The "TIP algorithm" for the accurate diagnosis of pediatric otitis media.

OBJECTIVES: The authors studied the correlation between the grading TIP which evaluates three otoendoscopic characteristics of the tympanic membrane (TM) (transparency, integrity and position) with the gold standard represented by the impedenzometry. METHODS AND MATERIALS: Cross-sectional studies with independent and blind comparison with the gold standard diagnostic. The setting was primary care and ambulatory. 115 TMs were examined (57 right and 58 left) of 60 children (36 males and 24 females) and classified according to the TIP grading (transparency, integrity, position). Each patient underwent otoendoscopy to obtain TIP grading and subsequently to tympanometry, which was considered the gold standard for diagnosis. The Transparency is the condition in which at least one or more structures behind the TM are visible: promontory, incudo-malleolar and incudo-stapedial articulations. The Integrity is such when no holes in the TM are visible. The TM must be displayed up to the anulus. The position of the TM is evaluated according to the handle and the short apophysis of the malleus. The correlation between TIP grade and tympanometry was measured by the "Chi Square" test. RESULTS: The method showed an average sensitivity and specificity of the three TIP parameters (TIP1 TIP2, TIP 4) versus tympanometry of 95.6% (I.C. 90.1-98.5); PPV and PPN 95.6 (I.C 90.3%-98.1%) Positive Likelihood Ratio 22,000 (I.C. 9.327 to 51.894) Negative Likelihood Ratio 0.045 0.019 to 0.107. CONCLUSION: Grading TIP is a valid method for accurate diagnosis of pediatric otitis media and can predict the tympanometry result with high statistical significance.

A comparative randomized study on the efficacy of a systemic steroid therapy vs. a thermal therapy in otitis media with effusion in children.

BACKGROUND: The aim of this study was to compare the effectiveness of a systemic steroid therapy vs. a thermal therapy based on sulphurous water insufflation. The therapy was performed in Telese Terme Spa based on the Salimbani-Politzer technique on children suffering of otitis media with effusion (OME), using the variations of the tympanogram as objective outcome in a short time follow-up. METHODS: Eighty children suffering of monolateral or bilateral OME (44 male, 36 female, age 4-12 years, average age 7.2±2.83 ys.), enrolled in ENT or paediatrics offices, have been included in the study. Children were included in a randomization list in order to obtain two therapeutic groups, the first one to be treated through a systemic steroid therapy, the second one to be treated through sulphuruos water insufflation in Telese Spa. Children underwent otoscopic/otomicroscopic visit and tympanometry before the beginning of the therapy (T0), 7 days after the beginning of the therapy (T1), 7-10 days after the end of the therapy (T2), 30-35 days after the end of the therapy (T3). The variation of the type of tympanogram was considered the objective outcome. The shift either from a type B to a type C or o type A tympanogram and from a type C to a type A tympanogram was considered a positive outcome; the persistence either of the same type of tympanogram and the shift from a type C to a type B or from a type A to a type C or a type B were considered a negative outcome. RESULTS: Thermal therapy showed better outcomes at each time, with differences in improvement and healing often reaching the statistical significance. The most important prognostic indicator was the presence of an initial type B tympanogram, associated to a worst prognosis in both therapeutic groups and in each subgroup of OME. CONCLUSIONS: Sulphurous water insufflation therapy appeared a good therapeutic choose in the treatment of OME in a pediatric population.

Resveratrol plus carboxymethyl-ß-glucan in children with recurrent respiratory infections: a preliminary and real-life experience.

BACKGROUND: Recurrent respiratory infections (RRI), such as the presence of at least one of the following criteria: i) >6 RI per year; ii) >1 RI per month involving upper airways from September to April; iii) >3 RI involving lower airways, constitute a social problem for both their pharmaco-economic impact and the burden for the family. However, several treatment have been proposed with controversial results. OBJECTIVE: As resveratrol plus carboxymethyl-ß-glucan is presently available as solution for aerosol, the aim of this study was to evaluate the effects of this compound, compared to saline solution, whether it is able to prevent RRI in children. DESIGN: The study was designed as real-life, randomized. Globally, 82 children (49 males, mean age 8.1 ± 2.6 years) with acute rhinopharyngitis and RRI were enrolled. Resveratrol plus carboxymethyl-ß-glucan or saline isotonic solution was randomly (ratio 1:1) administered immediately after an anti-infective and anti-inflammatory 10-day treatment (tiamphenicol associated with acetylcysteine plus beclomethasone dipropionate) for the acute rhinopharyngitis. Investigated treatments lasted 20 days. Days with respiratory symptoms, fever, medication use, medical visits, and school absences were evaluated. Children were visited 30, 60, and 90 days after starting treatments. RESULTS: The active compound was able to significantly reduce the number of days with nasal obstruction (p < 0.001), rhinorrhea (p < 0.001), sneezing (p < 0.001), cough (p = 0.002), fever (p < 0.001), medication use (p < 0.001), medical visits (p < 0.001), and school absence (p < 0.001). CONCLUSIONS: This preliminary and real-life study could suggest that an aerosolized solution containing resveratrol plus carboxymethyl-ß-glucan might exert preventive effects in children with RRI.