Dr Graeme Copley. Department of Paediatric Otorhinolaryngology Red Cross Children s Hospital
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1 Prevention of middle ear infections in children Dr Graeme Copley Department of Paediatric Otorhinolaryngology Red Cross Children s Hospital
2 Acute middle ear infections Seen mostly by primary care givers Rarely by ENT specialist We see the chronic end point Intervention on history provided If you suggest grommets that s what will happen
3 Are acute middle ear infections in children an issue? Most common reason for prescribing antibiotics 1995= US$ 2 billion School and work Incidence increasing Despite research improved healthcare?
4 Side-effects effects of treatment Antibiotic resistance Side-effects Diarrhoea and vomiting Nappy rash Immune suppression Cost
5 Why are children susceptible? Immune maturity / impairment Short narrow Eustachian tube Small nasopharynx Adenoidal tissue
6 Children at risk for AOM Genetic factors Male sex Low socio-economic status Immune function Nutrition Hand washing Over crowding Access to health care Breast vs bottle feeding Immune function Nutrition Household smokers Creche
7 Risk factors Syndromic children Cleft palate Down s syndrome Pacifier use? Sleeping position?
8 Pathophysiology Viral URTI ET Mucosal Injury AOM OME
9 AOM natural history
10 Chronic middle ear infections
11 Prevention of AOM Less middle ear damage Less meningitis Less antibiotic resistance Less burden on healthcare
12 Treatment of Acute Otitis Media in Children under 2 Years of Age Alejandro Hoberman NEJM Nov 2011
13 Antibiotic use and the incidence of resistance Antimicrobial Drug Use and Resistance in Europe van de Sande-Bruinsma Emerg Infect Dis November; 14(11):
14 Bacteria resistance is nothing personal
15 Bacteria resistance is nothing personal
16 What about grommets for acute infections?
17 A good indication for ventilation tubes Persistent middle ear effusion Hearing loss
18 Complications of grommets? complication of the grommet? Or due to chronic disease? Persistent infection Granulation tissue Persistent perforation Hearing loss
19 Key to middle ear health is the health of the nose and postnasal space
20 Lateral wall of nasal cavity
21 Adenoidals
22 Protection of upper airway and Mechanical Chemical Immunological postnasal space
23 Respiration Heat exchange Humidification Filtration Fluids and ciliary action
24 Removing particles Mechanical barrier Vibrissae Filtration Laminar Turbulent Physical characteristics mucus Mucociliary blanket
25 Blood supply turbinate
26 Respiratory mucosa
27 Respiratory epithilium
28 Mucus blanket
29 Sinonasal epithelial blanket flow
30 Mucus Goblet cells Glandular mucus cells Glycoproteins Quantity and quality Neurovascular control
31 Chemical protection of mucus Water Phospholipids Enzymes Complement layer
32 Immunological protection Ig A & Ig E on surface Ig M & Ig G in tissues Primed macrophages Lymphocytes Adenoids
33 Surface cells Mucus contains immunologically active cells Macrophages Mast cells Leukocytes Eosinophil Cytology of secretions assist diagnosis
34 Factors affecting ciliary Temperature Drying function URTI= epithelial damage Sloughing off of cells
35 The health of nasopharynx and nasal cavity Avoid viral infections Avoid allergens Immune function Quality of the mucus Action of the cilia
36 Avoid viral infections Hand washing Nasal saline douches Quarantine Temperature and humidity control Smokers in the house Smoking
37 Avoid allergens Skin prick tests Cigarette smoke Pollution Pollen House dust mite Nasal saline douche
38 Immune function boost Avoid infections Nutrition Raw food Avoid preservatives/ additives Immunizations MALT & GALT Natural probiotic= Kefir
39 Quality of the mucus Nasal saline douches Alkalinisation of secretions Raw food diet Vegetables Fruit
40 Maintain ciliary action Avoid viral infections! Temperature control Humidity control Nasal douches Smoking
41 Take home message Tailor intervention to the particular patient Reduce risk factors Boost the immune system Clean the nose Avoid viral URTI Stop smoking Wait till summer Avoid antibiotics and grommets A healthy body and mind doesn t get sick AOM is a public health disease
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