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Otitis media
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Otitis media
Synonyms
Otitis media with effusion: serous otitis media, secretory otitis media
A bulging tympanic membrane which is typical in a case of acute otitis media
Specialty
Otorhinolaryngology
Symptoms
Ear pain, fever, hearing loss[1][2]
Types
Acute otitis media, otitis media with effusion, chronic suppurative otitis media[3][4]
Causes
Viral, bacterial[4]
Risk factors
Smoke exposure, daycare[4]
Prevention
Vaccination, breastfeeding[1]
Medication
Paracetamol (acetaminophen), ibuprofen, benzocaine ear drops[1]
Frequency
471 million (2015)[5]
Deaths
3,200 (2015)[6]
Otitis media is a group of inflammatory diseases of the middle ear.[2] The two main types are acute otitis media (AOM) and otitis media with effusion (OME).[3] AOM is an infection of rapid onset that usually presents with ear pain.[1] In young children this may result in pulling at the ear, increased crying, and poor sleep.[1] Decreased eating and a fever may also be present.[1] OME is typically not associated with symptoms.[1] Occasionally a feeling of fullness is described.[4] It is defined as the presence of non-infectious fluid in the middle ear for more than three months.[4] Chronic suppurative otitis media (CSOM) is middle ear inflammation of greater than two weeks that results in episodes of discharge from the ear.[4] It may be a complication of acute otitis media.[4] Pain is rarely present.[4] All three may be associated with hearing loss.[2][3] The hearing loss in OME, due to its chronic nature, may affect a child's ability to learn.[4]
The cause of AOM is related to childhood anatomy and immune function.[4] Either bacteria or viruses may be involved.[4] Risk factors include exposure to smoke, use of pacifiers, and attending daycare.[4] It occurs more commonly among Indigenous peoples and those who have Down syndrome.[4][7] OME frequently occurs following AOM and may be related to viral upper respiratory infections, irritants such as smoke, or allergies.[3][4] Looking at the eardrum is important for making the correct diagnosis.[8] Signs of AOM include bulging or a lack of movement of the tympanic membrane from a puff of air.[1][9] New discharge not related to otitis externa also indicates the diagnosis.[1]
A number of measures decrease the risk of otitis media including pneumococcal and influenza vaccination, breastfeeding, and avoiding tobacco smoke.[1] The use of pain medications for AOM is important.[1] This may include paracetamol (acetaminophen), ibuprofen, benzocaine ear drops, or opioids.[1] In AOM, antibiotics may speed recovery but may result in side effects.[10] Antibiotics are often recommended in those with severe disease or under two years old.[9] In those with less severe disease they may only be recommended in those who do not improve after two or three days.[9] The initial antibiotic of choice is typically amoxicillin.[1] In those with frequent infections tympanostomy tubes may decrease recurrence.[1] In children with otitis media with effusion antibiotics may increase resolution of symptoms, but may cause diarrhoea, vomiting and skin rash.[11]
Worldwide AOM affects about 11% of people a year (about 325 to 710 million cases).[12][13] Half the cases involve children less than five years of age and it is more common among males.[4][12] Of those affected about 4.8% or 31 million develop chronic suppurative otitis media.[12] Before the age of ten OME affects about 80% of children at some point.[4] Otitis media resulted in 3,200 deaths in 2015 – down from 4,900 deaths in 1990.[6][14]
Contents
1 Signs and symptoms
2 Causes
3 Diagnosis
3.1 Acute otitis media
3.2 Otitis media with effusion
3.3 Chronic suppurative otitis media
3.4 Adhesive otitis media
4 Prevention
5 Management
5.1 Antibiotics
5.2 Tympanostomy tube
5.3 Otitis media with effusion
5.4 Alternative medicine
6 Outcomes
6.1 Membrane rupture
6.2 Hearing loss
7 Epidemiology
8 Etymology
9 References
10 External links
Signs and symptoms[edit]
Otitis media.
An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there are often accompanying symptoms like a cough and nasal discharge.[15]
Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).
Causes[edit]
The common cause of all forms of otitis media is dysfunction of the Eustachian tube.[16] This is usually due to inflammation of the mucous membranes in the nasopharynx, which can be caused by a viral URTI, strep throat, or possibly by allergies.[17] Because of the dysfunction of the Eustachian tube, the gas volume in the middle ear is trapped and parts of it are slowly absorbed by the surrounding tissues, leading to negative pressure in the middle ear. Eventually, the negative middle-ear pressure can reach a point where fluid from the surrounding tissues is sucked into the middle ear's cavity (tympanic cavity), causing a middle-ear effusion. This is seen as a progression from a Type A tympanogram to a Type C to a Type B tympanogram.
By reflux or aspiration of unwanted secretions from the nasopharynx into the normally sterile middle-ear space, the fluid may then become infected — usually with bacteria. The virus that caused the initial URI (upper respiratory infection) can itself be identified as the pathogen causing the infection.[17]
Diagnosis[edit]
Perforation of the right tympanic membrane resulting from a previous severe acute otitis media
As its typical symptoms overlap with other conditions, such as acute external otitis, clinical history alone is not sufficient to predict whether acute otitis media is present; it has to be complemented by visualization of the tympanic membrane.[18][19] Examiners use a pneumatic otoscope with a rubber bulb attached to assess the mobility of the tympanic membrane.
In more severe cases, such as those with associated hearing loss or high fever, audiometry, tympanogram, temporal bone CT and MRI can be used to assess for associated complications, such as mastoid effusion, subperiosteal abscess formation, bony destruction, venous thrombosis or meningitis.[20]
Acute otitis media in children with moderate to severe bulging of the tympanic membrane or new onset of otorrhea (drainage) is not due to external otitis. Also, the diagnosis may be made in children who have mild bulging of the ear drum and recent onset of ear pain (less than 48 hours) or intense erythema (redness) of the ear drum.
To confirm the diagnosis, middle-ear effusion and inflammation of the eardrum have to be identified; signs of these are fullness, bulging, cloudiness and redness of the eardrum.[15] It is important to attempt to differentiate between acute otitis media and otitis media with effusion (OME), as antibiotics are not recommended for OME.[15] It has been suggested that bulging of the tympanic membrane is the best sign to differentiate AOM from OME, with a bulging of the membrane suggesting AOM rather than OME.[21]
Viral otitis may result in blisters on the external side of the tympanic membrane, which is called bullous myringitis (myringa being Latin for "eardrum").[22]
However, sometimes even examination of the eardrum may not be able to confirm the diagnosis, especially if the canal is small. If wax in the ear canal obscures a clear view of the eardrum it should be removed using a blunt cerumen curette or a wire loop. Also, an upset young child's crying can cause the eardrum to look inflamed due to distension of the small blood vessels on it, mimicking the redness associated with otitis media.
Acute otitis media[edit]
The most common bacteria isolated from the middle ear in AOM are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,[15] and Staphylococcus aureus.[23]
Otitis media with effusion[edit]
Otitis media with effusion (OME), also known as serous otitis media (SOM) or secretory otitis media (SOM), and colloquially referred to as 'glue ear,'[24] is fluid accumulation that can occur in the middle ear and mastoid air cells due to negative pressure produced by dysfunction of the Eustachian tube. This can be associated with a viral URI or bacterial infection such as otitis media.[25] An effusion can cause conductive hearing loss if it interferes with the transmission of vibrations of middle ear bones to the vestibulocochlear nerve complex that are created by sound waves.[26]
Early-onset OME is associated with feeding of infants while lying down, early entry into group child care, parental smoking, lack, or too short a period of breastfeeding and greater amounts of time spent in group child care, particularly those with a large number of children. These risk factors increase the incidence and duration of OME during the first two years of life.[27]
Chronic suppurative otitis media[edit]
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity that is characterised by discharge from the middle ear through a perforated tympanic membrane for at least 6 weeks. CSOM occurs following an upper respiratory tract infection that has led to acute otitis media. This progresses to a prolonged inflammatory response causing mucosal (middle ear) oedema, ulceration and perforation. The middle ear attempts to resolve this ulceration by production of granulation tissue and polyp formation. This can lead to increased discharge and failure to arrest the inflammation, and to development of CSOM, which is also often associated with cholesteatoma. There may be enough pus that it drains to the outside of the ear (otorrhea), or the pus may be minimal enough to be seen only on examination with an otoscope or binocular microscope. Hearing impairment often accompanies this disease.
People are at increased risk of developing CSOM when they have poor eustachian tube function, a history of multiple episodes of acute otitis media, live in crowded conditions, and attend paediatric day care facilities. Those with craniofacial malformations such as cleft lip and palate, Down syndrome, and microcephaly are at higher risk.
Worldwide approximately 11% of the human population is affected by AOM every year, or 709 million cases.[12][28] About 4.4% of the population develop CSOM.[28]
According to the World Health Organization, CSOM is a primary cause of hearing loss in children.[29] Adults with recurrent episodes of CSOM have a higher risk of developing permanent conductive and sensorineural hearing loss.
In Britain, 0.9% of children and 0.5% of adults have CSOM, with no difference between the sexes.[29]
The incidence of CSOM across the world varies dramatically where high income countries have a relatively low prevalence while in low income countries the prevalence may be up to three times as great.[12]
Each year 21,000 people worldwide die due to complications of CSOM.[29]
Adhesive otitis media[edit]
Adhesive otitis media occurs when a thin retracted ear drum becomes sucked into the middle-ear space and stuck (i.e., adherent) to the ossicles and other bones of the middle ear.
Acute otitis media
Acute otitis media, myringitis bullosa
Myringitis bullosa in influenza
Chronic otitis media (otitis media chronica mesotympanalis)
Otitis media chronica mesotympanalis
Otitis media chronica mesotympanalis
Otitis media chronica mesotympanalis
Prevention[edit]
AOM is far less common in breastfed infants than in formula-fed infants,[30] and the greatest protection is associated with exclusive breastfeeding (no formula use) for the first six months of life.[1] A longer duration of breastfeeding is correlated with a longer protective effect.[30]
Pneumococcal conjugate vaccines (PCV) in early infancy decrease the risk of acute otitis media in healthy infants.[31] PCV is recommended for all children, and, if implemented broadly, PCV would have a significant public health benefit.[15] Influenza vaccine is recommended annually for all children.[15] PCV does not appear to decrease the risk of otitis media when given to high-risk infants or for older children who have previously experienced otitis media.[31]
Risk factors such as season, allergy predisposition and presence of older siblings are known to be determinants of recurrent otitis media and persistent middle-ear effusions (MEE).[32] History of recurrence, environmental exposure to tobacco smoke, use of daycare, and lack of breastfeeding have all been associated with increased risk of development, recurrence, and persistent MEE.[33][34] Pacifier use has been associated with more frequent episodes of AOM.[35]
Long-term antibiotics, while they decrease rates of infection during treatment, have an unknown effect on long-term outcomes such as hearing loss.[36] This method of prevention has been associated with emergence of antibiotic-resistant otitic bacteria. They are thus not recommended.[15]
There is moderate evidence that the sugar substitute xylitol may reduce infection rates in those who go to daycare.[37]
Evidence does not support zinc supplementation as an effort to reduce otitis rates except maybe in those with severe malnutrition such as marasmus.[38]
Management[edit]
Oral and topical pain killers are effective to treat the pain caused by otitis media. Oral agents include ibuprofen, paracetamol (acetaminophen), and opiates. Topical agents shown to be effective include antipyrine and benzocaine ear drops.[39] Decongestants and antihistamines, either nasal or oral, are not recommended due to the lack of benefit and concerns regarding side effects.[40] Half of cases of ear pain in children resolve without treatment in three days and 90% resolve in seven or eight days.[41] The use of steroids is not supported by the evidence for acute otitis media.[42]
Antibiotics[edit]
It is important to weigh the benefits and harms before using antibiotics for acute otitis media. As over 82% of acute episodes settle without treatment, about 20 children must be treated to prevent one case of ear pain, 33 children to prevent one perforation, and 11 children to prevent one opposite-side ear infection. For every 14 children treated with antibiotics, one child has an episode of either vomiting, diarrhea or a rash.[10] If pain is present, treatment to reduce it should be initiated.
Antibiotics should be prescribed for severe bilateral or unilateral disease in all infants and children with severe signs and symptoms, such as moderate to severe ear pain and high fever.
For bilateral acute otitis media in infants younger than 24 months of age, without severe signs and symptoms, antibiotics should be prescribed.[10]
When non-severe unilateral acute otitis media is diagnosed in young children either antibiotic therapy is given or observation with close follow-up based on joint decision making between parent(s)/caregiver in infants 6 to 23 months of age. If the child worsens or fails to improve in 2 to 3 days antibiotics should be administered.
Children 24 months or older with non-severe disease can have either antibiotics or observation.[10]
A 2015 Cochrane review concluded that watchful waiting is the preferred approach for children over six months with non severe acute otitis media.[43]
showSummary[43]
Outcome
Findings in words
Findings in numbers
Quality of evidence
Pain
Pain at 24 hours Antibiotics causes little or no reduction to the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high quality evidence. RR 0.89 (0.78 to 1.01) High
Pain at 2 to 3 days Antibiotics slightly reduces the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high quality evidence. RR 0.70 (0.57 to 0.86) High
Pain at 4 to 7 days Antibiotics slightly reduces the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high quality evidence. RR 0.76 (0.63 to 0.91) High
Pain at 10 to 12 days Antibiotics probably reduces the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on moderate quality evidence. RR 0.33 (0.17 to 0.66) Moderate
Abnormal tympanometry
2 to 4 weeks Antibiotics slightly reduces the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high quality evidence. RR 0.82 (0.74 to 0.90) High
3 months Antibiotics causes little or no reduction to the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high quality evidence. RR 0.97 (0.76 to 1.24) High
Vomiting
Diarrhoea or rash Antibiotics slightly increases the chance of experiencing the outcome when compared with placebo for acute otitis media in children. Data are based on high quality evidence. RR 1.38 (1.19 to 1.59) High
The first line antibiotic treatment, if warranted, is amoxicillin.[15] If there is resistance or use of amoxicillin in the last 30 days then amoxicillin-clavulanate or another penicillin derivative plus beta lactamase inhibitor is recommended.[15] Taking amoxicillin once a day may be as effective as twice[44] or three times a day. While less than 7 days of antibiotics have fewer side effects, more than seven days appear to be more effective.[45] If there is no improvement after 2–3 days of treatment a change in therapy may be considered.[15]
A treatment option for chronic suppurative otitis media with discharge is topical antibiotics. A Cochrane review found that topical quinolone antibiotics can improve discharge better than oral antibiotics.[46] Safety is not really clear.[46]
Tympanostomy tube[edit]
Tympanostomy tubes (also called "grommets") are recommended with three or more episodes of acute otitis media in 6 months or four or more in a year, with at least one episode or more attacks in the preceding 6 months.[15] There is tentative evidence of reduced recurrence rates in the 6 months after placement.[47][48] Evidence does not support an effect on long-term hearing or language development.[49][48] A common complication of having a tympanostomy tube is otorrhea, which is a discharge from the ear.[50]
Oral antibiotics should not be used to treat uncomplicated acute tympanostomy tube otorrhea.[50] Oral antibiotics are not a sufficient response to bacteria that cause this condition and have significant side effects including increased risk of opportunistic infection.[50] In contrast, topical antibiotic eardrops can treat this condition.[50]
Otitis media with effusion[edit]
The decision to treat is usually made after a combination of physical exam and laboratory diagnosis, with additional testing including audiometry, tympanogram, temporal bone CT and MRI.[51][52][53] Decongestants,[54] glucocorticoids,[55] and topical antibiotics are generally not effective as treatment for non-infectious, or serous, causes of mastoid effusion.[51] Moreover, it is recommended against using antihistamines and decongestants in children with OME.[56] In less severe cases or those without significant hearing impairment, the effusion can resolve spontaneously or with more conservative measures such as autoinflation.[57] In more severe cases, tympanostomy tubes can be inserted, possibly with adjuvant adenoidectomy[51] as it shows a significant benefit as far as the resolution of middle ear effusion in children with OME is concerned.[58]
Alternative medicine[edit]
Complementary and alternative medicine is not recommended for otitis media with effusion because there is no evidence of benefit.[25] Homeopathic treatments have not been proven to be effective for acute otitis media in a study with children.[59] An osteopathic manipulation technique called the Galbreath technique[60] was evaluated in one randomized controlled clinical trial; one reviewer concluded that it was promising, but a 2010 evidence report found the evidence inconclusive.[61]
Outcomes[edit]
Disability-adjusted life year for otitis media per 100,000 inhabitants in 2004.
no data
< 10
10-14
14-18
18-22
22-26
26-30
30-34
34-38
38-42
42-46
46-50
> 50
Deaths from otitis media per million persons in 2012
0-0
1-1
2-4
Complications of acute otitis media consists of perforation of the ear drum, infection of the mastoid space behind the ear (mastoiditis), and more rarely intracranial complications can occur, such as bacterial meningitis, brain abscess, or dural sinus thrombosis.[62] It is estimated that each year 21,000 people die due to complications of otitis media.[12]
Membrane rupture[edit]
In severe or untreated cases, the tympanic membrane may perforate, allowing the pus in the middle-ear space to drain into the ear canal. If there is enough, this drainage may be obvious. Even though the perforation of the tympanic membrane suggests a highly painful and traumatic process, it is almost always associated with a dramatic relief of pressure and pain. In a simple case of acute otitis media in an otherwise healthy person, the body's defenses are likely to resolve the infection and the ear drum nearly always heals. An option for severe acute otitis media in which analgesics are not controlling ear pain is to perform a tympanocentesis, i.e., needle aspiration through the tympanic membrane to relieve the ear pain and to identify the causative organism(s).
Hearing loss[edit]
Children with recurrent episodes of acute otitis media and those with otitis media with effusion or chronic suppurative otitis media have higher risks of developing conductive and sensorineural hearing loss. Globally approximately 141 million people have mild hearing loss due to otitis media (2.1% of the population).[63] This is more common in males (2.3%) than females (1.8%).[63]
This hearing loss is mainly due to fluid in the middle ear or rupture of the tympanic membrane. Prolonged duration of otitis media is associated with ossicular complications and, together with persistent tympanic membrane perforation, contributes to the severity of the disease and hearing loss. When a cholesteatoma or granulation tissue is present in the middle ear, the degree of hearing loss and ossicular destruction is even greater.[64]
Periods of conductive hearing loss from otitis media may have a detrimental effect on speech development in children.[65] Some studies have linked otitis media to learning problems, attention disorders, and problems with social adaptation.[66] Furthermore, it has been demonstrated that patients with otitis media have more depression/anxiety-related disorders compared to individuals with normal hearing.[67] Once the infections resolve and hearing thresholds return to normal, childhood otitis media may still cause minor and irreversible damage to the middle ear and cochlea.[68]
Epidemiology[edit]
Acute otitis media is very common in childhood. It is the most common condition for which medical care is provided in children under five years of age in the US.[17] Acute otitis media affects 11% of people each year (709 million cases) with half occurring in those below five years.[12] Chronic suppurative otitis media affects about 5% or 31 million of these cases with 22.6% of cases occurring annually under the age of five years.[12] Otitis media resulted in 2,400 deaths in 2013—down from 4,900 deaths in 1990.[14]
Etymology[edit]
The term otitis media is composed of otitis, Ancient Greek for "inflammation of the ear", and media, Latin for "middle".
References[edit]
^ Jump up to: a b c d e f g h i j k l m n o Lieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (March 2013). "The diagnosis and management of acute otitis media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
^ Jump up to: a b c Qureishi, A; Lee, Y; Belfield, K; Birchall, JP; Daniel, M (10 January 2014). "Update on otitis media - prevention and treatment". Infection and Drug Resistance. 7: 15–24. doi:10.2147/IDR.S39637. PMC 3894142. PMID 24453496.
^ Jump up to: a b c d "Ear Infections". cdc.gov. September 30, 2013. Archived from the original on 19 February 2015. Retrieved 14 February 2015.
^ Jump up to: a b c d e f g h i j k l m n o p Minovi, A; Dazert, S (2014). "Diseases of the middle ear in childhood". GMS current topics in otorhinolaryngology, head and neck surgery. 13: Doc11. doi:10.3205/cto000114. PMC 4273172. PMID 25587371.
Jump up ^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
^ Jump up to: a b GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
Jump up ^ "Ear disease in Aboriginal and Torres Strait Islander children" (PDF). AIHW. Archived (PDF) from the original on 17 February 2017. Retrieved 12 May 2017.
Jump up ^ Coker, TR; Chan, LS; Newberry, SJ; Limbos, MA; Suttorp, MJ; Shekelle, PG; Takata, GS (17 November 2010). "Diagnosis, microbial epidemiology, and antibiotic treatment of acute otitis media in children: a systematic review". JAMA. 304 (19): 2161–9. doi:10.1001/jama.2010.1651. PMID 21081729.
^ Jump up to: a b c "Otitis Media: Physician Information Sheet (Pediatrics)". cdc.gov. November 4, 2013. Archived from the original on 10 September 2015. Retrieved 14 February 2015.
^ Jump up to: a b c d Venekamp, RP; Sanders, SL; Glasziou, PP; Del Mar, CB; Rovers, MM (23 June 2015). "Antibiotics for acute otitis media in children". The Cochrane Database of Systematic Reviews. 6: CD000219. doi:10.1002/14651858.CD000219.pub4. PMID 26099233.
Jump up ^ Venekamp, RP; Burton, MJ; van Dongen, TM; van der Heijden, GJ; van Zon, A; Schilder, AG (12 June 2016). "Antibiotics for otitis media with effusion in children". The Cochrane Database of Systematic Reviews (6): CD009163. doi:10.1002/14651858.CD009163.pub3. PMID 27290722.
^ Jump up to: a b c d e f g h Monasta, L; Ronfani, L; Marchetti, F; Montico, M; Vecchi Brumatti, L; Bavcar, A; Grasso, D; Barbiero, C; Tamburlini, G (2012). "Burden of disease caused by otitis media: systematic review and global estimates". PLOS ONE. 7 (4): e36226. doi:10.1371/journal.pone.0036226. PMC 3340347. PMID 22558393.
Jump up ^ Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/s0140-6736(15)60692-4. PMC 4561509. PMID 26063472.
^ Jump up to: a b GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC 4340604. PMID 25530442.
^ Jump up to: a b c d e f g h i j k Lieberthal, AS; Carroll, AE; Chonmaitree, T; Ganiats, TG; Hoberman, A; Jackson, MA; Joffe, MD; Miller, DT; Rosenfeld, RM; Sevilla, XD; Schwartz, RH; Thomas, PA; Tunkel, DE (Feb 25, 2013). "The Diagnosis and Management of Acute Otitis Media". Pediatrics. 131 (3): e964–99. doi:10.1542/peds.2012-3488. PMID 23439909.
Jump up ^ Bluestone, CD (2005). Eustachian tube: structure, function, role in otitis media. Hamilton, London: BC Decker. pp. 1–219. ISBN 9781550090666.
^ Jump up to: a b c John D Donaldson. "Acute Otitis Media". Medscape. Archived from the original on 28 March 2013. Retrieved 17 March 2013.
Jump up ^ Laine MK, Tähtinen PA, Ruuskanen O, Huovinen P, Ruohola A (May 2010). "Symptoms or symptom-based scores cannot predict acute otitis media at otitis-prone age". Pediatrics. 125 (5): e1154–61. doi:10.1542/peds.2009-2689. PMID 20368317.
Jump up ^ Shaikh, Nader (2010). "Videos in clinical medicine. Diagnosing otitis media--otoscopy and cerumen removal". NEJM. 362 (20): e62. doi:10.1056/NEJMvcm0904397. PMID 20484393. Archived from the original on 2015-02-11. Retrieved Feb 11, 2015.
Jump up ^ Patel, MM; Eisenberg, L; Witsell, D; Schulz, KA (October 2008). "Assessment of acute otitis externa and otitis media with effusion performance measures in otolaryngology practices". Otolaryngology–Head and Neck Surgery. 139 (4): 490–494. doi:10.1016/j.otohns.2008.07.030. PMID 18922333.
Jump up ^ Shaikh, N; et al. (March 28, 2012). "Development of an algorithm for the diagnosis of otitis media". Academic Pediatrics. 12 (3): 214–218. doi:10.1016/j.acap.2012.01.007. PMID 22459064.
Jump up ^ Roberts DB (April 1980). "The etiology of bullous myringitis and the role of mycoplasmas in ear disease: a review". Pediatrics. 65 (4): 761–6. PMID 7367083.
Jump up ^ Benninger, Michael S. (2008-03-01). "Acute bacterial rhinosinusitis and otitis media: changes in pathogenicity following widespread use of pneumococcal conjugate vaccine". Otolaryngology–Head and Neck Surgery. 138 (3): 274–278. doi:10.1016/j.otohns.2007.11.011. ISSN 0194-5998. PMID 18312870.
Jump up ^ "Glue Ear". NHS Choices. Department of Health. Archived from the original on 13 November 2012. Retrieved 3 November 2012.
^ Jump up to: a b Rosenfeld RM, Culpepper L, Yawn B, Mahoney MC (June 2004). "Otitis media with effusion clinical practice guideline". Am Fam Physician. 69 (12): 2776, 2778–9. PMID 15222643.
Jump up ^ "Otitis media with effusion: MedlinePlus Medical Encyclopedia". U.S. National Library of Medicine. Archived from the original on 17 February 2017. Retrieved 17 February 2017.
Jump up ^ Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM (1993). "Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life". J. Pediatr. 123 (5): 702–11. doi:10.1016/S0022-3476(05)80843-1. PMID 8229477.
^ Jump up to: a b Global Burden of Disease Study 2013, Collaborators (22 August 2015). "Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 386 (9995): 743–800. doi:10.1016/S0140-6736(15)60692-4. PMC 4561509. PMID 26063472.
^ Jump up to: a b c Acuin, Jose; WHO Dept. of Child and Adolescent Health and Development; WHO Programme for the Prevention of Blindness and Deafness. Chronic suppurative otitis media : burden of illness and management options. Geneve: World Health Organization. ISBN 92-4-159158-7. Archived from the original on 2017-02-28.
^ Jump up to: a b Lawrence, Ruth (2016). Breastfeeding : a guide for the medical profession, 8th edition. Philadelphia, PA: Elsevier. pp. 216–217. ISBN 978-0-323-35776-0.
^ Jump up to: a b Fortanier, Alexandre C.; Venekamp, Roderick P.; Boonacker, Chantal W. B.; Hak, Eelko; Schilder, Anne G. M.; Sanders, Elisabeth A. M.; Damoiseaux, Roger A. M. J. (2014-04-02). "Pneumococcal conjugate vaccines for preventing otitis media". The Cochrane Database of Systematic Reviews (4): CD001480. doi:10.1002/14651858.CD001480.pub4. ISSN 1469-493X. PMID 24696098.
Jump up ^ Rovers MM, Schilder AG, Zielhuis GA, Rosenfeld RM (2004). "Otitis media". Lancet. 363 (9407): 564–573. doi:10.1016/S0140-6736(04)15495-0. PMID 14962529.
Jump up ^ Pukander J, Luotonem J, Timonen M, Karma P (1985). "Risk factors affecting the occurrence of acute otitis media among 2-3 year old urban children". Acta Otolaryngol. 100 (3–4): 260–265. doi:10.3109/00016488509104788. PMID 4061076.
Jump up ^ Etzel RA (1987). "Smoke and ear effusions". Pediatrics. 79 (2): 309–311. PMID 3808812.
Jump up ^ Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG (August 2008). "Is pacifier use a risk factor for acute otitis media? A dynamic cohort study". Fam Pract. 25 (4): 233–6. doi:10.1093/fampra/cmn030. PMID 18562333.
Jump up ^ Leach AJ, Morris PS (2006). Leach AJ, ed. "Antibiotics for the prevention of acute and chronic suppurative otitis media in children". Cochrane Database Syst Rev (4): CD004401. doi:10.1002/14651858.CD004401.pub2. PMID 17054203.
Jump up ^ Azarpazhooh, A; Lawrence, HP; Shah, PS (3 August 2016). "Xylitol for preventing acute otitis media in children up to 12 years of age". The Cochrane database of systematic reviews (8): CD007095. doi:10.1002/14651858.CD007095.pub3. PMID 27486835.
Jump up ^ Gulani, A; Sachdev, HS (Jun 29, 2014). "Zinc supplements for preventing otitis media". The Cochrane Database of Systematic Reviews. 6: CD006639. doi:10.1002/14651858.CD006639.pub4. PMID 24974096.
Jump up ^ Sattout, A.; Jenner, R. (February 2008). "Best evidence topic reports. Bet 1. The role of topical analgesia in acute otitis media". Emerg Med J. 25 (2): 103–4. doi:10.1136/emj.2007.056648. PMID 18212148.
Jump up ^ Coleman C, Moore M (2008). Coleman C, ed. "Decongestants and antihistamines for acute otitis media in children". Cochrane Database Syst Rev (3): CD001727. doi:10.1002/14651858.CD001727.pub4. PMID 18646076.
Jump up ^ Thompson, M; Vodicka, TA; Blair, PS; Buckley, DI; Heneghan, C; Hay, AD; TARGET Programme, Team (Dec 11, 2013). "Duration of symptoms of respiratory tract infections in children: systematic review". BMJ (Clinical research ed.). 347: f7027. doi:10.1136/bmj.f7027. PMC 3898587. PMID 24335668.
Jump up ^ Principi, N; Bianchini, S; Baggi, E; Esposito, S (February 2013). "No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, community-acquired pneumonia and acute otitis media". European Journal of Clinical Microbiology & Infectious Diseases. 32 (2): 151–60. doi:10.1007/s10096-012-1747-y. PMID 22993127.
^ Jump up to: a b Venekamp, R; Sanders, S; Glasziou, P (2015). "Antibiotics for acute otitis media in children". Cochrane Database of Systematic Reviews. 6: CD000219.pub4. doi:10.1002/14651858.CD000219.pub4.
Jump up ^ Thanaviratananich, S; Laopaiboon, M; Vatanasapt, P (13 December 2013). "Once or twice daily versus three times daily amoxicillin with or without clavulanate for the treatment of acute otitis media". The Cochrane Database of Systematic Reviews. 12: CD004975. doi:10.1002/14651858.CD004975.pub3. PMID 24338106.
Jump up ^ Kozyrskyj, A; Klassen, TP; Moffatt, M; Harvey, K (8 September 2010). "Short-course antibiotics for acute otitis media". The Cochrane Database of Systematic Reviews (9): CD001095. doi:10.1002/14651858.CD001095.pub2. PMID 20824827.
^ Jump up to: a b Macfadyen, CA; Acuin, JM; Gamble, C (Jan 25, 2006). "Systemic antibiotics versus topical treatments for chronically discharging ears with underlying eardrum perforations". The Cochrane Database of Systematic Reviews (1): CD005608. doi:10.1002/14651858.CD005608. PMID 16437533.
Jump up ^ McDonald S, Langton Hewer CD, Nunez DA (2008). McDonald S, ed. "Grommets (ventilation tubes) for recurrent acute otitis media in children". Cochrane Database Syst Rev (4): CD004741. doi:10.1002/14651858.CD004741.pub2. PMID 18843668.
^ Jump up to: a b Steele, DW; Adam, GP; Di, M; Halladay, CH; Balk, EM; Trikalinos, TA (June 2017). "Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis". Pediatrics. 139 (6): e20170125. doi:10.1542/peds.2017-0125. PMID 28562283.
Jump up ^ Browning GG, Rovers MM, Williamson I, Lous J, Burton MJ (2010). Browning GG, ed. "Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children". Cochrane Database Syst Rev (10): CD001801. doi:10.1002/14651858.CD001801.pub3. PMID 20927726.
^ Jump up to: a b c d American Academy of Otolaryngology–Head and Neck Surgery, "Five Things Physicians and Patients Should Question" (PDF), Choosing Wisely: an initiative of the ABIM Foundation, American Academy of Otolaryngology–Head and Neck Surgery, archived (PDF) from the original on May 13, 2015, retrieved August 1, 2013 , which cites
Rosenfeld, R. M.; Schwartz, S. R.; Pynnonen, M. A.; Tunkel, D. E.; Hussey, H. M.; Fichera, J. S.; Grimes, A. M.; Hackell, J. M.; Harrison, M. F.; Haskell, H.; Haynes, D. S.; Kim, T. W.; Lafreniere, D. C.; LeBlanc, K.; Mackey, W. L.; Netterville, J. L.; Pipan, M. E.; Raol, N. P.; Schellhase, K. G. (2013). "Clinical Practice Guideline: Tympanostomy Tubes in Children". Otolaryngology–Head and Neck Surgery. 149 (1 Suppl): S1–S35. doi:10.1177/0194599813487302. ISSN 0194-5998. PMID 23818543.
^ Jump up to: a b c Rosenfeld, RM; Shin, JJ; Schwartz, SR; Coggins, R; Gagnon, L; Hackell, JM; Hoelting, D; Hunter, LL; Kummer, AW; Payne, SC; Poe, DS; Veling, M; Vila, PM; Walsh, SA; Corrigan, MD (February 2016). "Clinical Practice Guideline: Otitis Media with Effusion (Update)". Otolaryngology–Head and Neck Surgery. 154 (1 Suppl): S1–S41. doi:10.1177/0194599815623467. PMID 26832942.
Jump up ^ Wallace, IF; Berkman, ND; Lohr, KN; Harrison, MF; Kimple, AJ; Steiner, MJ (February 2014). "Surgical treatments for otitis media with effusion: a systematic review". Pediatrics. 133 (2): 296–311. doi:10.1542/peds.2013-3228. PMID 24394689.
Jump up ^ Rosenfeld, RM; Schwartz, SR; Pynnonen, MA; Tunkel, DE; Hussey, HM; Fichera, JS; Grimes, AM; Hackell, JM; Harrison, MF; Haskell, H; Haynes, DS; Kim, TW; Lafreniere, DC; LeBlanc, K; Mackey, WL; Netterville, JL; Pipan, ME; Raol, NP; Schellhase, KG (July 2013). "Clinical practice guideline: Tympanostomy tubes in children". Otolaryngology–Head and Neck Surgery. 149 (1 Suppl): S1–35. doi:10.1177/0194599813487302. PMID 23818543.
Jump up ^ Griffin, G; Flynn, CA (7 September 2011). "Antihistamines and/or decongestants for otitis media with effusion (OME) in children". The Cochrane Database of Systematic Reviews (9): CD003423. doi:10.1002/14651858.CD003423.pub3. PMID 21901683.
Jump up ^ Simpson, SA; Lewis, R; van der Voort, J; Butler, CC (11 May 2011). "Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children". The Cochrane Database of Systematic Reviews (5): CD001935. doi:10.1002/14651858.CD001935.pub3. PMID 21563132.
Jump up ^ Griffin, G; Flynn, CA (7 September 2011). "Antihistamines and/or decongestants for otitis media with effusion (OME) in children". The Cochrane Database of Systematic Reviews (9): CD003423. doi:10.1002/14651858.CD003423.pub3. PMID 21901683.
Jump up ^ Blanshard, JD; Maw, AR; Bawden, R (June 1993). "Conservative treatment of otitis media with effusion by autoinflation of the middle ear". Clinical otolaryngology and allied sciences. 18 (3): 188–92. PMID 8365006.
Jump up ^ van den Aardweg, MT; Schilder, AG; Herkert, E; Boonacker, CW; Rovers, MM (20 January 2010). "Adenoidectomy for otitis media in children". The Cochrane Database of Systematic Reviews (1): CD007810. doi:10.1002/14651858.CD007810.pub2. PMID 20091650.
Jump up ^ Jacobs, J; Springer, DA; Crothers, D (February 2001). "Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial". The Pediatric Infectious Disease Journal. 20 (2): 177–83. doi:10.1097/00006454-200102000-00012. PMID 11224838.
Jump up ^ Pratt-Harrington D (October 2000). "Galbreath technique: a manipulative treatment for otitis media revisited". J Am Osteopath Assoc. 100 (10): 635–9. PMID 11105452.
Jump up ^ Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010). "Effectiveness of manual therapies: the UK evidence report". Chiropr Osteopat. 18 (1): 3. doi:10.1186/1746-1340-18-3. PMC 2841070. PMID 20184717. Archived from the original on 2016-02-24.
Jump up ^ Jung, TT; Alper, CM; Hellstorm, SO; Hunter, LL; Casselbrant, ML; Groth, A; Kemaloglu, YK; Kim, SG; Lim, D; Nittrourer, S; Park, KH; Sabo, D; Sprately, J (April 2013). "Panel 8: Complications and sequelae". Otolaryngol Head Neck Surg. 148 (4 Suppl): E122–43. doi:10.1177/0194599812467425. PMID 23536529.
^ Jump up to: a b Vos, T; Flaxman, A. D.; Naghavi, M; Lozano, R; Michaud, C; Ezzati, M; Shibuya, K; Salomon, J. A.; Abdalla, S; Aboyans, V; Abraham, J; Ackerman, I; Aggarwal, R; Ahn, S. Y.; Ali, M. K.; Alvarado, M; Anderson, H. R.; Anderson, L. M.; Andrews, K. G.; Atkinson, C; Baddour, L. M.; Bahalim, A. N.; Barker-Collo, S; Barrero, L. H.; Bartels, D. H.; Basáñez, M. G.; Baxter, A; Bell, M. L.; Benjamin, E. J.; et al. (Dec 15, 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
Jump up ^ Da Costa SS; Rosito, Letícia Petersen Schmidt; Dornelles, Cristina (February 2009). "Sensorineural hearing loss in patients with chronic otitis media". Eur Arch Otorhinolaryngol. 266 (2): 221–4. doi:10.1007/s00405-008-0739-0. PMID 18629531.
Jump up ^ Roberts K (June 1997). "A preliminary account of the effect of otitis media on 15-month-olds' categorization and some implications for early language learning". J Speech Lang Hear Res. 40 (3): 508–18. doi:10.1044/jslhr.4003.508. PMID 9210110. Archived from the original on 2016-03-04.
Jump up ^ Bidadi S, Nejadkazem M, Naderpour M (November 2008). "The relationship between chronic otitis media-induced hearing loss and the acquisition of social skills". Otolaryngol Head Neck Surg. 139 (5): 665–70. doi:10.1016/j.otohns.2008.08.004. PMID 18984261.
Jump up ^ Gouma P, Mallis A, Daniilidis V, Gouveris H, Armenakis N, Naxakis S (January 2011). "Behavioral trends in young children with conductive hearing loss: a case-control study". Eur Arch Otorhinolaryngol. 268 (1): 63–6. doi:10.1007/s00405-010-1346-4. PMID 20665042.
Jump up ^ Yilmaz S, Karasalihoglu AR, Tas A, Yagiz R, Tas M (February 2006). "Otoacoustic emissions in young adults with a history of otitis media". J Laryngol Otol. 120 (2): 103–7. doi:10.1017/S0022215105004871. PMID 16359151.
External links[edit]
Classification
D
ICD-10: H65-H67
ICD-9-CM: 017.40, 055.2, 381.0, 381.1, 381.2, 381.3, 381.4, 382
MeSH: D010033
DiseasesDB: 29620
External resources
MedlinePlus: 000638
eMedicine: emerg/351
ent/426 complications, ent/209 with effusion, ent/212 Medical treat., ent/211 Surgical treat. ped/1689
Wikimedia Commons has media related to Otitis media.
Neff MJ (June 2004). "AAP, AAFP, AAO-HNS release guideline on diagnosis and management of otitis media with effusion". Am Fam Physician. 69 (12): 2929–31. PMID 15222658.
Secretory otitis media (Ear disorder) at Encyclopædia Britannica
Otitis media (Pathology) at Encyclopædia Britannica
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District of Columbia Home Rule Act
From Wikipedia, the free encyclopedia
Jump to: navigation, search
District of Columbia Self-Government and Governmental Reorganization Act
Other short titles
District of Columbia Home Rule Act
Long title
To reorganize the governmental structure of the District of Columbia, to provide a charter for local government in the District of Columbia subject to acceptance by a majority of the registered qualified electors in the District of Columbia, to delegate certain legislative powers to the local government, to implement certain recommendations of the Commission on the Organization of the Government of the District of Columbia, and for other purposes.
Enacted by
the 93rd United States Congress
Citations
Public law
Pub.L. 93–198
Statutes at Large
87 Stat. 774
Legislative history
Introduced in the Senate as S.1435 by Sen. Thomas Eagleton (D-MO) on April 2, 1973
Signed into law by President Richard Nixon on December 24, 1973
The District of Columbia Home Rule Act is a United States federal law passed on December 24, 1973 which devolved certain congressional powers of the District of Columbia to local government, furthering District of Columbia home rule. In particular, it includes the District Charter (also called the Home Rule Charter), which provides for an elected mayor and the Council of the District of Columbia. The council is composed of a chairman elected at large and twelve members, four of whom are elected at large, and one from each of the District's eight wards. Council members are elected to four-year terms.
Under the "Home Rule" government, Congress reviews all legislation passed by the council before it can become law and retains authority over the District's budget. Also, the president appoints the District's judges, and the District still has no voting representation in Congress. Because of these and other limitations on local government, many citizens of the District continue to lobby for the greater autonomy, such as full statehood.
The Home Rule Act specifically prohibits the Council from enacting certain laws that, among other restrictions, would:[1]
lend public credit for private projects;
impose a tax on individuals who work in the District but live elsewhere;
make any changes to the Heights of Buildings Act of 1910;
pass any law changing the composition or jurisdiction of the local courts;
enact a local budget that is not balanced; and
gain any additional authority over the National Capital Planning Commission, Washington Aqueduct, or District of Columbia National Guard.
Laws blocked by Congress[edit]
The Home Rule Act gives Congress the authority to block any laws passed by the D.C. council. Since its enactment, Congress has exercised this power several times.[2]
In 1988, Congress voted to block D.C. from expending local funds to cover abortion services through Medicaid. This was repealed in 2009 but then reinstated in 2011.[2]
Passed by the D.C. Council in 1992, the Health Care Benefits Expansion Act, which allowed both gay and straight couples to register as domestic partners, allowing familial recognition for such things as hospital visits, and allows the partners of D.C. government employees to purchase private health insurance, was blocked by Congress. The act was finally allowed to go into effect in 2001.[3]
In 1996, the D.C. Council passed a clean needle exchange program law. However, in 1998, Congress voted to block the law.[4][3][5] In 2007, Congress voted to lift the ban, thus allowing the law to go into effect.[6]
In 1998, Congress voted to block Initiative 59 – Legalization of Marijuana for Medical Treatment Initiative of 1998 – via the Barr amendment. This also caused the result of the referendum to be withheld.[7] When this was challenged in court, it was determined that withholding the result of the referendum violated the First Amendment. In response to this, another amendment was passed in 2000 that simply overturned Initiative 59.[7] In 2009, Congress voted to overturn the ban on Initiative 59, allowing D.C.'s medical marijuana law to go into effect,[8][9] with the first medical marijuana sale occurring in 2013.[10]
In 2014, Congress voted to block Initiative 71 – Legalization of Possession of Minimal Amounts of Marijuana for Personal Use Act of 2014 – by blocking funds from being used to enact laws, rules or regulations for reducing or legalizing any Schedule I drug.[11] However, since this was passed after the results of Initiative 71 had already been announced, it did not prevent the legalization of marijuana, but had the effect of leaving marijuana legal, but without the authority to expend funds on enacting regulations or taxation.[12][13][14]
References[edit]
Jump up ^ "Title VI: Reservation of Congressional Authority". District of Columbia Home Rule Act. Retrieved 3 March 2012.
^ Jump up to: a b "Ending Congressional Interference". DCVote. 2015-07-31. Retrieved 2017-05-24.
^ Jump up to: a b "ACT UP DC: Congress blocks DC clean needle exchange, medical marijuana again". www.glaa.org. Retrieved 2017-05-24.
Jump up ^ Goldstein, Avram; Goldstein, Avram (1998-12-02). "CITY BLOCKS NEEDLE EXCHANGE EFFORT". The Washington Post. ISSN 0190-8286. Retrieved 2017-05-24.
Jump up ^ "Letter to the House on Needle Exchange in D.C. Appropriations Bill". American Civil Liberties Union. Retrieved 2017-05-24.
Jump up ^ Almendrala, Anna (2015-09-03). "Washington D.C. Is Proof That Needle Exchanges Save Lives". Huffington Post. Retrieved 2017-05-24.
^ Jump up to: a b "Democracy Held Hostage". American Civil Liberties Union. Retrieved 2017-05-24.
Jump up ^ "Congress Lifts Ban on Medical Marijuana for Nation's Capitol". Americans for Safe Access. Retrieved 2017-05-24.
Jump up ^ Project, Marijuana Policy (2010-07-27). "D.C. Medical Marijuana Law Clears Congressional Hurdle! - MPP Blog". MPP Blog. Retrieved 2017-05-24.
Jump up ^ Director, Erik Altieri, NORML Executive (2013-07-30). "First Medical Marijuana Sale Reported in Washington, DC". NORML Blog, Marijuana Law Reform. Retrieved 2017-05-24.
Jump up ^ "House Committee Votes to Block D.C. Marijuana Laws".
Jump up ^ "Frequently Asked Questions on Implementing D.C.’s Marijuana Legalization Initiative". Congresswoman Eleanor Holmes Norton. 2014-12-12. Retrieved 2017-05-24.
Jump up ^ "Marijuana Is About to Be Legal — and Virtually Unregulated — in Washington, DC | VICE News". VICE News. Retrieved 2017-05-24.
Jump up ^ "How D.C. pot legalization has become ‘the dealer-protection act of 2015’". Washington Post. Retrieved 2017-05-24.
External links[edit]
District of Columbia Home Rule Act, full text
[1], PDF of the bill from the Government Printing Office
Retrieved from "https://en.wikipedia.org/w/index.php?title=District_of_Columbia_Home_Rule_Act&oldid=797633183"
Categories:
Home rule and voting rights of the District of Columbia
1973 in law
1973 in Washington, D.C.
United States federal territory and statehood legislation
Legal history of the District of Columbia
District of Columbia law
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text:
How to Get Away with Murder (season 5)
From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
How to Get Away with Murder (season 5)
Promotional poster
Starring
Viola Davis
Billy Brown
Jack Falahee
Rome Flynn
Aja Naomi King
Matt McGorry
Conrad Ricamora
Karla Souza
Amirah Vann
Charlie Weber
Liza Weil
Timothy Hutton
Country of origin
United States
No. of episodes
5
Release
Original network
ABC
Original release
September 27, 2018 (2018-09-27) – present (present)
Season chronology
← Previous
Season 4
List of How to Get Away with Murder episodes
The fifth season of the American legal drama television series How to Get Away with Murder revolves around criminal defense attorney Annalise Keating after her class action was accepted, earning back her notoriety within the law field, as well as her personal life's setbacks. The season is produced by Shondaland and NoWalk Entertainment in association with ABC Studios, with Peter Nowalk serving as the showrunner. The season premiered on September 27, 2018.
Contents
1 Cast and characters
1.1 Main
1.2 Recurring
2 Episodes
3 Production
3.1 Development
3.2 Casting
3.3 Filming
4 Reception
4.1 Ratings
5 References
6 External links
Cast and characters[edit]
Main article: List of How to Get Away with Murder characters
Main[edit]
Viola Davis as Annalise Keating
Billy Brown as Nate Lahey
Jack Falahee as Connor Walsh
Rome Flynn as Gabriel Maddox[1]
Aja Naomi King as Michaela Pratt
Matt McGorry as Asher Millstone
Conrad Ricamora as Oliver Hampton
Karla Souza as Laurel Castillo
Amirah Vann as Tegan Price[2]
Charlie Weber as Frank Delfino
Liza Weil as Bonnie Winterbottom
Timothy Hutton as Emmett Crawford[3][4]
Recurring[edit]
John Hensley as Ronald Miller
Tamberla Perry as Theresa Hoff
Glynn Turman as Nate Lahey Sr.
Episodes[edit]
See also: List of How to Get Away with Murder episodes
No.
overall
No. in
season
Title
Directed by
Written by
Original air date
U.S. viewers
(millions)
61
1 "Your Funeral" Stephen Cragg Peter Nowalk September 27, 2018 (2018-09-27) 2.93[5]
As Connor Walsh, Michaela Pratt, Asher Millstone and Laurel Castillo start their third year at law school, Annalise Keating returns to teaching part-time for the Advanced Trial Skills class, selecting twenty four new students to help her retry old cases for her class action suit. Following her win at the Supreme Court, Annalise also starts working at Caplan & Gold after receiving multiple job offers, working asides Tegan and the new manager, Emmett Crawford. Meanwhile, Bonnie gets closer to A.D.A. Miller in an attempt to find out how much he knows about the group, as Nate investigates about Bonnie's child, whom she thought was dead but it's confirmed that he's alive. At the same time, new second year student Gabriel Maddox impresses Annalise and he's chosen one of the twenty four students to help her with the case load, while Asher gets left out. Oliver, Connor, Michaela and Laurel move in together into a new house, and Frank starts suspecting about Gabriel's own reasons for being on Middleton.
Flashforward: Three months later, Annalise is dancing on the floor of Connor and Oliver's Wedding, until she spots Frank across the room. She asks him why he looks like someone died, and his response results on her slapping him. Outside the wedding tent, an unknown bleeding person walks towards the wedding, and falls on the snow. Later, baby Christopher cries sitting on the snow close to them, and Bonnie walks in to suffocate this person with her bare hands.
62
2 "Whose Blood Is That?" Mike Smith Sarah L. Thompson October 4, 2018 (2018-10-04) 3.02[6]
Annalise takes on her first client from the class action suit, with Michaela working on the case too. Emmett starts to get a closer look to Annalise's class and students, finding out that Laurel Castillo is working on the clinic. Tegan is afraid that with Michaela and Laurel working there, everyone will find out she was the "Jane Doe" who exposed Jorge; so Laurel tells Emmett that her mother must have been the one who exposed Jorge since she has disappeared after he went to jail. Thankfully, Tegan gets Christopher into Caplan & Gold daycare. In the meantime, Asher lands a job on the D.A.'s office after stalking A.D.A. Miller and Bonnie herself. Frank continues to investigate Gabriel, and gets him to move into Rebecca's old apartment, where he has cameras installed; Nate goes to an agency and finds that a woman who looks similar to Bonnie stealing her baby.
Flashforward: Two and a half months later, Bonnie runs through the snow with Christopher to the bathroom, where she cleans his face. Michaela and Laurel enter the bathroom, asking her about Nate. After Laurel gets out of the bathroom with Christopher, Michaela asks her whose blood is on her leg.
63
3 "The Baby Was Never Dead" Valerie Weiss Erika Harrison October 11, 2018 (2018-10-11) 3.22[7]
Annalise and Emmett take on a wealthy client who is accused of killing his work partner, and the D.A. on charge of the case is Ronald Miller. During the case, Asher reveals to Miller that he and Bonnie used to date. In the meantime, the governor continues to threat Annalise's class action suit, by forcing everyone in Annalise's class into an ethics exam. Frank continues to investigate Gabriel, and finds a fake ID and a hard drive among his things; and Oliver finds out Frank's investigating Gabriel. Nate finds the nurse who worked on the shift when Bonnie's baby was stolen, and it seems like Bonnie is the one who took him. When he finally brings this to Annalise, she tells him that the woman on the picture is actually Bonnie's sister.
Flashforward: Two months later, Michaela asks Bonnie whose blood is on her leg, and Bonnie tells her that she cut herself shaving. Later, at the party, the DJ calls the grooms to center stage. Connor walks in with bruises on his face and asks if anyone has seen his husband. Michaela looks across the room at Bonnie.
64
4 "It's Her Kid" Cherie Nowlan Maisha Closson October 18, 2018 (2018-10-18) 2.74[8]
After Nate confronts Annalise about Bonnie's past, he asks her to tell Bonnie that her child may be alive. She hesitates to do so, while she tries to obtain permission to argue insanity in Nate Sr.'s case. Emmett tries to sign a new rich client with the help of Tegan, who tests Michaela's ambition by trying having her attempt to develop a blackmail ploy to force the client to sign. Connor discovers that Annalise did help him to get back into Middleton, and he later confronts her about it, causing her to make Gabriel, rather than Connor, second chair for Nate Sr.'s case. Oliver confronts Frank about hacking Gabriel, and both he and Laurel start investigating on their own. Eventually, Annalise tells Bonnie about the file that Denver had on her, and how Nate discovered her child may be alive.
Flashforward: One-and-a-half months later, Michaela unsuccessfully tries to reach Nate on his phone, which is in Bonnie's possession. She leaves a message telling him to call her back while Connor and Laurel start worrying about finding Oliver. Back at her apartment, a dazed Annalise collapses on the floor in anguish.
65
5 "It Was the Worst Day of My Life" Laura Innes Michael Russo October 25, 2018 (2018-10-25) 2.93[9]
Annalise asks her students what they think she did wrong on court on Nate Sr.'s trial that they couldn't win just yet. As the students start to analyze what they could've done wrong, we see the trial unfold as they change their strategies constantly. In the meantime, Bonnie reflects about her child, and she finally tells Miller a part of her dark past. At the end, Laurel confronts Frank about spying on Gabriel Maddox and who is he; Bonnie goes to her sister's house to get answers.
Flashforward: The night of the wedding, Connor looks for Oliver outside on the parking lot. There, as he starts to panic, he finds his mom and Asher together.
66
6 "We Can Find Him"[10] Jonathan Brown Tess Leibowitz November 1, 2018 (2018-11-01) TBD
67
7 "I Got Played"[11] Eric Laneuville Maya Goldsmith November 8, 2018 (2018-11-08) TBD
68
8 "I Want to Love You Until the Day I Die"[12] Stephen Cragg Joe Fazzio November 15, 2018 (2018-11-15) TBD
Production[edit]
Development[edit]
How to Get Away with Murder was renewed by ABC for a fifth season on May 11, 2018,[13] to premiere on September 27, 2018.[14] The season will most likely consist of fifteen episodes due to a deal made with Davis that the series would have only 15 or 16 episodes per season.[15][16] In July 2018, series creator and showrunner Peter Nowalk told Deadline Hollywood his plans for the fifth season, confirming that the wedding between Jack Falahee and Conrad Ricamora's characters would take place, as well as a flashback episode further exploring the marriage between Viola Davis and Tom Verica's characters Annalise and Sam Keating. Additionally, he stated that the season's flashforwards are expected to be "twisty, and more fun," and tonally different.[17]
Casting[edit]
In June 2018, Rome Flynn was promoted to the series' main cast after appearing in a guest capacity in the fourth-season finale.[1] In July 2018, Amirah Vann was promoted to the series' main cast after recurring in the fourth season.[2] Later that month, Timothy Hutton joined the main cast.[3][4]
Filming[edit]
The first table read took place on July 13, 2018.[18] Filming for the season started on July 19, 2018.[19]
Reception[edit]
Ratings[edit]
No.
Title
Air date
Rating/share
(18–49)
Viewers
(millions)
DVR
(18–49)
DVR viewers
(millions)
Total
(18–49)
Total viewers
(millions)
1 "Your Funeral" September 27, 2018 0.8/4 2.93[5] 1.0 2.58 1.8 5.51[20]
2 "Whose Blood Is That?" October 4, 2018 0.8/4 3.02[6] 0.8 2.30 1.6 5.32[21]
3 "The Baby Was Never Dead" October 11, 2018 0.8/4 3.28[7] 0.9 2.31 1.7 5.59[22]
4 "It's Her Kid" October 18, 2018 0.7/3 2.74[8] TBD TBD TBD TBD
5 "It Was the Worst Day of My Life" October 25, 2018 0.7/3 2.93[9] TBD TBD TBD TBD
References[edit]
^ Jump up to: a b Neelie, Andreeva (June 7, 2018). "'How To Get Away With Murder': Rome Flynn Upped To Series Regular For Season 5". Deadline Hollywood. Retrieved June 10, 2018.
^ Jump up to: a b Andreeva, Nellie (July 18, 2018). "'How To Get Away With Murder': Amirah Vann Upped To Series Regular For Season 5". Deadline Hollywood. Retrieved July 18, 2018.
^ Jump up to: a b Petski, Denise (July 30, 2018). "'How To Get Away With Murder': Timothy Hutton Joins As Series Regular In Season 5". Deadline Hollywood. Retrieved July 30, 2018.
^ Jump up to: a b Ausiello, Michael (August 29, 2018). "Ask Ausiello: Spoilers on Good Place, Empire, 9-1-1, Lucifer, The Flash, Supernatural, NCIS, TWD and More". TVLine. Retrieved August 29, 2018.
^ Jump up to: a b Welch, Alex (September 28, 2018). "'Grey's Anatomy,' 'Big Bang Theory,' and 'Thursday Night Football' adjust up: Thursday final ratings". TV by the Numbers. Retrieved September 28, 2018.
^ Jump up to: a b Welch, Alex (October 5, 2018). "'Thursday Night Football' adjusts up: Thursday final ratings". TV by the Numbers. Retrieved October 5, 2018.
^ Jump up to: a b Welch, Alex (October 12, 2018). "'Big Bang Theory' and 'Thursday Night Football' adjust up, 'I Feel Bad' adjusts down: Thursday final ratings". TV by the Numbers. Retrieved October 12, 2018.
^ Jump up to: a b Welch, Alex (October 19, 2018). "'Big Bang Theory,' 'Superstore,' and 'Thursday Night Football' adjust up: Thursday final ratings". TV by the Numbers. Retrieved October 19, 2018.
^ Jump up to: a b Welch, Alex (October 26, 2018). "'Big Bang Theory,' 'Supernatural,' and 'Thursday Night Football' adjust up, 'Will & Grace' adjusts down: Thursday final ratings". TV by the Numbers. Retrieved October 26, 2018.
Jump up ^ "(#506) "We Can Find Him"". The Futon Critic. Retrieved October 17, 2018.
Jump up ^ "(#507) "I Got Played"". The Futon Critic. Retrieved October 23, 2018.
Jump up ^ "(#508) "I Want to Love You Until the Day I Die"". The Futon Critic. Retrieved October 30, 2018.
Jump up ^ Iannucci, Rebecca (May 11, 2018). "How to Get Away With Murder Renewed for Season 5 at ABC". TV Line. Retrieved May 11, 2018.
Jump up ^ Swift, Andy (July 24, 2018). "ABC Fall Premiere Dates: XL Grey's , Nathan Fillion's Rookie , The Conners (Minus Roseanne) and More". TVLine. Retrieved July 24, 2018.
Jump up ^ "#Scandal will do a full 22-episode season, while #HowToGetAwayWithMurder will only do 15 or 16 episodes #TCA14". TV Guide. July 15, 2014. Archived from the original on August 17, 2014. Retrieved July 16, 2014.
Jump up ^ "'How To Get Away With Murder' & 'Black-Ish': Full-Season Orders At ABC - Deadline". Deadline. October 9, 2014. Archived from the original on October 24, 2014. Retrieved November 1, 2014.
Jump up ^ Blyth, Antonia (March 14, 2018). "'HTGAWM' Creator On Possible Season 5: "A New Mystery…Twisty & More Fun"". Deadline. Retrieved July 14, 2018.
Jump up ^ Ricamora, Conrad (July 13, 2018). "First table read of Season 5!! #htgawm #tgit". Instagram. Retrieved July 14, 2018.
Jump up ^ Nowalk, Peter [@petenowalk] (July 19, 2018). "First day of season 5. Feeling damn lucky to work with these folks #htgawm" (Tweet). Retrieved July 19, 2018 – via Twitter.
Jump up ^ Pucci, Douglas (October 11, 2018). "Live+7 Weekly Ratings: 'Manifest' is Most-Watched NBC Drama Series Premiere in 19 Years". Programming Insider. Retrieved October 20, 2018.
Jump up ^ Welch, Alex (October 18, 2018). "'A Million Little Things' and 'Manifest' score biggest viewer gains in broadcast Live +7 ratings for Oct. 1-7". TV by the Numbers. Retrieved October 20, 2018.
Jump up ^ Otterson, Joe (October 23, 2018). "Live+7 Ratings for Week of Oct. 8: 'Manifest' Doubles In Week 3". Variety. Retrieved October 26, 2018.
External links[edit]
Official website
How to Get Away with Murder on IMDb
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How to Get Away with Murder
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