{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:09:02Z","timestamp":1790399342323,"version":"4.1.0"},"reference-count":95,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T00:00:00Z","timestamp":1548979200000},"content-version":"unspecified","delay-in-days":31,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Laryngol. Otol."],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0022215119000057_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Important ear problems can affect the outer ear, the middle ear and the inner ear. Globally, the greatest burden of disease is due to ear conditions that are associated with otorrhoea and hearing loss.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215119000057_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>This study reviewed the literature on the prevention and treatment of common ear conditions that are most relevant to settings with high rates of ear disease and limited resources. The grading of recommendations assessment, development and evaluation (\u2018GRADE\u2019) approach was utilised to assess interventions.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215119000057_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Accurate diagnosis of ear disease is challenging. Much of the preventable burden of ear disease is associated with otitis media. Nine otitis media interventions for which there is moderate to high certainty of effect were identified. While most interventions only provide modest benefit, the impact of treatment is more substantial in children with acute otitis media with perforation and chronic suppurative otitis media.<\/jats:p><\/jats:sec><jats:sec id=\"S0022215119000057_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusion<\/jats:title><jats:p>Disease prevention through good hygiene practices, breastfeeding, reducing smoke exposure, immunisation and limiting noise exposure is recommended. Children with acute otitis media with perforation, chronic suppurative otitis media, complications of otitis media, and significant hearing loss should be prioritised for medical treatment.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0022215119000057","type":"journal-article","created":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T11:00:46Z","timestamp":1549018846000},"page":"59-72","source":"Crossref","is-referenced-by-count":5,"title":["Preventative and medical treatment of ear disease in remote or resource-constrained environments"],"prefix":"10.1017","volume":"133","author":[{"given":"S","family":"Brophy-Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Jarosz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A J","family":"Leach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P S","family":"Morris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2019,2,1]]},"reference":[{"key":"S0022215119000057_ref93","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1111\/j.1742-6723.2006.00865.x","article-title":"Presentation and management of aural foreign bodies in two Australian emergency departments","volume":"18","author":"Ryan","year":"2006","journal-title":"Emerg Med Australas"},{"key":"S0022215119000057_ref92","first-page":"CD004740","article-title":"Interventions for acute otitis externa","volume":"1","author":"Kaushik","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref90","first-page":"605","article-title":"Estimated burden of acute otitis externa\u2013United States, 2003\u20132007","volume":"60","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"S0022215119000057_ref88","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2005.04.012"},{"key":"S0022215119000057_ref87","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200207000-00005"},{"key":"S0022215119000057_ref86","doi-asserted-by":"publisher","DOI":"10.1177\/0194599813517083"},{"key":"S0022215119000057_ref85","first-page":"150","article-title":"The potential pitfalls of ear syringing. Minimising the risks","volume":"32","author":"Bird","year":"2003","journal-title":"Aust Fam Physician"},{"key":"S0022215119000057_ref83","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816671491"},{"key":"S0022215119000057_ref80","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e31817f736b"},{"key":"S0022215119000057_ref79","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215117001840"},{"key":"S0022215119000057_ref78","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24306"},{"key":"S0022215119000057_ref77","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000138"},{"key":"S0022215119000057_ref76","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-012-1924-8"},{"key":"S0022215119000057_ref71","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-0125"},{"key":"S0022215119000057_ref70","doi-asserted-by":"publisher","DOI":"10.3310\/hta18050"},{"key":"S0022215119000057_ref68","first-page":"CD008512","article-title":"Interventions for the prevention of postoperative ear discharge after insertion of ventilation tubes (grommets) in children","volume":"4","author":"Syed","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref67","first-page":"CD004741","article-title":"Grommets (ventilation tubes) for recurrent acute otitis media in children","volume":"4","author":"McDonald","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref66","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000002695"},{"key":"S0022215119000057_ref65","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606043"},{"key":"S0022215119000057_ref63","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2006.110429"},{"key":"S0022215119000057_ref62","first-page":"CD011534","article-title":"Paracetamol (acetaminophen) or non-steroidal anti-inflammatory drugs, alone or combined, for pain relief in acute otitis media in children","volume":"12","author":"Sjoukes","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref61","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000001099"},{"key":"S0022215119000057_ref60","doi-asserted-by":"publisher","DOI":"10.5694\/mja13.10533"},{"key":"S0022215119000057_ref59","first-page":"CD010375","article-title":"Water precautions for prevention of infection in children with ventilation tubes (grommets)","volume":"1","author":"Moualed","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref58","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-2787"},{"key":"S0022215119000057_ref45","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6605e3"},{"key":"S0022215119000057_ref47","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7421.967"},{"key":"S0022215119000057_ref16","first-page":"CD010089","article-title":"Influenza vaccines for preventing acute otitis media in infants and children","volume":"3","author":"Norhayati","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(14)70168-7"},{"key":"S0022215119000057_ref81","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2010.109793"},{"key":"S0022215119000057_ref50","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.300.6724.582"},{"key":"S0022215119000057_ref46","unstructured":"Arclight Medical. Otoscope Included. In: http:\/\/arclightscope.com\/2012\/07\/otoscope-included\/ [10 December 2018"},{"key":"S0022215119000057_ref48","doi-asserted-by":"publisher","DOI":"10.1097\/00020840-200310000-00012"},{"key":"S0022215119000057_ref6","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000366"},{"key":"S0022215119000057_ref75","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.08.007"},{"key":"S0022215119000057_ref95","doi-asserted-by":"publisher","DOI":"10.1097\/01.pec.0000227866.46439.3f"},{"key":"S0022215119000057_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-5876(99)00156-1"},{"key":"S0022215119000057_ref54","doi-asserted-by":"publisher","DOI":"10.1177\/00034894941030S510"},{"key":"S0022215119000057_ref74","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2017.06.038"},{"key":"S0022215119000057_ref91","first-page":"0510","article-title":"Otitis externa","volume":"2015","author":"Hajioff","year":"2015","journal-title":"BMJ Clin Evid"},{"key":"S0022215119000057_ref22","first-page":"CD011684","article-title":"Interventions for children with ear discharge occurring at least two weeks following grommet (ventilation tube) insertion","volume":"11","author":"Venekamp","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref23","first-page":"CD004618","article-title":"Topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations","volume":"4","author":"Macfadyen","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref72","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e31802c938b"},{"key":"S0022215119000057_ref31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0086397"},{"key":"S0022215119000057_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-199411000-00009"},{"key":"S0022215119000057_ref52","volume-title":"Recommendations for Clinical Care Guidelines on the Management of Otitis Media in Aboriginal and Torres Strait Islander Populations","author":"Morris","year":"2011"},{"key":"S0022215119000057_ref89","doi-asserted-by":"publisher","DOI":"10.1080\/00039896.1975.10666747"},{"key":"S0022215119000057_ref40","first-page":"139","article-title":"The clinical effectiveness of pneumococcal conjugate vaccines: a systematic review and meta-analysis of randomized controlled trials","volume":"113","author":"Ewald","year":"2016","journal-title":"Dtsch Arztebl Int"},{"key":"S0022215119000057_ref12","volume-title":"Chronic Suppurative Otitis Media. Burden of Illness and Management Options","year":"2004"},{"key":"S0022215119000057_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68304-9"},{"key":"S0022215119000057_ref53","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d1088"},{"key":"S0022215119000057_ref84","first-page":"CD004326","article-title":"Ear drops for the removal of ear wax","volume":"1","author":"Burton","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref21","first-page":"CD001801","article-title":"Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children","volume":"10","author":"Browning","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref55","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69606-2"},{"key":"S0022215119000057_ref33","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1111\/jpc.12741","article-title":"Prevalence and risk factors for parent-reported recurrent otitis media during early childhood in the Western Australian Pregnancy Cohort (Raine) Study","volume":"51","author":"Brennan-Jones","year":"2015","journal-title":"J Paediatr Child Health"},{"key":"S0022215119000057_ref32","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12652"},{"key":"S0022215119000057_ref19","first-page":"CD004401","article-title":"Antibiotics for the prevention of acute and chronic suppurative otitis media in children","volume":"4","author":"Leach","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref57","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-017-4586-8"},{"key":"S0022215119000057_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/12.Supplement_8.S1006"},{"key":"S0022215119000057_ref34","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2011.158"},{"key":"S0022215119000057_ref2","doi-asserted-by":"publisher","DOI":"10.1080\/14992027.2017.1291264"},{"key":"S0022215119000057_ref49","volume-title":"The Selection and Use of Essential Medicines. Report of the WHO Expert Committee, 2015 (including the 19th WHO Model List of Essential Medicines and the 5th WHO Model List of Essential Medicines for Children)","year":"2015"},{"key":"S0022215119000057_ref10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-200"},{"key":"S0022215119000057_ref5","volume-title":"Epidemiology and Management of Otitis Media in Indigenous and Non-Indigenous Children","author":"Gunasekera","year":"2009"},{"key":"S0022215119000057_ref56","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000155"},{"key":"S0022215119000057_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60921-5"},{"key":"S0022215119000057_ref43","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piw010"},{"key":"S0022215119000057_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308875"},{"key":"S0022215119000057_ref20","first-page":"CD000219","article-title":"Antibiotics for acute otitis media in children","volume":"6","author":"Venekamp","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0b013e3181c0eaec"},{"key":"S0022215119000057_ref42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001657"},{"key":"S0022215119000057_ref82","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2017.07.020"},{"key":"S0022215119000057_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12640"},{"key":"S0022215119000057_ref4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0036226"},{"key":"S0022215119000057_ref15","first-page":"CD001480","article-title":"Pneumococcal conjugate vaccines for preventing otitis media","volume":"4","author":"Fortanier","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piv038"},{"key":"S0022215119000057_ref11","volume-title":"Prevention of Hearing Impairment from Chronic Otitis Media: Report of a WHO\/CIBA Foundation Workshop, London, UK, 19\u201321 November 1996","year":"1998"},{"key":"S0022215119000057_ref14","volume-title":"WHO Handbook for Guideline Development","year":"2012"},{"key":"S0022215119000057_ref18","first-page":"CD003423","article-title":"Antihistamines and\/or decongestants for otitis media with effusion (OME) in children","volume":"9","author":"Griffin","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref24","first-page":"CD005608","article-title":"Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations","volume":"1","author":"Macfadyen","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15495-0"},{"key":"S0022215119000057_ref73","doi-asserted-by":"publisher","DOI":"10.1177\/0194599816633697"},{"key":"S0022215119000057_ref26","first-page":"CD006207","article-title":"Physical interventions to interrupt or reduce the spread of respiratory viruses","volume":"7","author":"Jefferson","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2007.12.013"},{"key":"S0022215119000057_ref64","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-3488"},{"key":"S0022215119000057_ref28","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph14040371"},{"key":"S0022215119000057_ref94","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-200311000-00010"},{"key":"S0022215119000057_ref17","first-page":"CD009163","article-title":"Antibiotics for otitis media with effusion in children","volume":"6","author":"Venekamp","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref30","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13151"},{"key":"S0022215119000057_ref36","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/j.1651-2227.2009.01506.x","article-title":"Prenatal and postnatal parental smoking and acute otitis media in early childhood","volume":"99","author":"Haberg","year":"2010","journal-title":"Acta Paediatr"},{"key":"S0022215119000057_ref69","first-page":"CD007810","article-title":"Adenoidectomy for otitis media in children","volume":"1","author":"van den Aardweg","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"S0022215119000057_ref37","doi-asserted-by":"crossref","first-page":"599","DOI":"10.5694\/j.1326-5377.2008.tb01801.x","article-title":"The effect of passive smoking on the risk of otitis media in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder region of Western Australia","volume":"188","author":"Jacoby","year":"2008","journal-title":"Med J Aust"},{"key":"S0022215119000057_ref38","doi-asserted-by":"publisher","DOI":"10.1007\/s10393-014-0965-4"},{"key":"S0022215119000057_ref44","doi-asserted-by":"publisher","DOI":"10.1542\/peds.108.1.40"},{"key":"S0022215119000057_ref51","unstructured":"Overview of tympanostomy tube placement, postoperative care, and complications in children. In: https:\/\/www.uptodate.com\/contents\/overview-of-tympanostomy-tube-placement-postoperative-care-and-complications-in-children [10 December 2018]"}],"container-title":["The Journal of Laryngology &amp; Otology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0022215119000057","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,14]],"date-time":"2024-07-14T13:43:43Z","timestamp":1720964623000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0022215119000057\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":95,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,1]]}},"alternative-id":["S0022215119000057"],"URL":"https:\/\/doi.org\/10.1017\/s0022215119000057","relation":{},"ISSN":["0022-2151","1748-5460"],"issn-type":[{"value":"0022-2151","type":"print"},{"value":"1748-5460","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}