1/2. lateral sinus thrombosis after untreated otitis media. A clinical problem--again?Antimicrobial agents have greatly reduced the incidence of intracranial complications of infections of the middle ear and mastoid. Too many prescriptions and overconsumption of antibiotics when otitis media is suspected has caused resistance to many antibiotics, leading to a pronounced and justifiable desire to reduce the widespread excessive use of antibiotics. The possible untoward consequences of a too restricted antibiotic policy, however, is illustrated by the following case of a 14-year-old boy who, after non-treatment of an ear infection, fell ill with one-sided headache and vomiting caused by a lateral sinus thrombosis. After intravenous treatment with antibiotics, anticoagulants and ventilation of the middle ear, the infection was cured without complications. This case calls attention to the symptoms of otitic complications arising outside the temporal bone. The physician must always bear in mind the possibility of an unusual event. The general treatment of endocranial complications is outlined, giving details of the treatment given in this special case. We stress that one should not be too cautious in prescribing antibiotics in otitis media.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. Practice variations among pediatricians and family physicians in the management of otitis media.OBJECTIVES: To determine theoretical practice patterns and medicaid practices in the management of persistent and recurrent otitis media by family physicians and pediatricians in colorado. methods: Members of the colorado chapters of the American Academy of pediatrics and the colorado Academy of family medicine were surveyed with the use of two hypothetical case management scenarios for which they were asked to indicate which international classification of diseases, Ninth Revision, medicaid codes they would use. physicians were presented with two case scenarios (one involving a persistent asymptomatic middle ear effusion and the second involving recurrent otitis media) and were asked to choose from a variety of management options, including observation, antibiotic therapy, decongestants, corticosteroids, antibiotic prophylaxis, and referral for ventilation tube surgery. RESULTS: family physicians would have prescribed high-cost antibiotics (amoxicillin plus clavulanate potassium, cefaclor, or cefixime) to treat persistent middle ear effusions twice as often as pediatricians would have (P < .002). At the 6-week visit, 50 family physicians (43%) would administer an oral decongestant either alone or in combination with other therapy as compared with 16 (14%) of pediatricians (P < .001). family physicians would refer patients for ventilating tube surgery three times more often than pediatricians at the 9-week visits (P < .001). Recurrent episodes of acute otitis media would be managed similarly by both physician groups. Respondents reported a wide variety of international classification of diseases, Ninth Revision, coding, often coding persistent effusions as acute otitis or as unspecified otitis media. CONCLUSIONS: The findings of this survey document the wide variation in practice patterns for treating children with persistent otitis media and children with recurrent otitis media in colorado.- - - - - - - - - - ranking = 9keywords = physician (Clic here for more details about this article) |