Parents' experiences caring for children with acute otitis media: a qualitative analysis

Trends in the incidence and burden of otitis media in children: a global analysis from 1990 to 2021

BACKGROUND

Otitis media (OM) is a prevalent and serious condition in childhood, but comprehensive global studies assessing its burden are lacking.

METHODS

Using data from the 2021 Global Burden of Disease (GBD) study, we analyzed OM incidence cases and disability-adjusted life years (DALYs) in children aged 0-14 from 1990 to 2021. Trends were analyzed across regions, age groups, sexes, and socio-demographic index (SDI) using estimated annual percentage changes (EAPC). Predictive models were used to forecast trends to 2050.

RESULTS

The global number of OM incidence cases in children increased from 256 million in 1990 to 297 million in 2021, a 15.97% rise. The age-standardized incidence rate (ASIR) showed a slight increase (EAPC: 0.12). Despite some variations across age, sex, and regions, the age-standardized DALY rate (ASDR) declined. ASIR and ASDR were highest in children aged < 1 year and gradually decreased with age. The largest burden was observed in low- and middle-low-SDI regions, although these regions showed the greatest declines in EAPC. Correlation analysis indicated that ASDR decreases as the SDI increases. By 2050, the number of global OM incidence cases in children is projected to reach 334 million, with most of the increase concentrated in low-SDI regions, while ASIR is expected to remain stable.

CONCLUSION

Although progress has been made in controlling OM in children over the past 30 years, the ASIR remains high. The sustained high burden and incidence of OM in low-SDI regions, and among young children, pose a significant challenge to children's health.

Modification of an outcome measure to follow symptoms of children with acute otitis media

BACKGROUND

To modify a parent-reported acute otitis media severity of symptoms scale (AOM-SOS) to ensure that it accurately reflects parental concerns.

METHODS

Using qualitative interviews with parents of children with acute otitis media (AOM) (n = 24), we generated 39 candidate items for inclusion in the new version of the scale. We determined the importance of each item by enrolling 50 other parents of children with AOM. We selected 15 items with high importance and used them to create a new version of the scale. During successive rounds of cognitive interviews, 3 items were dropped. Two additional items were dropped because they were highly correlated. We evaluated the psychometric properties of the new, 10-item version (version 6.0) in 139 children with AOM.

RESULTS

AOM-SOS scores correlated with functional status (r = -0.53), parent assessment of child's pain level (r = 0.69), and overall symptom severity (r = 0.41). The internal consistency of the scale, as measured by Cronbach's alpha, was 0.90. Responsiveness (standardized response mean = 1.82) and test-retest reliability (0.77) were excellent and good, respectively.

CONCLUSION

Data presented here support the use of the new version of the scale as a longitudinal measure of symptom burden in clinical trials of children with AOM.

IMPACT STATEMENT

The AOM-SOS scale, which now incorporates parental views, can be used to track symptom severity in future efficacy trials in young children with acute otitis media. Data is presented on the validity, reliability, and responsiveness of the AOM-SOS scale. Otitis media is the most frequent indication for antibiotic use in young children. The AOM-SOS is one of the few validated disease specific scales available for use in efficacy trials of children with acute otitis media.

Postoperative care for children after ventilation tube surgery: A qualitative study of parents' experiences over time in Norway

OBJECTIVE

To explore the parents' experience of postoperative care during the first two years after ventilation tube (VT) surgery in a setting where the check-ups were conducted either by otolaryngologists or their regular general practitioner (GP).

METHODS

55 individual interviews of parents at up to three different time points (<1, 6, and 24 months) after their child received VT-surgery, analyzed with reflexive thematic analysis.

RESULTS

1. Parents' trust in the healthcare system and responsibility for booking check-ups. Nearly all parents seemed to maintain trust in the healthcare system and felt safeguarded regardless of where they had their check-ups. Still, they would prefer otolaryngologist-led care if they could choose from the top shelf. They took responsibility for seeking healthcare when needed and experienced that their GP referred their child if necessary. 2. As time goes by, parental worries are reduced. Most experienced that their child stayed healthy after surgery, and their demand for postoperative check-ups decreased. For the children who faced ongoing issues, most parents experienced that their child's challenges had been handled professionally, and they became less worried. Some parents attribute other diagnoses to their child's behavior or speech delays, refining their understanding of their child's condition. 3. The desire for closure. Parents sought reassurance about their child's recovery and desired professional evaluation for closure. While some advocated for audiometry, others trusted their own assessments about hearing. The transition to school marked a pivotal time, prompting concerns about social inclusion.

CONCLUSION

Overall, the parents experienced that their child was safeguarded irrespective of whether postoperative care was provided by otolaryngologists or GPs. Still, many preferred check-ups by an otolaryngologist. The parental worries and focus on the VTs were reduced as time went by after surgery, but even so many wanted a 'closure' to be sure that the hearing was as good as it could be and the VTs rejected. We advocate for an individualized approach to postoperative care that addresses specific medical needs without imposing unnecessary check-ups.

Knowledge, Attitude, and Practices Regarding Risk Factors for Otitis Media among Caretakers of Children in Puducherry- A Descriptive Cross Sectional Study

Otitis media is a common childhood disease in developing countries and is the most important cause of preventable hearing loss among Indian children. To study the knowledge, attitude, and practices regarding risk factors for otitis media among caretakers of children in Puducherry. This was a questionnaire based descriptive cross-sectional study conducted from April 2023 to June 2023. All the caregivers of children aged 2-12 years presented or diagnosed with otitis media under our inclusion criteria were interviewed. Overall, most caretakers displayed good knowledge (67%), positive attitude (62%) and good care-seeking practices (49%). There was a positive correlation with sociodemographic parameters. The odd's ratio for overcrowding was high (OR = 4, p = 0.042 for knowledge and attitude, OR = 3.929, p = 0.041 for practices). Higher score was seen among middle class with odd's ratio 1.417 for knowledge and attitude and 4.875 for practices (p = 0.041). Graduate parents had higher score with the odd's ratio that was statistically significant. Most of the caregivers had a good knowledge regarding symptoms of otitis media and an acceptable level of caregivers' attitude and care seeking practices. Higher scores were associated with overcrowding, socioeconomic status, parental education. Improvement in risk factors and providing health education will reduce prevalence of OM in children and thereby reduce preventable hearing loss in children.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-04551-9.

New insights into the treatment of acute otitis media

INTRODUCTION

Acute otitis media (AOM) affects most (80%) children by 5 years of age and is the most common reason children are prescribed antibiotics. The epidemiology of AOM has changed considerably since the widespread use of pneumococcal conjugate vaccines, which has broad-reaching implications for management.

AREAS COVERED

In this narrative review, we cover the epidemiology of AOM, best practices for diagnosis and management, new diagnostic technology, effective stewardship interventions, and future directions of the field. Literature review was performed using PubMed and ClinicalTrials.gov.

EXPERT OPINION

Inaccurate diagnoses, unnecessary antibiotic use, and increasing antimicrobial resistance remain major challenges in AOM management. Fortunately, effective tools and interventions to improve diagnostic accuracy, de-implement unnecessary antibiotic use, and individualize care are on the horizon. Successful scaling of these tools and interventions will be critical to improving overall care for children.