The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patients
2.3. Treatment
2.3.1. P for Pneumatization Exercises
2.3.2. E for Education of Parents and Patients
2.3.3. A for Antiallergic Diet
2.3.4. N for Nasal Local Preparations
2.3.5. U for Useful Constitutional Medication
2.3.6. T for Thermal Interventions (Externally Applied Warm)
2.4. Outcome Variables
2.5. Statistical Analysis
2.6. Human Research Ethics Committee
3. Results
3.1. Baseline Characteristics
3.2. Primary Outcomes Results
3.3. Frequency of Antibiotic Use
3.4. Frequency of Analgesic or Antipyretic Medication
3.5. Number of Surgical Interventions
3.6. Improvement in Tympanometric and Audiometric Measurements
3.7. Results of Secondary Outcomes
4. Discussion
4.1. Main Findings
4.2. Additional Finding
4.3. Strengths and Limitations
4.4. Interpretation, Relation to Previously Published Work
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Patents
References
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(1) Number of invasive surgical interventions | Count |
(2) Number of acute infection episodes needing antibiotic therapy | Number during the observation period |
(3) Number of acute infection episodes needing analgesic therapy (local and systemic) | Number during the observation period |
(4) Tympanometric measurement with evaluation of the worse ear | A-type curve: normal pressure C- or D-type curve: under- or overpressure B-type curve: low admittance |
(5) Audiometric measurement with evaluation of the worse ear | Normal hearing: −10 to −20 dB Light hearing loss: −30 to −40 dB Middle hearing loss: −50 to −60 dB Severe hearing loss: >−60 dB |
(1) Frequency of acute otitis media during the observed time period | Count |
(2) Parents’ report on treatment outcome by subjective scales: (a) nasal congestion;(b) hearing | (a) 1 = no, 2 = moderate, 3 = severe (b) 1 = good, 2 = moderate, 3 = bad |
(3) Adherence to therapy by subjective scale | 1 = good, 2 = moderate, 3 = bad |
(4) Median time of follow-ups | Days |
(5) Mean number of days counted from the first visit during the follow-up period | Days |
(6) Participation in the visits | Number of patients, % |
2015 | 2020 | p-Value | |
---|---|---|---|
Number of patients evaluated | 28 | 48 | - |
Mean baseline age in months | 56.2 | 58.5 | Mann–Whitney test 0.76 |
Tympanometry: abnormal findings (B + C + D type curves at least 2 times during the first 3 visits) | 75% | 87.5% | Mann–Whitney test 0.166 |
Audiometry: hearing loss at baseline | minimal = 50% moderate = 32% severe = 11% | minimal = 37% moderate = 43% severe = 0% | Chi-squared test 0.001 |
Parents’ initial report on nasal obstruction (abnormal = 2 and 3 on subjective scale 1–3) | 96% | 70% | Mann–Whitney test 0.006 |
Parents’ initial self-report on hearing (abnormal = 2 and 3 on subjective scales 1–3) | 86% | 77% | Mann–Whitney test 0.34 |
Prior number of acute otitis media/year/patient | 1.6 | 1.5 | Mann–Whitney test 0.46 |
Prior number of antibiotic treatments/year | 1.6 | 1.7 | Mann–Whitney test 0.71 |
Prior number of analgesic treatments/year | 1.4 | 2.0 | Mann–Whitney test 0.35 |
Indication for adenoidectomy present at baseline | 7 out of 28 = 25% | 27 out of 48 = 56.3% | Mann–Whitney test 0.01 |
2015 | 2020 | p-Value | |
---|---|---|---|
Frequency of antibiotic use, number of patients | 5 out of 28 = 17.9% | 10 out of 48 = 20.8% | Chi-squared test 0.753 |
Number of antibiotic treatments/year/patient | 0.21 | 0.48 | Mann–Whitney test 0.545 |
Use of analgesic or antipyretic medication, number of patients | 6 out of 28 = 21.4% | 16 out of 48 = 33.3% | Chi-squared test 0.27 |
Number of analgesic treatments/year/patient | 0.36 | 0.63 | Mann–Whitney test 0.257 |
Number of invasive surgical interventions | 1 out of 28 = 3.6% | 3 out of 48 = 6.25% | Mann–Whitney test 0.616 |
Improvement in tympanometric measurement with evaluation of the worse ear | A-type curve: normal pressure C- or D-type curve: under- or overpressure B-type curve: low admittance | See comparison in Figure 1a,b | |
Improvement in audiometric measurement with evaluation of the worse ear | Normal hearing: −10 to −20 dB Minimal hearing loss: −30 to −40 dB Middle hearing loss: −50 to −60 dB Severe hearing loss: >−60 dB | See the comparison in Figure 2 |
2015 | 2020 | p-Value | |
---|---|---|---|
Number of acute otitis media during the observation period, count of patients | 13 out of 28 = 46.4% | 21 out of 48 = 43.8% | Chi-squared test 0.82 |
Number of acute otitis media/year/patient during the observation period | 0.86 | 0.71 | Mann–Whitney test 0.877 |
Adherence to prescribed therapies | 1 (good) = 67.3 % 2 (intermediate) = 29.1% 3 (bad) = 3.6% | 1 (good) = 56.2% 2 (intermediate) = 38.4% 3 (bad) = 5.4% | - |
Average days between follow-up visits (visit 1–12), days, mean | 49.4 | 48.7 | Test for median differences and Mann–Whitney test 0.000 |
Length of observation period visit 1–12, days, mean | 353 | 208 | Mann–Whitney test 0.000 |
Adverse reactions | 2% | 2% | - |
Reference | Mean Age (Years Range) | Diagnostic Method | Intervention | Time of Follow-Up (Months) | Effect |
---|---|---|---|---|---|
Rosenfeld 2016, 2003 [10,37] | NA (0–18) | NA | No intervention = Natural resolution | 6 vs. 12 | 26% vs. 33% |
Williamson 2015 [38] | 5.4 (4–11) | Tympanometry, quality of life | Usual care alone ------------ Usual care plus autoinflation | 1 vs. 3 ----------- 1 vs. 3 | 36% vs. 38% ----------- 47% vs. 50% |
Bidarian-Moniri 2014 [39] | 5 (2–8) | Tympanometry middle ear pressure (daPa) for both ears --------------- Audiometry mean, median hearing level (dB) for best ear | Balloon autoinflation | Inclusion 2 6 12 ------------ Inclusion 2 6 12 | −389, −400 −189, −182 −196, −185 −151, −123 ------------ 22,22 16,13 16,13 14,12 |
Szőke [11] | 4.7 (1–8) | Tympanometry, audiometry | P.E.A.N.U.T. method | 12 | 70–80% |
Chen 2020 [40] | NA | Audiometry (air-bone gap) | Surgery | 6–18 | 80–90% (range 60–94) |
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Szőke, H.; Maródi, M.; Vagedes, J.; Székely, B.; Magyarosi, I.; Bedő, A.; Fellegi, V.; Somogyvári, K.; Móricz, P. The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children. Antibiotics 2021, 10, 134. https://doi.org/10.3390/antibiotics10020134
Szőke H, Maródi M, Vagedes J, Székely B, Magyarosi I, Bedő A, Fellegi V, Somogyvári K, Móricz P. The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children. Antibiotics. 2021; 10(2):134. https://doi.org/10.3390/antibiotics10020134
Chicago/Turabian StyleSzőke, Henrik, Márta Maródi, Jan Vagedes, Balázs Székely, István Magyarosi, Adél Bedő, Veronika Fellegi, Krisztina Somogyvári, and Péter Móricz. 2021. "The P.E.A.N.U.T. Method: Update on an Integrative System Approach for the Treatment of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children" Antibiotics 10, no. 2: 134. https://doi.org/10.3390/antibiotics10020134