Experience of respiratory and allergic illness in children attending childcare

OBJECTIVES: To describe previous illness for children attending two types of formal childcare (130 family daycare homes and 11 child daycare centres). DESIGN: A questionnaire was completed by the parents of 846 children, which provided information about previous illness and associated factors. The questionnaire was conducted in Perth, Western Australia. RESULTS: Of all children, 39% had experienced otitis media, 11% glue ear and 26% allergies; 18% had been diagnosed with asthma; 10% had been admitted to hospital with respiratory illness, and 9% had experienced more than six respiratory conditions in the previous year. Attending centre daycare compared with family daycare was more likely to be associated with some of the previous illness outcomes (more than six respiratory illnesses in the past year, asthma, otitis media and glue ear) but, for all children, the major predisposing factors associated with these illnesses were a family history of atopy or bronchitis. CONCLUSIONS: Children with a history of respiratory illness or otitis media are more likely to be attending centre than family daycare, but family history of respiratory illness is an important risk factor for all children in childcare.     

Middle ear effusion in children and the indoor environment: an epidemiological study

A prospective study of 337 children was carried out during a 3-month period. The purpose of the study was to evaluate the importance of indoor environmental factors in homes and day-care institutions for the incidence of middle ear effusion (MEE). The indoor environmental factors measured in institutions were carbon dioxide, temperature, and relative humidity. Conditions in the homes were assessed by a questionnaire. Middle ear effusion was measured by tympanometry. No relationship was found between indoor environmental factors and MEE, with the exception of parental smoking at home, which increased the frequency of MEE in children.     

Long-term prognosis of acute otitis media in infancy: determinants of recurrent acute otitis media and persistent middle ear effusion

OBJECTIVES: Children under 2 years of age with acute otitis media are known to have a relatively poor prognosis. The objective of this study was to assess whether known determinants for recurrent acute otitis media and persistent middle ear effusion after an episode of acute otitis media during childhood also apply to children under 2 years. METHODS: Study design: prospective study of 210 children under 2, with identification of potential prognostic determinants. Univariate and multivariate logistic regression analyses were applied to evaluate which parameters independently contributed to the prediction of both outcome measures (recurrent acute otitis media and persistent middle ear effusion). A prognostic function was developed, and the area under the receiving operating characteristic (ROC) was used to estimate the predictive ability of the prognostic models. Population: children under 2 years of age with an episode of acute otitis media in family practice. Outcomes measured: recurrent acute otitis media and persistent middle ear effusion. RESULTS: For the outcome recurrent acute otitis media data from 210 children were used and winter season, male sex, passive smoking and persistent symptoms for more than 10 days at presentation were independent prognostic determinants. For the outcome persistent middle ear effusion data from 190 children were used and winter season, bilateral disease at entry, a sibling history of recurrent acute otitis media, and a previous episode of acute otitis media independently predicted the outcome. No sufficiently discriminatory prognostic model could be constructed for either outcome measure. CONCLUSION: Prediction of recurrent acute otitis media or persistent middle ear effusion in individual young children remains poor.     

Otitis media in young children: A case for early intervention

Although recurrent otitis media, or middle ear disease, is common in young children, the importance of early intervention for otitis media prone youngsters is often overlooked. Recent research contributions from both medicine and education indicate that the fluctuating hearing loss often accompanying recurrent otitis media may have significant adverse effects on the young child's speech and language development and may be related to later learning disorders identified during the school years. The gravity of such findings strongly supports the need for all professionals working with young children to be aware of the important role they have in the screening process and in providing appropriate intervention strategies for these children. Implications addressed include the following: (a) involving an interdisciplinary team at all phases of intervention, (b) identifying comprehensive screening procedures, and (c) developing an appropriate intervention program. Comprehensive early intervention for young children with recurrent otitis media is considered to be of critical significance in the prevention of later language and/or learning disabilities.     

Parents' response to recurrent middle ear infection in their children

Recurrent ear infection in children during pre-school years is an important public health problem. Common advice given to parents is to minimize exposure of susceptible children to crowding and air pollution. This study aimed at investigating what changes parents undertake to improve the health of an otitis-prone child. Parents of children with greater than or equal to 5 events before age thirty months (index children; n = 198) and a matched control group (n = 396) were asked to fill in a questionnaire. Results show that 22.3% of index-families and 9.5% (p less than 0.001) of control families had changed one or more of the following conditions: working hours, child day-care, housing and smoking habits. In summary, index families and control families were remarkably similar given the striking difference in otitis media, a finding that rises concern.     

An overview of acute otitis media in Australian Aboriginal children living in remote communities

Australian Aboriginal children experience early, persistent and severe middle ear infections. We conducted a review of the medical literature that addressed acute otitis media (AOM) in Australian Aboriginal children. Comparisons were made with the recent guidelines on the diagnosis and management of AOM prepared by the American Academies of Pediatrics and Family Physicians (AAP & AAFP 2004). Otitis media in Aboriginal children living in remote communities begins in the first 3 months of life following early bacterial colonisation. Young children with persistent signs of suppurative disease (bulging of the tympanic membrane or middle ear discharge) are probably most at risk of developing chronic suppurative otitis media.     

Factors associated with tympanostomy tube insertion among preschool-aged children in the United States

OBJECTIVES: Recurrent and persistent otitis media is often treated by tympanostomy tube insertion to ventilate the middle ear and restore hearing. This study examined the factors that predict which children are most likely to receive tympanostomy tubes through 3 years of age. METHODS: Multiple logistic regression was conducted on data from a nationally representative sample of children (N = 8285). RESULTS: By 3 years of age, 6.8% of US children had tubes inserted. Logistic regression indicated that after control for number of ear infections, children without any gaps in health insurance, who attended a day-care center, who were White, whose birth-weight was less than 1500 g, and who lived in the Midwest or South were significantly more likely to have tympanostomy tubes. CONCLUSIONS: These data suggest that differences exist as to who receives tubes. Of particular concern are differences by race/ethnicity and continuity of health insurance coverage. With expansions in health care coverage to larger proportions of uninsured children, it will be important to monitor these programs to ensure that all children who may need tympanostomy tubes have access to them.     

Consensus in the therapy of acute otitis media]

Treatment strategies in acute otitis media show important differences. To find agreement on the different therapeutic options a Dutch Consensus Conference was organized. An attitude of watchful waiting is the approach of choice for all children older than one year. Although myringotomy was advised for pain relief for many years, analgesics are the preferred symptomatic treatment at this moment. Antibiotics are useful in very young children up to age of one year, recurrences of otitis media in young children and in children in whom the infection recurs an irregular course. Myringotomy is limited to cases in which antibiotics fail to improve the middle ear condition, determination of the causative agent is mandatory or to confirm the middle ear infection if this cannot be done by mirror examination. Since the clinical course of acute otitis media has become milder in the last three decades adjustment of the present consensus will be necessary in the near future.     

Middle ear effusion: rate and risk factors in Australian children attending day care

There have been no previous longitudinal studies of otitis media conducted in non-Aboriginal Australian children. This paper describes the rate and risk factors for middle ear effusion (MEE) in children attending day care in Darwin, Australia. A prospective cohort study of 252 children under 4 years was conducted in 9 day care centres over 12 fortnights between 24 March and 15 September 1997. Tympanometry was conducted fortnightly and multivariate analysis used to determine risk factors predicting MEE. The outcome of interest was the rate of type B tympanograms per child detected in either ear at fortnightly examinations. After adjusting for clustering by child, MEE was detected on average 4.4 times in 12 fortnights (37% of all examinations conducted). Risk factors associated with presence of effusion were younger age, a family history of ear infection, previous grommets (tympanostomy tubes), ethnicity and the day care centre attended. A history of wheeze appeared protective. These effects were modest (RR 0.57-1.70). Middle ear effusion is very common in children attending day care in Darwin. This has clinical importance, since MEE during early childhood may affect optimal hearing, learning and speech development. There is little scope for modification for many of the risk factors for MEE predicted by this model. Further study of the day care environment is warranted.     

The role of respiratory viruses in otitis media

Evidence derived from numerous studies ranging from animal experiments to extensive clinical trials supports a crucial role for respiratory viruses in acute otitis media. Viral infection of the upper respiratory tract initiates the whole cascade of events that ultimately leads to development of acute otitis media, and viruses contribute to the pathogenesis of this disease by several mechanisms. Recent data indicate that at least some types of viruses actively invade the middle ear and may also interfere with the outcome of otitis media. The availability of effective vaccines against the principal viruses predisposing to acute otitis media could be expected to result in a substantial reduction in the incidence of this disease.     

The 'health culture' of families as an influence on the use of surgery for glue ear: a case-control study

The influence of elements of a family's health culture (its health beliefs, attitudes and behaviour) on the decision for children to undergo surgery for glue ear was investigated by means of a case-control study. One hundred and forty-two children who had undergone such surgery were compared with the same number of children from their school class. Data derived from a structured questionnaire administered to the parents in their own homes revealed that the families were similar with regard to most biosocial factors. However, there were clear differences in the labelling of middle ear disease. Children in case families were more likely to be diagnosed as suffering from glue ear rather than recurrent acute otitis media, particularly if an older sibling of the same sex had previously been so diagnosed (for boys RR 6.68; for girls RR 4.55). This influence of the family's health culture was supported by the findings that parents tended to view their children as having presented more developmental problems; and to be more conscious themselves of health promoting activities. Further studies employing different methodologies are required to confirm these findings.     

Tympanometry for diagnosis and treatment of otitis media in general practice

OBJECTIVE: The aim of this study was to evaluate the role of tympanometry for diagnosis, treatment and follow-up of otitis media in general practice. METHODS: The results from otoscopy performed by 40 physicians in general practice in Vejle County, Denmark were combined with the clinical condition and this was recorded as the preliminary decision about diagnosis, treatment and follow-up. Subsequently, tympanometry was performed in 3176 children aged between 1 month and 16 years; a total of 6352 tympanometries. With this added knowledge, a final decision about diagnosis, treatment and follow-up was recorded. The practitioners were trained in performing tympanometry including the interpretation of the results. Simultaneously, they were involved in the establishment of guidelines for diagnosis, treatment and follow-up of otitis media in general practice. The main outcome measures were changes between preliminary and final decisions about diagnoses, treatments and follow-up regimens. RESULTS: Tympanometry was performed successfully in 87.7% of the children, and in 26.4% changes in diagnoses were found. However, tympanometry did not influence the distributions of the main outcome measures in the sample as a whole. Uncomplicated cases were checked in general practice and referrals to specialists were not increased. CONCLUSION: Tympanometry can be performed successfully in general practice after appropriate instruction. In 26.4% of children, the diagnoses were changed, which may result in more appropriate treatment and follow-up. Tympanometry is a clinically relevant supplement to the examination of a child in general practice.     

The family study of otitis media: Design and disease and risk factor profiles

Recurrent acute otitis media (RAOM) and chronic otitis media with effusion (COME) exhibit familial aggregation, but environmental risk factors (day care attendance, cigarette smoke exposure, and bottle feeding) are also important in their development. The Family Study of OM was designed to ascertain the RAOM/COME status of families whose children participated in Otitis Media Research Center studies between 1978 and 1984. Probands were treated with tympanostomy tubes, and had their RAOM/COME status ascertained as criteria for entry into these studies. For the Family Study of OM parents were interviewed about their otitis media and risk factor history; mothers were interviewed about their children's history, and pertinent medical records were obtained. Members of 173 families were examined with otomicroscopy and multifrequency tympanometry; 19% of parents and 32% of siblings were classified as affected, which is substantially higher than RAOM/COME rates from previous reports. Risk factor profiles differed significantly (P < .001) between parents and their children. Younger generation (adjusted odds ratio [OR] = 4.18, 95% confidence interval [Cl], 2.74, 6.36), day care attendance (OR = 1.96, 95% Cl, 1.32, 2.91) and male gender (OR = 1.42, 95% Cl, 1.03, 1.97) were significantly related to RAOM/COME using logistic regression. Analyses confirm (1) higher disease rates in families with an affected member compared to existing studies of the general population, (2) increased risk of RAOM/COME associated with known risk factors, and (3) increased risk for parents irrespective of risk factors. Additional analyses will explore competing models of disease susceptibility using genetic models and known risk factors. © 1996 Wiley-Liss, Inc.     

Preventing deafness in Africa's children

Researchers have conducted few population-based studies on the prevalence of deafness or hearing impairment in sub-Saharan Africa. The few studies that do exist focus on children attending schools for the deaf or special clinics, but they do not uncover the mild and moderate cases of hearing impairment, those who face the stigma of deafness or hearing loss, or those who cannot afford to go to special schools or clinics. A recent study of 2-10 year old children in all villages of 8 districts of Gambia reveals a 2.7/1000 prevalence of severe to profound hearing loss. All these children also have significant speech problems and require special education programs. Meningitis caused hearing impairment in 31% of cases. 33/1000 5-14 year old children in Swaziland suffer from mild hearing impairment and 10/1000 suffer from moderate to more severe hearing loss. Extrapolation of these figures results in 3.9 million children in Africa with mild hearing loss and 1.2 million with moderate to severe hearing loss. The most common cause of hearing impairment in Swaziland and in Botswana is otitis media, particularly chronic otitis media. Indeed, chronic suppurative otitis media (CSOM) follows foreign bodies and impacted wax as the 2nd most prevalent cause of hearing impairment in Africa. Despite the significance of CSOM, parents, school teachers, schools and primary health care programs neglect it. Researchers in Kenya are currently comparing different ways (ear swabbing, antibiotics, or topical steroids) to prevent CSOM. The results of this study should reveal a key means for primary prevention of hearing loss in Africa. Other primary prevention means include immunization against meningitis, measles, and rubella; improved prenatal care; improved awareness of danger of ototoxic drugs; better nutrition; and control of noise levels. Secondary prevention basically involves hearing aids, but often there are not enough trained audiologists to identify hearing loss, and hearing aids cost too much.     

儿童中耳炎隐蔽性的临床研究

【目的】探讨儿童中耳炎隐蔽发病的特性，提高对儿童中耳炎隐蔽发病的诊治及预防水平。【方法】回顾分析无明显临床症状的儿童中耳炎患者30例（44耳）的临床资料。【结果】44耳全部表现为临床症状轻微或完全没有自觉症状，发病隐蔽，体征轻微，鼓膜完整，但全部都有鼓膜活动度减弱的征象。经过治疗，10耳（22．7％）痊愈，17耳（38．6％）显效，9耳（20．5％）有效，8耳（18．2％）无效，总有效率81．8％。【结论】儿童中耳炎隐蔽性发病是一种常见的临床现象，其发病的隐蔽性是相对的，只要早期发现早期治疗，治疗效果良好。     

What do the children really think about a day-care centre – the 5–7-year-old Finnish children speak out

A day-care centre is a place where a child spends most of his/her week nowadays. A day-care centre as an institution of early childhood education has often been studied from the early childhood educators’ point of view or within a wider societal context. The children’s voices have not been heard much. The purpose of this article is to describe, on the one hand, the experiences that the children have of the day-care centre as a place and, on the other hand, to bring out how the children talk about their experiences. Twenty-nine Finnish day-care children (aged five to seven) are the research subjects. This study uses the existential-phenomenological method to describe children’s experiences as they appear to the children themselves. The children’s opinions on a day-care centre are an essential means for developing the day-care centre.     

Physical and Behavioral Aspects of Middle Ear Disease in School Children

Middle ear disease is today's primary aural health problem in school-age children. Until recently, pediatric health researchers were aware only of the medical consequences that middle ear disease had on children. Except in a few cases of chronic otitis media, the effects of middle ear disease were considered transitory. However, current research on middle ear disease suggests permanent changes in hearing sensitivity, reduced development of the auditory neural network and developmental delays in speech, language and cognitive skills dependent on hearing. This article presents a review of recent studies on the physical and behavioral aspects of middle ear disease and its sequelae in school children.     

Influenza virus and rhinovirus-related otitis media: potential for antiviral intervention

Adults frequently develop eustachian tube dysfunction and middle ear pressure (MEP) abnormalities during natural and experimental influenza and human rhinovirus (HRV) infections. Oral rimantadine treatment did not reduce the otologic manifestations of experimental influenza in adults or natural influenza in children. However, intranasal zanamivir and oral oseltamivir significantly reduced MEP abnormalities during experimental influenza in adults, and oseltamivir treatment appears to reduce the likelihood of otitis media in children with acute influenza. Investigational anti-HRV agents, including intranasal tremacamra, intranasal AG7088, and oral pleconaril, warrant study in this regard. Depending on the virus, early antiviral therapy has the potential to impact the risk of otitis media following respiratory tract infections.     

The reevaluation visit for acute otitis media

Seventy children with acute otitis media diagnosed at a suburban, private primary care practice were examined after a ten-day course of antibiotic therapy and were then monitored closely for an additional 20 days. Parents were advised to seek prompt attention if symptoms of earache, fussiness, or fever recurred at any time during the 30-day study period. Of 14 symptomatic recurrences of acute otitis media, eight (57 percent) occurred within one week of discontinuing antibiotic therapy. Four (10 percent) of 41 children with persistent otitis media with effusion on days 10 to 14 developed symptomatic acute otitis media over the next 18 days, as did four (17 percent) of 23 children who had a normal middle ear examination on days 10 to 14. Early follow-up visits immediately following antibiotic therapy commonly detect persistent otitis media with effusion but appear to have limited value in detecting asymptomatic, posttreatment acute otitis media. the optimal timing of reevaluation visits for children with acute otitis media deserves further study.     

The burden of otitis media

Otitis media is the most frequent reason that children go to the doctor for illness. In developing countries, where children have limited access to medical care, suppurative complications of otitis media (OM) are frequent and permanent hearing loss results. In developed countries, the most common morbidity of OM is conductive hearing loss due to middle ear effusion. Infants with severe and recurrent OM and persistent middle ear effusion are at risk for problems in behavior and development of speech, language and cognitive abilities. Parent stress is frequent. The cost of otitis media is large (>$5 billion in the United States). Selection and spread of multi-drug resistant bacterial pathogens arising from extensive use of antimicrobial agents for OM is a problem for management of all diseases due to the pathogens. The incidence and severity of OM may diminish with introduction of new bacterial and viral vaccines.