procedures performed at short-time intervals are associated with good TM closure rates.
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Rates of tympanic membrane closure in double-Tympanocentesis studies.
The Pediatric infectious disease journal, 2008Co-Authors: Youval Slovik, Alberto Leiberman, Ron Dagan, Simon Raiz, Moshe Puterman, Eugene LeibovitzAbstract:Data on the outcome of tympanic membrane (TM) closure after Tympanocentesis in acute otitis media (AOM) patients is limited. To analyze the dynamics of TM perforation closure after 1 or 2 Tympanocentesis procedures performed at diagnosis and during AOM treatment. Study population included 113 children enrolled in 4 double-Tympanocentesis studies. Only the files of patients whose first and second examination were performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid (MEF) was cultured on day 1 and days 4-6, the latter only in initially culture-positive patients. Patients were also examined on days 11-14 and followed until days 22-28. Ninety-three (82%) patients underwent Tympanocentesis on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28, respectively. One hundred seventy-three ears underwent Tympanocentesis on day 1 and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One hundred fifty-three (88%) Tympanocentesis procedures performed at enrollment were closed on days 4-6. No differences were recorded in the closure rates as function of patient age, previous AOM history, MEF culture positivity, pathogens isolated at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. TM perforation closed in most cases within a few days regardless of patient and disease characteristics, and 2 consecutive Tympanocentesis procedures performed at short-time intervals are associated with good TM closure rates.
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Persistence of pathogens despite clinical improvement in antibiotic-treated acute otitis media is associated with clinical and bacteriologic relapse
The Pediatric infectious disease journal, 2008Co-Authors: Elad Asher, Noga Givon-lavi, David Greenberg, Alberto Leiberman, Ron Dagan, Shai Libson, Nurith Porat, Eugene LeibovitzAbstract:Background: Pathogen eradication in patients with acute otitis media (AOM) is associated with a reduced risk of clinical failures, but most children in whom middle ear fluid (MEF) culture remains positive show clinical improvement or clinical cure. We investigated the relationship between MEF culture-positivity during treatment in patients with clinical improvement/cure, and the occurrence of subsequent AOM. Methods: A total of 673 patients with culture-positive MEF were enrolled in double-Tympanocentesis studies and followed for 3 weeks after completion of treatment. Results: On day 4–6, 189/673 (28%) patients had culture-positive MEFs. Patients with clinical improvement/cure on day 11–14 (end of treatment) despite having culture-positive MEF on day 4–6 more often had recurrent AOM episodes (53/151, 35%) than those with culture-negative MEF (114/476, 24%; P = 0.007). 41/53 (77%) culture-positive patients with clinical improvement/cure on day 11–14 underwent Tympanocentesis when AOM recurred and 29/41 (71%) were culture-positive. Pulsed field gel electrophoresis identity between pathogens at recurrence and those persisting on day 4–6 was found in 19/29 (66%) compared with 31/86 (36%) of the evaluable patients with recurrence and culture-negative MEF on day 4–6 (P = 0.005). Conclusions: (1) Failure to eradicate MEF pathogens during antibiotic treatment is associated with clinical recurrences, even in patients showing clinical improvement/cure at end of treatment; (2) these recurrences are mostly caused by pathogens initially present in MEF and persisting during treatment.
Ron Dagan - One of the best experts on this subject based on the ideXlab platform.
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Acute otitis media severity of symptom score in a Tympanocentesis study.
The Pediatric infectious disease journal, 2011Co-Authors: Nader Shaikh, Ron Dagan, Elaine E. L. Wang, Adriano Arguedas, Carolina Soley, James X. Song, Roger EcholsAbstract:We followed symptoms of children with acute otitis media (AOM), who were enrolled in a clinical trial that included a baseline Tympanocentesis. We observed marked and rapid improvement in symptom scores after Tympanocentesis. Although symptom scores (measured by the AOM-SOS) correlated with overall clinical assessment and bacteriologic outcome, the early effect of Tympanocentesis rendered the AOM-SOS less useful as a primary outcome measure.
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Epidemiologic and Microbiologic Characteristics of Culture-positive Spontaneous Otorrhea in Children With Acute Otitis Media
The Pediatric infectious disease journal, 2009Co-Authors: Eugene Leibovitz, Merav Serebro, Noga Givon-lavi, David Greenberg, Arnon Broides, Alberto Leiberman, Ron DaganAbstract:Objectives We aimed to describe the epidemiologic and microbiologic characteristics of acute otitis media (AOM) with spontaneous otorrhea in children and compare it with AOM with intact tympanic membrane in children who underwent Tympanocentesis. Patients and methods All infants and young children aged Results Of 12,617 AOM patients from whom a middle ear fluid was obtained, 5247 (42%) culture-positive patients were enrolled; spontaneous otorrhea was observed in 822 (15%) patients. Patients with spontaneous otorrhea were older than patients with AOM who underwent Tympanocentesis (15.8 +/- 8.2 vs. 9.7 +/- 6.7 months, respectively, P or =1 previous AOM episode (OR: 3.2, 95% CI: 2.6-4.0, P 1 previous Tympanocentesis (OR: 1.4, 95% CI: 1.4-1.7, P = 0.001), and infection with S. pyogenes (OR: 8.2, 95% CI: 5.4-12.3, P Conclusions AOM presenting as spontaneous otorrhea in patients less than 3 years of age is characterized by older age, previous repeated tympanocenteses, > or =1 previous AOM episodes, lack of recent antibiotic treatment, and infection with S. pyogene.
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rates of tympanic membrane closure in double Tympanocentesis studies
Pediatric Infectious Disease Journal, 2008Co-Authors: Youval Slovik, Alberto Leiberman, Ron Dagan, Simon Raiz, Moshe Puterman, Eugene LeibovitzAbstract:Background: Data on the outcome of tympanic membrane (TM) closure after Tympanocentesis in acute otitis media (AOM) patients is limited. Objectives: To analyze the dynamics of TM perforation closure after 1 or 2 Tympanocentesis procedures performed at diagnosis and during AOM treatment. Patients and Methods: Study population included 113 children enrolled in 4 double-Tympanocentesis studies. Only the files of patients whose first and second examination were performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid (MEF) was cultured on day 1 and days 4-6, the latter only in initially culture-positive patients. Patients were also examined on days 11-14 and followed until days 22-28. Results: Ninety-three (82%) patients underwent Tympanocentesis on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28, respectively. One hundred seventy-three ears underwent Tympanocentesis on day 1 and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One hundred fifty-three (88%) Tympanocentesis procedures performed at enrollment were closed on days 4-6. No differences were recorded in the closure rates as function of patient age, previous AOM history, MEF culture positivity, pathogens isolated at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. Conclusions: TM perforation closed in most cases within a few days regardless of patient and disease characteristics, and 2 consecutive Tympanocentesis procedures performed at short-time intervals are associated with good TM closure rates.
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Rates of tympanic membrane closure in double-Tympanocentesis studies.
The Pediatric infectious disease journal, 2008Co-Authors: Youval Slovik, Alberto Leiberman, Ron Dagan, Simon Raiz, Moshe Puterman, Eugene LeibovitzAbstract:Data on the outcome of tympanic membrane (TM) closure after Tympanocentesis in acute otitis media (AOM) patients is limited. To analyze the dynamics of TM perforation closure after 1 or 2 Tympanocentesis procedures performed at diagnosis and during AOM treatment. Study population included 113 children enrolled in 4 double-Tympanocentesis studies. Only the files of patients whose first and second examination were performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid (MEF) was cultured on day 1 and days 4-6, the latter only in initially culture-positive patients. Patients were also examined on days 11-14 and followed until days 22-28. Ninety-three (82%) patients underwent Tympanocentesis on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28, respectively. One hundred seventy-three ears underwent Tympanocentesis on day 1 and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One hundred fifty-three (88%) Tympanocentesis procedures performed at enrollment were closed on days 4-6. No differences were recorded in the closure rates as function of patient age, previous AOM history, MEF culture positivity, pathogens isolated at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. TM perforation closed in most cases within a few days regardless of patient and disease characteristics, and 2 consecutive Tympanocentesis procedures performed at short-time intervals are associated with good TM closure rates.
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Persistence of pathogens despite clinical improvement in antibiotic-treated acute otitis media is associated with clinical and bacteriologic relapse
The Pediatric infectious disease journal, 2008Co-Authors: Elad Asher, Noga Givon-lavi, David Greenberg, Alberto Leiberman, Ron Dagan, Shai Libson, Nurith Porat, Eugene LeibovitzAbstract:Background: Pathogen eradication in patients with acute otitis media (AOM) is associated with a reduced risk of clinical failures, but most children in whom middle ear fluid (MEF) culture remains positive show clinical improvement or clinical cure. We investigated the relationship between MEF culture-positivity during treatment in patients with clinical improvement/cure, and the occurrence of subsequent AOM. Methods: A total of 673 patients with culture-positive MEF were enrolled in double-Tympanocentesis studies and followed for 3 weeks after completion of treatment. Results: On day 4–6, 189/673 (28%) patients had culture-positive MEFs. Patients with clinical improvement/cure on day 11–14 (end of treatment) despite having culture-positive MEF on day 4–6 more often had recurrent AOM episodes (53/151, 35%) than those with culture-negative MEF (114/476, 24%; P = 0.007). 41/53 (77%) culture-positive patients with clinical improvement/cure on day 11–14 underwent Tympanocentesis when AOM recurred and 29/41 (71%) were culture-positive. Pulsed field gel electrophoresis identity between pathogens at recurrence and those persisting on day 4–6 was found in 19/29 (66%) compared with 31/86 (36%) of the evaluable patients with recurrence and culture-negative MEF on day 4–6 (P = 0.005). Conclusions: (1) Failure to eradicate MEF pathogens during antibiotic treatment is associated with clinical recurrences, even in patients showing clinical improvement/cure at end of treatment; (2) these recurrences are mostly caused by pathogens initially present in MEF and persisting during treatment.
Nader Shaikh - One of the best experts on this subject based on the ideXlab platform.
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Pain Management in Young Children Undergoing Diagnostic
2016Co-Authors: Nader Shaikh, Ro Hoberman, Marcia Kurs-lasky, Howard E. Rockette, Kathleen D. Colborn, Emma G. Hooper, Evelyn Cohen ReisAbstract:Objective. To describe the pain associated with diagnostic Tympanocentesis and to gather preliminary data comparing the efficacy of 3 methods of pain reduction for Tympanocentesis. Methods. In children 6 to 36 months of age undergoing Tympanocentesis for acute otitis media, the authors measured pain and distress throughout all phases of the procedure and recovery using physiological (heart rate) and behavioral measures (cry duration, Global Mood Scale score, and pain visual analog scales). They compared—in a randomized controlled trial—3 pain reduction interventions: acetaminophen, acetaminophen plus codeine, and ibuprofen plus midazolam. Results. Heart rate increased throughout the procedure, peaking during needle aspiration. Children treated with acetaminophen alone had higher peak heart rates and Global Mood Scale scores during parts of the procedure. Conclusions. Acetaminophen alone may not be as effective in reducing pain-related physiological and behavioral changes as acetaminophen plus codeine or ibuprofen plus midazolam during diagnostic Tympanocentesis
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Videos in clinical medicine. Tympanocentesis in children with acute otitis media.
The New England journal of medicine, 2011Co-Authors: Nader Shaikh, Alejandro Hoberman, Diana H. Kearney, Robert YellonAbstract:Tympanocentesis involves needle aspiration of fluid from the middle ear. The technique permits drainage of pus from the middle ear, identification of pathogens, and pressure relief. This video demonstrates Tympanocentesis.
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Acute otitis media severity of symptom score in a Tympanocentesis study.
The Pediatric infectious disease journal, 2011Co-Authors: Nader Shaikh, Ron Dagan, Elaine E. L. Wang, Adriano Arguedas, Carolina Soley, James X. Song, Roger EcholsAbstract:We followed symptoms of children with acute otitis media (AOM), who were enrolled in a clinical trial that included a baseline Tympanocentesis. We observed marked and rapid improvement in symptom scores after Tympanocentesis. Although symptom scores (measured by the AOM-SOS) correlated with overall clinical assessment and bacteriologic outcome, the early effect of Tympanocentesis rendered the AOM-SOS less useful as a primary outcome measure.
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Pain Management in Young Children Undergoing Diagnostic Tympanocentesis
Clinical pediatrics, 2010Co-Authors: Nader Shaikh, Alejandro Hoberman, Marcia Kurs-lasky, Howard E. Rockette, Emma G. Hooper, Dk Colborn, Anita Chandra, Evelyn Cohen ReisAbstract:Objective. To describe the pain associated with diagnostic Tympanocentesis and to gather preliminary data comparing the efficacy of 3 methods of pain reduction for Tympanocentesis. Methods. In children 6 to 36 months of age undergoing Tympanocentesis for acute otitis media, the authors measured pain and distress throughout all phases of the procedure and recovery using physiological (heart rate) and behavioral measures (cry duration, Global Mood Scale score, and pain visual analog scales). They compared—in a randomized controlled trial—3 pain reduction interventions: acetaminophen, acetaminophen plus codeine, and ibuprofen plus midazolam. Results. Heart rate increased throughout the procedure, peaking during needle aspiration. Children treated with acetaminophen alone had higher peak heart rates and Global Mood Scale scores during parts of the procedure. Conclusions. Acetaminophen alone may not be as effective in reducing pain-related physiological and behavioral changes as acetaminophen plus codeine or i...
Alberto Leiberman - One of the best experts on this subject based on the ideXlab platform.
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Epidemiologic and Microbiologic Characteristics of Culture-positive Spontaneous Otorrhea in Children With Acute Otitis Media
The Pediatric infectious disease journal, 2009Co-Authors: Eugene Leibovitz, Merav Serebro, Noga Givon-lavi, David Greenberg, Arnon Broides, Alberto Leiberman, Ron DaganAbstract:Objectives We aimed to describe the epidemiologic and microbiologic characteristics of acute otitis media (AOM) with spontaneous otorrhea in children and compare it with AOM with intact tympanic membrane in children who underwent Tympanocentesis. Patients and methods All infants and young children aged Results Of 12,617 AOM patients from whom a middle ear fluid was obtained, 5247 (42%) culture-positive patients were enrolled; spontaneous otorrhea was observed in 822 (15%) patients. Patients with spontaneous otorrhea were older than patients with AOM who underwent Tympanocentesis (15.8 +/- 8.2 vs. 9.7 +/- 6.7 months, respectively, P or =1 previous AOM episode (OR: 3.2, 95% CI: 2.6-4.0, P 1 previous Tympanocentesis (OR: 1.4, 95% CI: 1.4-1.7, P = 0.001), and infection with S. pyogenes (OR: 8.2, 95% CI: 5.4-12.3, P Conclusions AOM presenting as spontaneous otorrhea in patients less than 3 years of age is characterized by older age, previous repeated tympanocenteses, > or =1 previous AOM episodes, lack of recent antibiotic treatment, and infection with S. pyogene.
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rates of tympanic membrane closure in double Tympanocentesis studies
Pediatric Infectious Disease Journal, 2008Co-Authors: Youval Slovik, Alberto Leiberman, Ron Dagan, Simon Raiz, Moshe Puterman, Eugene LeibovitzAbstract:Background: Data on the outcome of tympanic membrane (TM) closure after Tympanocentesis in acute otitis media (AOM) patients is limited. Objectives: To analyze the dynamics of TM perforation closure after 1 or 2 Tympanocentesis procedures performed at diagnosis and during AOM treatment. Patients and Methods: Study population included 113 children enrolled in 4 double-Tympanocentesis studies. Only the files of patients whose first and second examination were performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid (MEF) was cultured on day 1 and days 4-6, the latter only in initially culture-positive patients. Patients were also examined on days 11-14 and followed until days 22-28. Results: Ninety-three (82%) patients underwent Tympanocentesis on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28, respectively. One hundred seventy-three ears underwent Tympanocentesis on day 1 and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One hundred fifty-three (88%) Tympanocentesis procedures performed at enrollment were closed on days 4-6. No differences were recorded in the closure rates as function of patient age, previous AOM history, MEF culture positivity, pathogens isolated at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. Conclusions: TM perforation closed in most cases within a few days regardless of patient and disease characteristics, and 2 consecutive Tympanocentesis procedures performed at short-time intervals are associated with good TM closure rates.
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Rates of tympanic membrane closure in double-Tympanocentesis studies.
The Pediatric infectious disease journal, 2008Co-Authors: Youval Slovik, Alberto Leiberman, Ron Dagan, Simon Raiz, Moshe Puterman, Eugene LeibovitzAbstract:Data on the outcome of tympanic membrane (TM) closure after Tympanocentesis in acute otitis media (AOM) patients is limited. To analyze the dynamics of TM perforation closure after 1 or 2 Tympanocentesis procedures performed at diagnosis and during AOM treatment. Study population included 113 children enrolled in 4 double-Tympanocentesis studies. Only the files of patients whose first and second examination were performed by the same 2 otorhinolaryngologists were analyzed. Middle ear fluid (MEF) was cultured on day 1 and days 4-6, the latter only in initially culture-positive patients. Patients were also examined on days 11-14 and followed until days 22-28. Ninety-three (82%) patients underwent Tympanocentesis on days 4-6; 103 (91%) and 95 (84%) were evaluable on days 11-14 and 22-28, respectively. One hundred seventy-three ears underwent Tympanocentesis on day 1 and 139 on days 4-6. Ninety-seven (86%) patients had positive MEF cultures. One hundred fifty-three (88%) Tympanocentesis procedures performed at enrollment were closed on days 4-6. No differences were recorded in the closure rates as function of patient age, previous AOM history, MEF culture positivity, pathogens isolated at enrollment, and pathogen eradication on days 4-6. The 20 eardrums still open on days 4-6 were closed on days 11-14. Eleven (9%) of the evaluable ears tapped on days 4-6 were not closed on days 11-14 and 9 of 10 were closed on days 22-28. TM perforation closed in most cases within a few days regardless of patient and disease characteristics, and 2 consecutive Tympanocentesis procedures performed at short-time intervals are associated with good TM closure rates.
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Persistence of pathogens despite clinical improvement in antibiotic-treated acute otitis media is associated with clinical and bacteriologic relapse
The Pediatric infectious disease journal, 2008Co-Authors: Elad Asher, Noga Givon-lavi, David Greenberg, Alberto Leiberman, Ron Dagan, Shai Libson, Nurith Porat, Eugene LeibovitzAbstract:Background: Pathogen eradication in patients with acute otitis media (AOM) is associated with a reduced risk of clinical failures, but most children in whom middle ear fluid (MEF) culture remains positive show clinical improvement or clinical cure. We investigated the relationship between MEF culture-positivity during treatment in patients with clinical improvement/cure, and the occurrence of subsequent AOM. Methods: A total of 673 patients with culture-positive MEF were enrolled in double-Tympanocentesis studies and followed for 3 weeks after completion of treatment. Results: On day 4–6, 189/673 (28%) patients had culture-positive MEFs. Patients with clinical improvement/cure on day 11–14 (end of treatment) despite having culture-positive MEF on day 4–6 more often had recurrent AOM episodes (53/151, 35%) than those with culture-negative MEF (114/476, 24%; P = 0.007). 41/53 (77%) culture-positive patients with clinical improvement/cure on day 11–14 underwent Tympanocentesis when AOM recurred and 29/41 (71%) were culture-positive. Pulsed field gel electrophoresis identity between pathogens at recurrence and those persisting on day 4–6 was found in 19/29 (66%) compared with 31/86 (36%) of the evaluable patients with recurrence and culture-negative MEF on day 4–6 (P = 0.005). Conclusions: (1) Failure to eradicate MEF pathogens during antibiotic treatment is associated with clinical recurrences, even in patients showing clinical improvement/cure at end of treatment; (2) these recurrences are mostly caused by pathogens initially present in MEF and persisting during treatment.
