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Bacterial Reservoirs in the Middle Ear of Otitis-prone Children Are Associated With Repeat Ventilation Tube Insertion
Elke J Seppanen1, Ruth B Thornton1,2,3, Hannah Jd North4
1From the Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.
Background:
Repeat ventilation tube insertion (VTI) is common in children with recurrent acute otitis media (rAOM). Identifying risk factors associated with repeat surgery will improve clinical management and prevent repeat VTI.
Methods:
Surgical records were assessed at 8 years following VTI surgery for rAOM in children 6-36 months of age. Children were grouped according to detection of bacterial otopathogen in their middle ear effusion (MEE) at the time of VTI, and outcomes for future otorhinolaryngology surgery compared.
Results:
Age, gender, pneumococcal vaccination status, antibiotic usage, day-care attendance, number of siblings and number of AOM episodes were similar between groups. Of the 63 children who had PCR +ve MEE, 58.7% required repeat VTI compared with 31.4% of the 51 children with no otopathogen detected in their MEE (odds ratio = 3.1, 95% confidence interval [1.4-6.8]; P = 0.004). Nontypeable Haemophilus influenzae (NTHi) was the predominant otopathogen in MEE (79% of all PCR +ve MEE). Respiratory virus detection was not associated with repeat VTI.
Conclusions:
Presence of bacterial otopathogen, specifically nontypeable H. influenzae, in the middle ear during VTI was a predictor of children at-risk of repeat VTI. Here, we identify a modifiable microbiologic factor for repeat VTI that can be targeted to improve clinical management of rAOM.
Insights
Children with bacteria in middle ear fluid during ventilation tube insertion (VTI) are more likely to need repeat surgery for recurrent acute otitis media (rAOM). Nontypeable Haemophilus influenzae was a key predictor of repeat VTI.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Recurrent acute otitis media (rAOM) frequently necessitates repeat ventilation tube insertion (VTI) in children.
- Identifying predictors for repeat VTI is crucial for optimizing clinical management and preventing further surgical interventions.
Purpose of the Study:
- To investigate the association between bacterial otopathogens in middle ear effusion (MEE) during VTI and the likelihood of requiring repeat VTI in children with rAOM.
- To identify specific microbial risk factors for repeat VTI.
Main Methods:
- A retrospective analysis of surgical records for children aged 6-36 months who underwent VTI for rAOM.
- Children were categorized based on the presence or absence of bacterial otopathogens in MEE, detected via PCR.
- Outcomes, specifically the need for subsequent otorhinolaryngology surgery, were compared between groups.
Main Results:
- Children with bacterial otopathogens detected in MEE at the time of VTI had a significantly higher rate of repeat VTI (58.7%) compared to those without detected otopathogens (31.4%).
- The odds ratio for repeat VTI in the presence of otopathogens was 3.1 (95% CI [1.4-6.8], P = 0.004).
- Nontypeable Haemophilus influenzae (NTHi) was the most prevalent otopathogen identified (79% of PCR-positive MEE); respiratory viruses were not associated with repeat VTI.
Conclusions:
- The presence of bacterial otopathogens, particularly NTHi, in the middle ear during VTI is a significant predictor of repeat VTI in children with rAOM.
- This finding highlights a modifiable microbiologic factor that can be targeted to improve the management of recurrent acute otitis media and reduce the need for repeat surgeries.
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