Global Otitis Media Incidence Changes During the COVID Pandemic: Systematic Review and Meta-Analysis

OBJECTIVE

The aim was to analyze the global impact of the COVID-19 pandemic and national lockdowns on the incidence of otitis media (OM), a common otolaryngologic disease.

DATA SOURCES

PubMed, Scopus, and CINAHL.

REVIEW METHODS

A systematic review and meta-analysis were performed using PRISMA reporting guidelines. OM incidence (measured as newly diagnosed OM cases over total patients seen over a time period), OM antibiotic prescriptions (OM cases for which antibiotics were prescribed over total OM cases), and tympanostomy tube surgeries (all tympanostomy tube surgeries over total surgical cases) were extracted. Meta-analysis of proportions and comparison of proportions were performed.

RESULTS

Of 1004 studies screened, 26 studies in 11 countries met inclusion criteria. The percentages of OM cases pre- and during-lockdown were 6.67%, 95% CI [4.68%, 8.99%], and 2.63% [2.02%, 3.31%], respectively, with an OR of 0.31 favoring during-lockdown [0.25, 0.39] (p < 0.00001). Antibiotic prescriptions per all OM episodes pre- and during-lockdown were 1.61% [0.17%, 8.46%] and 0.62% [0.07%, 3.32%], with an OR of 0.37 favoring during-lockdown ([0.35, 0.40], p < 0.00001). Tympanostomy tube surgery proportions pre- and during-lockdown were 31.64% [6.85%, 64.26%] and 29.99% [4.14%, 66.55%], with an OR of 0.94 favoring neither during- nor pre-lockdown [0.45, 2.00] (p = 0.88).

CONCLUSION

The incidence of OM decreased significantly following international lockdowns due to the COVID-19 pandemic, with antibiotic prescriptions for OM episodes showing a corresponding decrease. Despite these reductions, numbers of tympanostomy tube procedures did not change significantly. These reductions are likely due to social distancing, decreased exposure through high transmission facilities such as day cares, decreased health care utilization, and even possibly decreased air pollution. Laryngoscope, 134:2028-2037, 2024.

Complete genome sequences of eight Auritidibacter ignavus strains isolated from ear infections in Germany

Here, we present the complete genome sequences of eight Auritidibacter ignavus strains isolated from clinical samples of patients with ear infections in Bochum, Germany. The sequence information will give assistance to greater knowledge about the virulence potential of this unfamiliar putative pathogen.

QbD Design, Formulation, Optimization and Evaluation of Trans-Tympanic Reverse Gelatination Gel of Norfloxacin: Investigating Gene-Gene Interactions to Enhance Therapeutic Efficacy

Traditional otic drug delivery methods lack controlled release capabilities, making reverse gelatination gels a promising alternative. Reverse gelatination gels are colloidal systems that transition from a sol to a gel phase at the target site, providing controlled drug release over an extended period. Thermosensitive norfloxacin reverse gelatination gels were developed using a Quality by Design (QbD)-based optimization approach. The formulations were evaluated for their in vitro release profile, rheological behavior, visual appearance, pH, gelling time, and sol-gel transition temperature. The results show that the gelation temperatures of the formulations ranged from 33 to 37 °C, with gelling durations between 35 and 90 s. The drug content in the formulations was uniform, with entrapment efficiency ranging from 55% to 95%. Among the formulations, F10 exhibited the most favorable properties and was selected for a stability study lasting 60 days. Ex-vivo release data demonstrate that the F10 formulation achieved 95.6percentage of drug release at 360 min. This study successfully developed thermosensitive norfloxacin reverse gelatination gels using a QbD-based optimization approach. The selected formulation, F10, exhibited desirable properties in terms of gelling temperature, drug content, and release profile. These gels hold potential for the controlled delivery of norfloxacin in the treatment of ear infections.

No evidence from a systematic review for the use of probiotics to prevent otitis media

AIM

This systematic review evaluates the current evidence for the use of probiotics in the prevention of acute otitis media (AOM) in children.

METHODS

This study is registered with PROSPERO prior to commencement. PubMed, MEDLINE, EMBASE and Cochrane database were searched using relating keywords. All literature was screened to determine relatability to the topic. Review articles were also screened for additional literature.

RESULTS

Thirteen studies were found on probiotics and their role in preventing AOM in children. They ranged in quality from poor to moderate. Half (2/4) of the studies that used nasal probiotic formulations showed a significant difference in reducing otitis media, while only a third (3/9) of the studies using oral formulations suggest benefit in reducing AOM. None of the studies demonstrated significant adverse effects from probiotics.

CONCLUSION

The evidence for any effect of probiotics on the prevention of AOM is limited, and the overall low quality of studies makes it difficult to draw definitive conclusions. No serious adverse events were noted, and there is some evidence to suggest possible benefit with nasal probiotic administration.

Analysis of health outcomes in vaccinated and unvaccinated children: Developmental delays, asthma, ear infections and gastrointestinal disorders

Objective:

The aim of this study was to compare the health of vaccinated versus unvaccinated pediatric populations.

Methods:

Using data from three medical practices in the United States with children born between November 2005 and June 2015, vaccinated children were compared to unvaccinated children during the first year of life for later incidence of developmental delays, asthma, ear infections and gastrointestinal disorders. All diagnoses utilized International Classification of Diseases–9 and International Classification of Diseases–10 codes through medical chart review. Subjects were a minimum of 3 years of age, stratified based on medical practice, year of birth and gender and compared using a logistic regression model.

Results:

Vaccination before 1 year of age was associated with increased odds of developmental delays (OR = 2.18, 95% CI 1.47–3.24), asthma (OR = 4.49, 95% CI 2.04–9.88) and ear infections (OR = 2.13, 95% CI 1.63–2.78). In a quartile analysis, subjects were grouped by number of vaccine doses received in the first year of life. Higher odds ratios were observed in Quartiles 3 and 4 (where more vaccine doses were received) for all four health conditions considered, as compared to Quartile 1. In a temporal analysis, developmental delays showed a linear increase as the age cut-offs increased from 6 to 12 to 18 to 24 months of age (ORs = 1.95, 2.18, 2.92 and 3.51, respectively). Slightly higher ORs were also observed for all four health conditions when time permitted for a diagnosis was extended from ⩾ 3 years of age to ⩾ 5 years of age.

Conclusion:

In this study, which only allowed for the calculation of unadjusted observational associations, higher ORs were observed within the vaccinated versus unvaccinated group for developmental delays, asthma and ear infections. Further study is necessary to understand the full spectrum of health effects associated with childhood vaccination.

Otitis externa-climatic associations and evidence-based management strategies for Australian practice

OBJECTIVES

There is a lack of consensus for the management of otitis externa. In addition to looking at seasonal trends surrounding otitis externa, this article also reviews a collection of local and international guidelines on the management of this condition.

DESIGN

Retrospective case audit of clinician-diagnosed otitis externa at the Hedland Health Campus over 18 months. Review of 2007-2017 evidence-based guidelines relevant to area of practice.

SETTING

Hedland Health Campus Emergency Department in the remote Pilbara region of Western Australia.

PARTICIPANTS

Two-hundred-thirty-six otitis externa cases in 193 individuals were seen by our service.

MAIN OUTCOME MEASURED

Number of otitis externa presentations each month.

RESULT

Nine guidelines were reviewed, which varied widely in recommendations. An overrepresentative proportion of patients identified as either Aboriginal or Torres Strait Islander. There was a strong positive correlation between the monthly rainfall and otitis externa, moderate correlation between higher monthly minimum temperatures and no correlation with maximum temperature. Given the variety of guidelines available, it was difficult to assess whether prescribing was always consistent with guidelines.

CONCLUSION

This research makes evidence-based suggestions for Australian practitioners. Patients should be treated with oral analgesia, ear toileting and targeted topical therapy. There is no evidence for swabs, ear wicks and oral antibiotics. The authors hypothesise that re-presentation rates might be in part attributable to freshwater pseudomonal infection.

Antibiotic use in infancy and the risk of asthma in Mexican American children

OBJECTIVE

This study examined the associations of antibiotic use in infancy with lifetime doctor-diagnosed asthma and current wheeze among Mexican American children.

METHODS

In a population-based, cross-sectional investigation, parents of 2023 children 4-18 years of age completed a questionnaire/interview addressing respiratory conditions, antibiotic use, and covariates.

RESULTS

In adjusted analyses, among children without history of ear infections in infancy, children who used antibiotics ≥3 times and 1-2 times were more likely to report doctor-diagnosed asthma compared with their peers who did not use antibiotics in infancy [adjusted odds ratio (aOR) = 5.14, 95% confidence interval (CI): 2.88-9.17, and aOR = 2.15, 95% CI: 1.26-3.69, respectively, p trend < 0.0001]. The respective aORs for current wheeze were 3.67 (95% CI: 1.95-6.89) and 1.63 (95% CI: 0.91-2.95). Antibiotic use in infancy was not associated with asthma or current wheeze in children who had ear infections in infancy. In additional analyses, antibiotic use in infancy was associated with asthma in children without parental history of asthma or allergies (aOR = 2.73, 95% CI: 1.70-4.39) but not in those with parental history of asthma or allergies. Among Mexico-born participants born in rural areas, antibiotic use in infancy was associated with a seven-fold increase in risk of asthma (aOR = 7.21, 95% CI: 1.46-35.65), while the association was non-significant in Mexico-born children born in urban areas in Mexico.

CONCLUSIONS

Antibiotic use in infancy may increase the risk of asthma and wheezing, but these associations were limited to subgroups of children.

Early-life exposure to outdoor air pollution and respiratory health, ear infections, and eczema in infants from the INMA study

BACKGROUND

Prenatal and early-life periods may be critical windows for harmful effects of air pollution on infant health.

OBJECTIVES

We studied the association of air pollution exposure during pregnancy and the first year of life with respiratory illnesses, ear infections, and eczema during the first 12-18 months of age in a Spanish birth cohort of 2,199 infants.

METHODS

We obtained parentally reported information on doctor-diagnosed lower respiratory tract infections (LRTI) and parental reports of wheezing, eczema, and ear infections. We estimated individual exposures to nitrogen dioxide (NO(2)) and benzene with temporally adjusted land use regression models. We used log-binomial regression models and a combined random-effects meta-analysis to estimate the effects of air pollution exposure on health outcomes across the four study locations.

RESULTS

A 10-µg/m(3) increase in average NO(2) during pregnancy was associated with LRTI [relative risk (RR) = 1.05; 95% CI: 0.98, 1.12] and ear infections (RR = 1.18; 95% CI: 0.98, 1.41). The RRs for an interquartile range (IQR) increase in NO(2) were 1.08 (95% CI: 0.97, 1.21) for LRTI and 1.31 (95% CI: 0.97, 1.76) for ear infections. Compared with NO(2), the association for an IQR increase in average benzene exposure was similar for LRTI (RR = 1.06; 95% CI: 0.94, 1.19) and slightly lower for ear infections (RR = 1.17; 95% CI: 0.93, 1.46). Associations were slightly stronger among infants whose mothers spent more time at home during pregnancy. Air pollution exposure during the first year was highly correlated with prenatal exposure, so we were unable to discern the relative importance of each exposure period.

CONCLUSIONS

Our findings support the hypothesis that early-life exposure to ambient air pollution may increase the risk of upper and lower respiratory tract infections in infants.