Items in FPM with MESH term: Otitis Media

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Antimicrobial Resistence: A Plan of Action for Community Practice - Article

ABSTRACT: Antibiotic resistance was once confined primarily to hospitals but is becoming increasingly prevalent in family practice settings, making daily therapeutic decisions more challenging. Recent reports of pediatric deaths and illnesses in communities in the United States have raised concerns about the implications and future of antibiotic resistance. Because 20 percent to 50 percent of antibiotic prescriptions in community settings are believed to be unnecessary, primary care physicians must adjust their prescribing behaviors to ensure that the crisis does not worsen. Clinicians should not accommodate patient demands for unnecessary antibiotics and should take steps to educate patients about the prudent use of these drugs. Prescriptions for targeted-spectrum antibiotics, when appropriate, can help preserve the normal susceptible flora. Antimicrobials intended for the treatment of bacterial infections should not be used to manage viral illnesses. Local resistance trends may be used to guide prescribing decisions.

Differential Diagnosis and Treatment of Hearing Loss - Article

ABSTRACT: Hearing loss is a common problem that can occur at any age and makes verbal communication difficult. The ear is divided anatomically into three sections (external, middle, and inner), and pathology contributing to hearing loss may strike one or more sections. Hearing loss can be categorized as conductive, sensorineural, or both. Leading causes of conductive hearing loss include cerumen impaction, otitis media, and otosclerosis. Leading causes of sensorineural hearing loss include inherited disorders, noise exposure, and presbycusis. An understanding of the indications for medical management, surgical treatment, and amplification can help the family physician provide more effective care for these patients.

Tympanometry - Article

ABSTRACT: Tympanometry provides useful quantitative information about the presence of fluid in the middle ear, mobility of the middle ear system, and ear canal volume. Its use has been recommended in conjunction with more qualitative information (e.g., history, appearance, and mobility of the tympanic membrane) in the evaluation of otitis media with effusion and to a lesser extent in acute otitis media. It also can provide useful information about the patency of tympanostomy tubes. Tympanometry is not reliable in infants younger than seven months because of the highly compliant ear canals of infants. Tympanogram tracings are classified as type A (normal), type B (flat, clearly abnormal), and type C (indicating a significantly negative pressure in the middle ear, possibly indicative of pathology). According to the Agency for Healthcare Research and Quality guidelines on otitis media with effusion, the positive predictive value of an abnormal (flat, type B) tympanogram is between 49 and 99 percent. A type C curve may be useful when correlated with other findings, but by itself it is an imprecise estimate of middle ear pressure and does not have high sensitivity or specificity for middle ear disorders.

Diagnosis and Treatment of Otitis Media - Article

ABSTRACT: Diagnostic criteria for acute otitis media include rapid onset of symptoms, middle ear effusion, and signs and symptoms of middle ear inflammation. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Fever, otalgia, headache, irritability, cough, rhinitis, listlessness, anorexia, vomiting, diarrhea, and pulling at the ears are common, but nonspecific symptoms. Detection of middle ear effusion by pneumatic otoscopy is key in establishing the diagnosis. Observation is an acceptable option in healthy children with mild symptoms. Antibiotics are recommended in all children younger than six months, in those between six months and two years if the diagnosis is certain, and in children with severe infection. High-dosage amoxicillin (80 to 90 mg per kg per day) is recommended as first-line therapy. Macrolide antibiotics, clindamycin, and cephalosporins are alternatives in penicillin-sensitive children and in those with resistant infections. Patients who do not respond to treatment should be reassessed. Hearing and language testing is recommended in children with suspected hearing loss or persistent effusion for at least three months, and in those with developmental problems.

Appropriate Use of Antibiotics for URIs in Children: Part I. Otitis Media and Acute Sinusitis - Article

ABSTRACT: Five conditions--otitis media, acute sinusitis, cough, pharyngitis and the common cold--account for most of the outpatient use of antibiotics in the United States. The first part of this two-part article presents guidelines that encourage physicians to make an appropriate distinction between acute otitis media and otitis media with effusion, to use shorter courses of antibiotic therapy in uncomplicated cases of otitis media and to limit prophylaxis to recurrence as defined strictly by number of episodes. Sinusitis in younger children is difficult to distinguish from the common cold, and the criterion for use of antibiotics should be duration of symptoms.

Topical Fluoroquinolones for Eye and Ear - Article

ABSTRACT: Topical fluoroquinolones are now available for use in the eye and ear. Their broad spectrum of activity includes the common eye and ear pathogens Staphylococcus aureus and Pseudomonas aeruginosa. For the treatment of acute otitis externa, these agents are as effective as previously available otic preparations. For the treatment of otitis media with tympanic membrane perforation, topical fluoroquinolones are effective and safe. These preparations are approved for use in children, and lack of ototoxicity permits prolonged administration when necessary. Topical fluoroquinolones are not appropriate for the treatment of uncomplicated conjunctivitis where narrower spectrum agents suffice; they represent a simplified regimen for the treatment of bacterial keratitis (corneal ulcers). When administered topically, fluoroquinolones are well tolerated and offer convenient dosing schedules. Currently, bacterial resistance appears limited.

Treatment of Otitis Media with Perforated Tympanic Membrane - FPIN's Clinical Inquiries

Acute Otitis Media in Children - Improving Patient Care

Should We Prescribe Antibiotics for Acute Otitis Media? - Cochrane for Clinicians

Acute Otitis Media in Children - Point-of-Care Guides

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