Morbidity of very young infants with and without acute otitis media

Diagnosing Conductive Dysfunction in Infants Using Wideband Acoustic Immittance: Validation and Development of Predictive Models

Purpose The aims of this study were (a) to validate the wideband acoustic immittance (WAI) model developed by Myers et al. (2018a) in a new sample of neonates and (b) to develop a prediction model for diagnosing middle ear dysfunction in infants aged 6-18 months using wideband absorbance, controlling for the effect of age. Method Tympanometry, distortion product otoacoustic emissions, and WAI were measured in 124 neonates and longitudinally in 357 infants at 6, 12, and 18 months of age. Results of tympanometry and distortion product otoacoustic emissions were used to assess middle ear function of each infant. For the first study, results from the neonates were applied to the diagnostic WAI model developed by Myers et al. (2018a). For the second study, a prediction model was developed using results from the 6- to 18-month-old infants. Results from 1 ear of infants in each age group (6, 12, and 18 months) were used to develop the model. The amount of bias (overfitting) was estimated with bootstrap resampling and by applying the model to the opposite ears (the test sample). Performance was assessed using measures of discrimination (c-index) and calibration (calibration curves). Results For the validation study, the Myers et al. (2018a) model was well calibrated and had a c-index of 0.837 when applied to a new sample of neonates. Although this was lower than the apparent performance c-index of 0.876 reported by Myers et al., it was close to the bias-corrected estimate of 0.845. The model developed for 6- to 18-month-old infants had satisfactory calibration and apparent, bias-corrected, and test sample c-index of 0.884, 0.867, and 0.887, respectively. Conclusions The validated and developed models may be clinically useful, and further research validating, updating, and assessing the clinical impact of the models is warranted.

Infant Health of Mothers with Multiple Sclerosis

Controversy surrounds whether mothers with multiple sclerosis (MS) who wish to breast-feed their infants should forgo breast-feeding in order to resume immunomodulating therapy following birth even though breast-feeding has not been shown to have deleterious effects on these mothers. Knowledge of potential health benefits to infants through breast-feeding could influence health care providers to encourage mothers with MS who wish to breast-feed to do so. This study of 140 breast-feeding and 35 non-breast-feeding mothers with MS identifies the type and prevalence of illnesses experienced by their infants during the first 6 postpartum months and at 9 months and 12 months. Significantly more non-breast-fed than breast-fed infants experienced otitis media, lower respiratory illness, constipation, milk intolerance, and allergy during the 1st year. Study results support the need to encourage mothers with MS who wish to breast-feed their infants to do so and to delay immunomodulating therapy until breast-feeding cessation.

Acute otitis media in neonatal life: a review

Acute otitis media is frequently encountered by general practitioners and pediatricians. In the neonatal period acute otitis media may present as an isolated local infection or as part of septicemia. Diagnosis of the condition by otoscopy is difficult. Considering the wide spectrum of middle ear disorders (acute otitis media, otitis media with effusion, chronic suppurative otitis media) one can appreciate why opinions on the management of the condition are diverse. This is a review of the literature on clinical presentation, etiology, risk factors, treatment and prevention of acute otitis media in neonatal life.

Histopathologic differences due to bacterial species in acute otitis media

OBJECTIVE

To compare selected features of histopathology in acute otitis media caused by various bacteria and examine potential differences due to bacterial species, as well as possible correlation to experimental and human clinical findings.

METHODS

Rat models of acute otitis media caused by Streptococcus pneumoniae (MC), non-typeable or type b Haemophilus influenzae (NTHI/HIB) or Moraxella catarrhalis (MC) were studied longitudinally up to 6 months after bacterial challenge. Findings related to dynamics of goblet cell density, modeling and remodeling of bone tissue structures and polyp, as well as fibrous adhesion formation and persistence are presented.

RESULTS

Middle ear goblet cell density progressed to peak 2 weeks after bacterial inoculation, thereafter gradually normalizing. However, density and accordingly middle ear secretory capacity was still significantly increased after 6 months in all bacteria, except MC. The HI species induced the highest increase. Initial osteoresorption was followed by massive osteoneogenesis, progressing to a peak after 2-3 months, followed by some degree of normalization, concurrently classic remodeling. Primarily SP, but also the HI species induced more new bone formation than MC. Mucosal polyp and fibrous adhesion formation occurred regardless of bacterial species. Most polyps appeared in the early phases and the HI species induced formation of more polyps and adhesions than the other bacteria.

CONCLUSION

Acute middle ear infection with the Haemophilus species induce the highest increase of mucosal secretory capacity, lasting for at least 6 months after the acute incident. Thus, a subsequent development of secretory otitis media seems more likely following infection with these bacteria. Equivalently, mucosal scarring observed as polyp and fibrous adhesion formation was more severe following Haemophilus infection. S. pneumoniae induced the most marked changes of bone tissue structures, seen as initial osteoresorption and subsequent osteoneogenesis. Overall, infection with M. catarrhalis induced the mildest changes.

Epidemiology of otitis media onset by six months of age

OBJECTIVE

Although early otitis media (OM) onset predicts later recurrent and chronic OM, little research has been directed at illuminating the role of prenatal exposures in early OM. This prospective study examined prenatal, innate, and early environmental exposures associated with acute otitis media (AOM) onset and recurrent OM (ROM) by age 6 months.

DESIGN AND METHODS

Prospective study of 596 infants from a health maintenance organization followed from birth to 6 months. Mothers completed monthly forms on prenatal exposures (diet, medications, and illnesses) and infant risk factors (eg, smoke exposure and child care) during pregnancy and until infants were 6 months old. Urine samples were collected when infants were 2 months of age and analyzed for cotinine and creatinine. Physicians and nurse practitioners examined infants at each clinic visit and completed standard ear examination forms.

RESULTS

Thirty-nine percent had an episode of AOM and 20% had ROM by age 6 months. Using Cox's regression models to control for confounding, respiratory tract infection (relative risk [RR] 7.5), day care (RR 1. 7), >1 sibling (RR 1.4), maternal, paternal, and sibling OM history (RR 1.6, 1.5, and 1.7, respectively) were significantly related to early OM onset. ROM was related to respiratory tract infection (RR 9. 5), day care (RR 1.9), conjunctivitis (RR 2.0), maternal OM history (RR 1.9), and birth in the fall (RR 2.6). Among prenatal exposures, only high prenatal dietary vitamin C intake was significantly inversely related to early AOM with univariate but not multivariate analysis.

CONCLUSION

Prenatal factors were not linked to early AOM onset with multivariate analysis, but environmental and innate factors play an important role in early AOM onset. Strategies to reduce exposure to environmental variables could reduce rates of early AOM, which could potentially result in declining rates of ROM and chronic OME.

Abnormalities of the neonatal ear: otoscopic observations, histologic observations, and a model for contamination of the middle ear by cellular contents of amniotic fluid

It is unknown whether childhood ear disease could be present long before symptoms provoke an initial otoscopic examination. A newborn middle ear might or might not start in a pristine, privileged state. The clinician evaluating later infant and childhood ear disease is often unaware of the status of a patient's ear from the neonatal period, the earliest time at which the tympanic membrane can be evaluated. Adding to the physician's handicap, normative otoscopic and histologic data on the neonatal ear are incomplete. In order to test the hypothesis that disease in the neonatal middle ear may be more common than is generally appreciated, the population of critically ill neonates was selected for study since this group can provide both clinical as well as histologic data. This manuscript is divided into three parts. Clinically, otoscopic observations were analyzed on infants in an intensive care unit. Histologically, neonatal temporal bones were studied for normal anatomy and pathology of the middle ear and antrum. Experimentally, an animal study was performed to evaluate the potential effect of amniotic fluid cellular contents aspirated into the middle ear. I. Clinical Otoscopic Observations. Daily otoscopic examination was conducted on 44 neonates in an intensive care unit. Specific parameters of the otoscopic examination were evaluated to compare with the normal, translucent tympanic membrane of the older child. The otoscopic appearance was found to be abnormal in 97.7% of neonatal ears. Of the otoscopic parameters evaluated, right ears averaged 2.6 abnormalities and left ears averaged 2.5 otoscopic abnormalities. The otoscopic appearance of the neonate in the neonatal intensive care unit is nearly universally abnormal. II. Temporal Bone Histologic Observations. One hundred eleven temporal bones from 56 neonates were collected for histologic study by light microscopy. Mesenchyme filling more than 60% of the middle ear space was found in 13 bones. Amniotic fluid cellular content was detected in 90 bones. Purulent otitis media was detected in 24 bones. Varying amounts of blood were found in the middle ear space of 34 bones. Only 7 of the bones had no significant middle ear abnormality. It is concluded that in the critically ill neonate, the middle ear and antrum usually contain cellular or fluid material, often in significant volume, that would not be considered normal in the older patient. III. An Animal Model Simulating Contamination of the Middle Ear by Cellular Contents of Amniotic Fluid.(ABSTRACT TRUNCATED AT 400 WORDS)