Traumatic Brain Injury and Concussion in Sports

The applicability of these findings is obscured by the different entry criteria of the various studies and the ongoing confusion that arises when studies of recurrent AOM are compared with COME. Is OM 1 disease with 2 faces—acute and chronic—or does the pathophysiology of recurrent AOM and COME differ sufficiently to preclude such comparisons? The debate undoubtedly will continue for a long time. Where, then, does this leave parents of children with recurrent AOM? Clearly, parents shoulder the burden of care of fretful infants and children who cannot sleep due to ear pain, and they incur costs that far exceed health care expenditures. 19 Are there subgroups of children who are severely affected with OM for whom aggressive therapy is appropriate? If so, how can these cases be identified? Children younger than age 4 years are at the greatest risk of recurrent AOM, and adenoidectomy performed by experienced clinicians has been shown to be safe in this patient group. 20 However, the effectiveness of adenoidectomy in preventing recurrent AOM has not been studied in this age group. As the incidence of AOM due to resistant organisms increases, outcomes research and effectiveness clinical trials should focus on this problem. In selected cases of recurrent AOM with multiple risk factors, early adenoidectomy and tympanostomy tube placement might prove to be the most rational therapy. However, such a hypothesis must await validation by further research. For now, physicians should rely on environmental control, vaccines, and episodic antimicrobial therapy for prevention and treatment, with tympanostomy tube placement and selected use of adenoidectomy when nonoperative therapy fails.