Danhauer Jeffrey L, Johnson Carole E, Rotan Suzanne N, Snelson Tasha A, Stockwell Jennifer S
Department of Speech and Hearing Sciences, University of California Santa Barbara, Goleta, CA 93117, USA.
J Am Acad Audiol. 2010 May;21(5):329-46. doi: 10.3766/jaaa.21.5.5.
Acute otitis media (AOM) is the main reason for physician visits and antibiotic prescriptions in children. Pediatricians (Peds) are gatekeepers for services and sources of information for families. The 2004 American Academy of Pediatrics/American Academy of Family Physicians (AAP/AAFP) Clinical Practice Guideline: Diagnosis and Management of Acute Otitis Media recommended preventative and management measures for Peds' practice. Treatments for AOM (antimicrobial therapy and surgery) sometimes have questionable effectiveness, risks, and high costs. Thus, Peds should consider using prophylactics for AOM that are easy to administer, cost-effective, and have minimal side effects. Xylitol, a naturally occurring sugar alcohol, is widely used to prevent AOM and for other health conditions in Europe, and as a dental caries prophylaxis in the United States. It would be helpful to know Peds' attitudes and practices to identify barriers to xylitol's use as a prophylaxis for AOM in the United States.
To conduct a national survey of Peds in the United States to evaluate how closely they adhered to the AAP/AAFP guideline, and their knowledge and opinions about xylitol use.
A randomized, national postal survey.
A 48-item questionnaire developed for this study was mailed to a random sample of 506 Peds within the United States during spring 2009. It assessed Peds' demographics, adherence to the guideline, and knowledge and opinions about and use of xylitol as a prophylaxis for AOM in children.
The questionnaire response rate was 22% (98 useable/506 mailed - 63 returned undeliverable). Participants were about equal for gender, and almost all were in private practice for over 10 yr. Most had pediatric patients with at least one bout of AOM annually. The majority adhered to the guideline (e.g., almost all routinely assessed and managed patients' pain for AOM and encouraged prevention by recommending that families reduce risk factors). Most used and were comfortable with otoscopy for diagnosing AOM, but not tympanometry. Almost all believed that conductive hearing loss could hinder speech-language and academic development, and AOM could reduce quality of life of children. They also believed that those under 6 mo of age with AOM should receive antibacterial therapy beginning with amoxicillin but did not use complementary and alternative medicine (CAM). Only about half knew about medical uses for xylitol, but of those, most were aware of its use in chewing gum to prevent AOM but had not used it with patients. They were not sure of xylitol's effectiveness or appropriate dosages but cited stomach cramping and diarrhea as possible side effects. Most would use xylitol if evidence supported it and wanted information about it via reprints or electronically. Few agreed that audiologists are important in diagnosing/managing AOM.
Most of these Peds adhered to the AAP/AAFP guideline. They were not using CAMs like xylitol for preventing AOM in children. Future research should focus on prevention and the use of xylitol as a possible prophylaxis regimen for AOM in patients.
急性中耳炎（AOM）是儿童就诊和使用抗生素处方的主要原因。儿科医生是家庭服务的把关者和信息来源。2004年美国儿科学会/美国家庭医生学会（AAP/AAFP）《急性中耳炎诊断和管理临床实践指南》推荐了儿科实践中的预防和管理措施。AOM的治疗方法（抗菌治疗和手术）有时效果存疑、存在风险且成本高昂。因此，儿科医生应考虑使用易于给药、具有成本效益且副作用最小的AOM预防措施。木糖醇是一种天然存在的糖醇，在欧洲广泛用于预防AOM和其他健康状况，在美国则用作预防龋齿。了解儿科医生对木糖醇作为美国AOM预防措施的态度和做法，将有助于识别其使用障碍。
对美国儿科医生进行全国性调查，以评估他们对AAP/AAFP指南的遵循程度，以及他们对木糖醇使用的知识和看法。
一项随机的全国邮政调查。
2009年春季，为本研究制定的一份包含48个条目的问卷被邮寄给美国506名儿科医生的随机样本。问卷评估了儿科医生的人口统计学特征、对指南的遵循情况，以及对木糖醇作为儿童AOM预防措施的知识、看法和使用情况。
问卷回复率为22%（98份可用/506份邮寄 - 63份未送达）。参与者的性别大致相等，几乎所有人都从事私人执业超过10年。大多数人每年都有患有至少一次AOM的儿科患者。大多数人遵循指南（例如，几乎所有人都常规评估和处理AOM患者的疼痛，并通过建议家庭降低风险因素来鼓励预防）。大多数人使用耳镜诊断AOM且感觉舒适，但不使用鼓室图。几乎所有人都认为传导性听力损失会阻碍言语语言和学业发展，AOM会降低儿童的生活质量。他们还认为，6个月以下患有AOM的儿童应从阿莫西林开始接受抗菌治疗，但未使用补充和替代医学（CAM）。只有大约一半的人了解木糖醇的医学用途，但其中大多数人知道其在口香糖中用于预防AOM，但未在患者中使用过。他们不确定木糖醇的有效性或合适剂量，但提到胃痉挛和腹泻可能是副作用。大多数人表示如果有证据支持会使用木糖醇，并希望通过重印本或电子方式获取相关信息。很少有人同意听力学家在诊断/管理AOM方面很重要。
这些儿科医生中的大多数遵循了AAP/AAFP指南。他们未使用木糖醇等CAM来预防儿童AOM。未来的研究应聚焦于预防以及木糖醇作为AOM患者可能的预防方案的使用。
