Showing papers by "Media Research Center published in 1988"
TL;DR: An understanding of the anatomy and physiology of the system can aid the clinician in understanding the role of eustachian tube dysfunction in the cause and pathogenesis of middle ear disease and the possible contribution of allergy to this disease.
Abstract: The middle ear is part of a functional system composed of the nasopharynx and the eustachian tube (anteriorly) and the mastoid air cells (posteriorly). The only active muscle that opens the eustachian tube is the tensor veli palatini, which promotes ventilation of the middle ear. The eustachian tube also functions to protect the middle ear from excessive sound pressure, and nasopharyngeal secretions. The eustachian tube helps drain the middle ear during opening and closing by pumping secretions from the middle ear; clearance of secretions also occurs. An understanding of the anatomy and physiology of the system can aid the clinician in understanding the role of eustachian tube dysfunction in the cause and pathogenesis of middle ear disease and the possible contribution of allergy to this disease.
146 citations
TL;DR: Otitis media, the diagnosis most frequently made by the pediatrician, is most effectively treated with antimicrobial therapy and amoxicillin is the recommended prophylactic antimicrobial agent for prevention of frequently recurrent acute otitis media.
Abstract: Otitis media, the diagnosis most frequently made by the pediatrician, is most effectively treated with antimicrobial therapy. Amoxicillin (or ampicillin) has been the standard for infants and children with acute otitis media because it is safe and effective for most of the causative bacterial pathogens. Amoxicillin has also been shown to be effective for treatment of some children with otitis media with effusion ("secretory" otitis media) and is the recommended prophylactic antimicrobial agent for prevention of frequently recurrent acute otitis media. However, during the past decade there has been an increasing rate of bacteria that are resistant to amoxicillin, primarily beta-lactamase-producing Haemophilus influenzae and Branhamella catarrhalis. Because of the emergence of these bacteria, other antimicrobial agents both old and new have been advocated for treatment and prevention of otitis media; amoxicillin-clavulanate and cefuroxime axetil are the newer agents. These agents are indicated for selected infants and children but for most patients amoxicillin remains a safe and relatively inexpensive effective "old friend".
46 citations
TL;DR: Most children who have chronic suppurative otitis media require hospitalization and the parenteral administration of an antimicrobial agent, while middle ear and mastoid surgery should be reserved for those children who fail to respond to intensive medical therapy.
Abstract: Most children who have chronic suppurative otitis media require: (1) a thorough examination of the external canal and tympanic membrane with the otomicroscope (under general anesthesia, if necessary); (2) a Gram stain and culture obtained directly from the middle ear; (3) thorough aspiration of the ear canal and, if possible, the middle ear, i.e. "aural toilet"; (4) treatment with an orally administered antimicrobial agent and an ototopical medication, if the organisms are susceptible; and if the suppurative process is unresponsive to this management, hospitalization and the parenteral administration of an antimicrobial agent. Parenteral antimicrobial therapy should be selected following microbiologic assessment of the discharge. If the infection can be eliminated using the methods described above, prevention of recurrence can be achieved by the following options: (1) prophylactic antimicrobial therapy; (2) removal of the tympanostomy tube; or (3) surgical repair of the tympanic membrane defect. The choice of these options depends on the age of the child and the status of the function of the eustachian tube. Middle ear and mastoid surgery should be reserved for those children who fail to respond to intensive medical therapy.
20 citations
TL;DR: In a series of 37 children who had a congenital perilymphatic fistula treated at the Children's Hospital of Pittsburgh, 28 (76%) had had documented otitis media in the past or a history of middle ear disease, and this finding should alert the clinician to the possibility of the presence of a congenitals perILYmphatic Fistula when sensorineural hearing loss develops or progresses during an episode of otitisMedia.
Abstract: In all infants and children who have progressive, fluctuating or sudden sensorineural hearing loss, the possibility of a congenital perilymphatic fistula should be considered. Factors determined to be highly suggestive of the presence of a congenital perilymphatic fistula as the cause of sensorineural hearing loss or vertigo, or both, include the following: mixed conductive and sensorineural hearing loss; antecedent sudden physical exertion or barotrauma; congenital deformities of the external ear and head; and abnormal findings on computed tomograms of the temporal bone, especially Mondini-like ear dysplasias. In a series of 37 children who had a congenital perilymphatic fistula treated at the Children's Hospital of Pittsburgh, 28 (76%) had had documented otitis media in the past or a history of middle ear disease. This finding should alert the clinician to the possibility of the presence of a congenital perilymphatic fistula when sensorineural hearing loss develops or progresses during an episode of otitis media. Perilymphatic fistula is caused by either congenital ossicular deformities or abnormalities of the labyrinthine windows or coexistence of both conditions. The likelihood of there being no further deterioration in hearing after surgical repair of a perilymphatic fistula is high. Every infant and child with unexplained hearing loss or disequilibrium or both deserves an attempt to uncover the cause at the earliest possible age.
13 citations