Trends in Otitis Media and Mastoiditis

Trends in Otitis Media and Mastoiditis
Mastoiditis is uncommon, and fewer than one third of children who develop it have recent diagnoses of AOM.
Has the watch-and-wait approach to managing children with acute otitis media (AOM) increased the incidence of mastoiditis? Investigators used a general practice U.K. database of more than 2.5 million children (age range, 3 months to 15 years) to examine trends in diagnosis of AOM and mastoiditis from 1990 through 2006.
Of 854 children with diagnoses of mastoiditis, only 36% had received diagnoses of AOM during the previous 3 months. During the 16-year study, the incidence of mastoiditis remained stable (average incidence, 1.2 per 10,000 child-years), whereas the incidence of AOM diagnoses declined 34%, and the proportion of children with AOM who were treated with antibiotics declined significantly from 77% to 58%. Risk for developing mastoiditis was 53% lower in children with AOM who received antibiotics than in children with AOM who did not receive antibiotics (1.8 vs. 3.8 per 10,000 episodes). However, the authors estimate that 4831 children with AOM would have to be treated with antibiotics to prevent one case of mastoiditis.
Comment: In the U.S., AOM diagnoses have declined recently for a number of reasons, including use of the conjugate pneumococcal vaccine. In addition, the number of children with AOM who receive antibiotics has declined because some clinicians have adopted a watch-and-wait approach rather than treating children immediately with antibiotics. These reassuring data indicate that mastoiditis is uncommon and that about two thirds of children who develop it do not have recent diagnoses of AOM. Because these data were collected before introduction of the conjugate pneumococcal vaccine in the U.K., the authors speculate that the incidences of AOM and mastoiditis are even lower for countries in which the vaccine is used.
— Howard Bauchner, MD
Published in Journal Watch Pediatrics and Adolescent Medicine March 4, 2009

Medicine News

Vicks VapoRub May Cause Respiratory Distress in Infants, Animal Study Suggests

Parents may ask about a Chest study suggesting that Vicks VapoRub may act as an airway irritant in very young children.
When an 18-month-old child was brought to an emergency room in severe respiratory distress after a grandparent applied Vicks VapoRub directly under her nose, clinicians investigated whether the ointment — a mixture of camphor, menthol, and eucalyptus oil — was at fault. (The product is not recommended for application to the nostril or for children under age 2 years.)
Their studies in healthy ferrets, which have an airway anatomy similar to humans, showed that mucus secretion increased and ciliary activity decreased in the presence of the ointment.
The authors conclude that the effect "may be of little physiologic consequence in older children and adults, but in infants and small children this potentially can lead to respiratory distress

Chest
Website of Vicks VapoRub


Treadmill Exercise Recommended for Peripheral Arterial Disease
Physicians should prescribe treadmill exercise for patients with peripheral arterial disease, a JAMA study concludes.
Some 150 patients with peripheral arterial disease, with or without intermittent claudication, were randomized to one of three groups: treadmill exercise, lower-extremity resistance training, or a control group. (The active treatment groups exercised three times a week for 6 months under supervision.)
By the end of the trial, treadmill exercise resulted in greater improvement in the 6-minute-walk test than resistance training, and it also improved brachial artery flow-mediated dilation. For its part, resistance training improved several measures of functional performance, such as stair-climbing ability.
The authors say their results "suggest ... treadmill exercise confers a favorable systemic vascular effect that may reduce cardiovascular events" in these patients, regardless of the presence of intermittent claudication.

Little Evidence That Herbal Medicines Relieve Menopausal Symptoms
A systematic review has found little evidence that herbal remedies help relieve menopausal symptoms.
Among the findings, published online in Drug and Therapeutics Bulletin:
Black cohosh: Three controlled trials suggested a salutary effect, whereas four others did not. The herb has been linked to liver toxicity.
Red clover: A meta-analysis found no benefit.
Dong quai: The remedy was no better than placebo in one trial, but better than placebo in another, where it was combined with chamomile. It's contraindicated in patients taking warfarin, as it may increase the risk for bleeding.
Evening primrose: The treatment was not superior to placebo in one trial. Evidence suggests that it may further increase the risk for seizures when used along with other drugs that can cause seizures.
Ginseng: Two trials showed no effect.
(These findings are similar to those of a previous systematic review.)