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PROGNOSIS IN CHILDREN WITH OTITIS MEDIA WITH EFFUSION

Titmus, Joshua (2008) PROGNOSIS IN CHILDREN WITH OTITIS MEDIA WITH EFFUSION. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

The public health significance of this study is to provide researchers and clinicians interested in the study and treatment of Otitis Media with effusion (OME) with a better understanding of the associations between covariates and antibiotic treatment with the resolution of OME, which in turn will inform the decision-to-treat process. In a secondary analysis of the data from a series of three efficacy trials, we focus on the roles of laterality (unilateral vs. bilateral disease) and sidedness (right vs. left ear) as prognostic factors. The D&A trial compared the efficacy of decongestant and antihistamine (D/A) to placebo, the ABI trial was similar but compared amoxicillin (with and without to D/A) to placebo, and the ABII trial compared the efficacy of 2 promising antibiotics to amoxicillin. Each trial assessed subjects for OME at baseline, 2 weeks, and 4 weeks.The prevalence of OME at each time point was described by laterality and sidedness. McNemar's test showed no evidence that left and right ears differ with respect to prevalence rates at 2 or 4 weeks (OR = 1.106 and OR = 0.858, respectively). Transition matrices of changes in OME status from 0 to 2 weeks and 2 to 4 weeks described the dependence of prior effusion status on a subject's current OME status. Multinomial regression was used to assess baseline covariates associated with prevalence and transitions of effusion status at each time point. We identified statistically significant prognostic factors of OME, including duration of effusion. Our analyses showed no differences in either prevalence of OME or in transitions of effusion status attributable to sidedness. A Chi Square Goodness-of-Fit test at each timepoint rejected the hypothesis of independence, p < 0.001. An ear-level GEE analysis demonstrated that effusion status of a contralateral ear was a significant predictor of effusion in the other ear (OR = 1.44, p < 0.001). There was no significant effect of sidedness (p = 0.86) and bilateral disease does not resolve at the rate predicted by unilateral resolution. This reanalysis using correlated data methods augments the initial findings by further examining sidedness and documenting transitions over time.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Titmus, Joshuajet9@pitt.edu; josh_titmus@hotmail.comJET9
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairStone, Roslyn Aroslyn@pitt.eduROSLYN
Committee MemberMandel, Ellen Mmandele@pitt.ed
Committee MemberRockette, Howard Eherbst@pitt.eduHERBST
Committee MemberWilson, John Wjww@pitt.eduJWW
Date: 30 January 2008
Date Type: Completion
Defense Date: 19 December 2007
Approval Date: 30 January 2008
Submission Date: 7 December 2007
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Biostatistics
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: laterality; otitis media; prognosis factors; transition probability
Other ID: http://etd.library.pitt.edu/ETD/available/etd-12072007-112302/, etd-12072007-112302
Date Deposited: 10 Nov 2011 20:08
Last Modified: 15 Nov 2016 13:53
URI: http://d-scholarship.pitt.edu/id/eprint/10153

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