Morphologic significance of bifid uvula

Bifid uvula is often regarded as a marker for submucous cleft palate although this relationship has not been fully confirmed. The reason for the tacitly assumed connection between these two anomalies has, in part, been perpetuated by the generally accepted definition of submucous cleft palate as the triad of bifid uvula, notching of the hard palate, and muscular diastasis of the soft palate. Recently, investigations have provided evidence of more subtle manifestations of submucous cleft palate by the use of nasopharyngoscopic examination of the palate and pharynx. It has been determined that submucous cleft palate can occur even when a peroral examination shows an intact uvula. This finding places the "marker" relationship in question. In order to determine the frequency of association between bifid uvula and submucous clefting, a total ascertainment of children with bifid uvula from a suburban pediatric practice was examined nasopharyngoscopically. It was determined that in all but two cases, children with bifid uvula had some or all of the landmarks of submucous cleft palate. Several of the children were found to have velopharyngeal insufficiency and mildly hypernasal speech. This finding prompts caution in the recommendation of adenoidectomy in the presence of bifid uvula.     

腭裂患儿手术年龄与分泌性中耳炎恢复的相关性分析

目的从腭裂患儿分泌性中耳炎恢复的角度探讨适宜手术年龄。方法对不同年龄段腭裂患儿于术前和术后半年进行鼓膜检查，声导抗测试，脑干听性诱发电位测试（ABR）。并对年龄构成相儿配的正常儿童进行同样测试。结果腭裂患儿分泌性中耳炎的指标与正常儿童比较有显著差异；各年龄段腭裂患儿分泌性中耳炎的指标比较，差异无统计学意义（P〉0．05）。患儿术前术后指标比较，差异有统计学意义（P〈0．05）。6～18个月组与18个月至3岁组、3～7岁组比较，差异有统计学意义（P〈0．05），而18个月至3岁组和3～7岁组比较，差异无统计学意义（P〉0．05）。结论腭裂手术对中耳功能的恢复、听力损失的改善起着积极的作用，于术时年龄越小，分泌忡中耳炎的恢复越好，6～18个月是较为适宜的手术年龄。     

Day-care and otitis media in young children: a critical overview

To review the evidence concerning the association between (different forms of) day-care and otitis media in children aged 0-4 years, we performed a meta-analysis of studies identified by a systematic search with Medline from 1966 to July 1997 and by the reference lists. Seventeen articles were classified as useful because these articles studied children of 0-4 years of age and because odds ratios as well as confidence intervals were presented or could be calculated. All these studies found a association between attending a day-care centre and otitis media. The association between otitis media and family care was less clear. Differences in study design, age of the subjects, and controlled variables did not explain the association. Conclusion Day-care is a risk factor for developing otitis media: the number of children seems to be important for this effect, probably due to increased exposure to otitis media pathogens.     

Acute otitis media and respiratory virus infections

We studied the association of acute otitis media with different respiratory virus infections in a pediatric department on the basis of epidemics between 1980 and 1985. Altogether 4524 cases of acute otitis media were diagnosed. The diagnosis was confirmed by tympanocentesis in 3332 ears. Respiratory virus infection was diagnosed during the same period in 989 patients by detecting viral antigen in nasopharyngeal mucus. There was a significant correlation between acute otitis media and respiratory virus epidemics, especially respiratory syncytial virus epidemics. There was no significant correlation between outbreaks of other respiratory viruses and acute otitis media. Acute otitis media was diagnosed in 57% of respiratory syncytial virus, 35% of influenza A virus, 33% of parainfluenza type 3 virus, 30% of adenovirus, 28% of parainfluenza type 1 virus, 18% of influenza B virus and 10% of parainfluenza type 2 virus infections. These observations show a clear association of respiratory virus infections with acute otitis media. In this study on hospitalized children Haemophilus influenzae strains were the most common bacteriologic pathogens in middle ear fluid, occurring in 19% of cases. Streptococcus pneumoniae was present in 16% and Branhamella catarrhalis in 7% of cases. There was no association between specific viruses and bacteria observed in this study.     

Otitis media in early childhood and cognitive, academic, and classroom performance of the school-aged child

The relationship between the occurrence of otitis media during the first 3 years of life and cognitive, academic, and classroom performance during the third year of elementary school was evaluated in 44 socioeconomically disadvantaged children. The children attended a research day-care program where their otitis media experience and psychoeducational development were documented prospectively from birth. No significant relationship was found between otitis media in early childhood and performance on tests of verbal intelligence or academic achievement in the third year of school. The number of days of otitis media before 3 years of age was significantly correlated with teachers' ratings of children's attentional behavior in the classroom, however. Children with more early otitis media tended to be rated as less task oriented and less able to work independently than children with less otitis media. This was an exploratory study of a small number of children. Further study of the potential association is needed.     

Management of chronic glue ear

‘Glue ear’ may be described as the presence within the middle ear cleft of an effusion which may be serous, seromucinous or mucoid but it is not frankly purulent. It is not usually associated with obvious signs or symptoms of infection, thuogh bacteria may be cultured from the effusion in one third to one half of cases. It is known by a variety of synonyms including catarrhal, exudative, serous, secretory and non suppurative otitis media or otitis media with effusion. The later term allows sub-division according to the type of effusion and also its duration.     

Bacterial etiology of acute myringitis in children less than two years of age.

BACKGROUND: Acute myringitis is an inflammation of the tympanic membrane that occurs alone or in association with external otitis or otitis media. The two clinical entities, based on physical examination, are bullous myringitis and hemorrhagic myringitis. OBJECTIVES: To investigate the association of concomitant middle ear disease with acute myringitis and to analyze the bacteriologic findings of the middle ear fluid in children with acute myringitis. METHODS: A prospective longitudinal cohort study of 2028 children age 7 to 24 months at primary care level in the Finnish Otitis Media Vaccine Trial. Matched case-control design for analysis of bacterial pathogen distribution. RESULTS: There were 82 children in whom 92 ears were diagnosed with acute bullous myringitis and 37 children in whom 40 ears were diagnosed with hemorrhagic myringitis during the follow-up. Middle ear disease was associated with bullous myringitis in 97% of ears and with hemorrhagic myringitis in 82% of ears. Bacterial pathogen distribution was similar to that of acute otitis media, although a higher proportion of Streptococcus pneumoniae was detected in both bullous and hemorrhagic acute myringitis. CONCLUSIONS: Middle ear fluid was present in vast majority of ears with acute myringitis in young children. The same etiologic bacteria were found in acute myringitis as in acute otitis media, but S. pneumoniae was the major pathogen. Acute bullous myringitis should be treated as acute otitis media in children <2 years of age.     

Facial paralysis secondary to acute otitis media

We describe a case of facial paralysis in a 19-month-old male recently diagnosed with acute otitis media. Results of his physical examination was remarkable for left-sided peripheral facial nerve palsy with an associated middle ear infection. Physicians should understand the etiology, pathophysiology, treatment options, and prognosis of facial palsy in association with otitis media.     

Recurrent otitis: what is the place of complementary examinations]

Recurrent otitis media is defined by the occurrence of three episodes of acute otitis media in a year. Several risk factors are now well recognized, particularly the occurrence before six months of age of a first episode of otitis media, day care centers, and upper respiratory tract infections (rhinopharyngitis). In most cases biological or radiological investigations are of little interest. They are only indicated in case of persistent recurrent episodes, despite eviction of all risk factors and adenoidectomy, and mainly in case of association with bronchopulmonary pathology.     

Paroxysmal non-epileptic events resembling seizures in children with otitis media

Children may frequently present with recurrent spells, which are often thought to be seizures. However, there are several benign non-epileptic conditions that mimic seizures. A group of 8 children is described who were diagnosed with otitis media and presented with recurrent, stereotypic spells suggestive of seizures. A paroxysmal phenomenon, in association with otitis media, resembling seizures, has not been previously described. These paroxysmal phenomena resembling seizures may be related to acute otitis media and should be included in the differential diagnosis of paroxysmal non-epileptic events in infants and young children.     

Bacteremia in 28 ambulatory children: relationship to pneumonitis and meningitis

Bacteremia with known pathogens was documented in 28 acutely ill, febrile outpatients during a 29-month period. All of the children were previously healthy and were initially managed as outpatients. Eight patients presented with no identifiable focus of infection. Twenty patients had either otitis media or pneumonitis. An association between otitis media and bacteremia with H. influenzae type b was noted in 5 patients. Bacterial meningitis occurred subsequently in 7 patients (25%); 1 death occurred in this group. The blood culture, as an outpatient procedure, was helpful in establishing a bacterial etiology in selected children with either high fever (with or without otitis media), febrile seizures, or pneumonia. In addition, the positive blood culture was a vital aid in identifying the young child at risk for meningitis.     

Operative Therapie der Schallleitungsschwerhörigkeit

The cause of a conductive hearing loss can be a defect of the eardrum (chronic otitis mediia, cholesteatoma, trauma), but also a fixation or discontinuity of the ossicular chain (chronic inflammation, trauma, malformation) or a deficiency in the aeration of the middle ear cleft (serous otitis media, adhesions). All these problems are of mechanical origin and can be treated by surgical procedures (reconstruction of the eardrum and the ossicles, aeration of the ear), which in most cases are successful. In the following the surgical steps are explained. The prognosis and the surgical procedure of greater malformations of the ear must be discussed individually in every case.     

Incidence of acute otitis media associated with group A and B respiratory syncytial virus infections

The comparative association of respiratory syncytial virus group A and B infections with acute otitis media was determined by analysing the hospital records of children with community–acquired respiratory syncytial virus infection during three successive outbreaks from 1987 to 1992. Of 326 episodes analysed, 192 (59%) were caused by group A and 134 (41%) by group B infections. Acute otitis media was diagnosed in 101 (75%) children with group B infection, compared with 119 (62%) with group A infection (p = 0.01). Group A infections were more often associated with wheezing (71% versus 59% in group B; p = 0.02) and oxygen therapy in inpatients (48% versus 31%, respectively; p = 0.008). The higher incidence of acute otitis media associated with group B infections was observed both after adjustment for potential confounding variables and during each outbreak.     

Adenoidectomy during early life and the risk of asthma

The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.     

The Psychological, Educational and Auditory Sequelae of Early, Persistent Secretory Otitis Media

Previous studies have suggested an association between chronic middle ear disorders due to secretory otitis media and adverse effects on auditory, educational and psychological development in children. Experimental design of such studies has often been poor. In this study, attempts were made to control extraneous variables more rigorously, using matched pairs. A group of children (n = 10) without current hearing problems but with a history of recurrent early secretory otitis media, aged 7-11 yrs, were compared on auditory, educational and psychological measures with a matched group of children with no history of otitis media. The results indicated weak but distinct differences between the two groups on the educational and psychological measures in favour of the control group. The implications for medical and educational services are outlined.     

Prediction of acute otitis media with symptoms and signs

We carried out a prospective study to analyse if it would be possible to predict the coexistence of acute otitis media on the basis of symptoms and signs of infection. Of the 658 patients admitted to hospital during the period concerned, 197 (29.9%) had otitis media. For each child with otitis, the next patient of the same age was chosen as a control. The risk of having otitis media was increased among patients with cough, rhinitis and earache. All three variables together correctly classified 67% of those not having otitis media and 63% of those with acute otitis, compared with the 50% which would theoretically be achieved by chance alone. Prediction was worst (55%) among patients younger than 2 years of age not having otitis media and best among older patients who had otitis media, i.e. 78%. Prediction on these grounds would have caused significant over-treatment, and one-third of the otitis cases among the youngest group would have been missed. Thus it is important to always examine the ears of a child with an infection in order to reliably exclude the possibility of acute otitis media.     

Erythromycin prophylaxis for recurrent otitis media

Patients with recurrent otitis media without persistent middle ear effusion were studied for antibiotic prophylaxis efficacy. In the first phase, erythromycin ethylsuccinate was used as prophylaxis for otitis media in 45 patients in a dose of 10 mg/kg twice daily. Acute otitis media occurred in eight of 45 (18%) while receiving erythromycin, and in 22 of 41 (54%) following prophylaxis termination. The attack rate (episodes of otitis media per 2-month period) was 0.86 before prophylaxis, 0.20 during prophylaxis, and 0.79 following prophylaxis. In a second phase of the study, erythromycin was compared with sulfisoxazole for otitis media prophylaxis in a group of 42 children. Sulfisoxazole (500 mg per dose) was administered twice daily. Acute otitis media occurred in five of 28 (18%) children while receiving erythromycin and in nine of 21 (43%) children while receiving no prophylaxis. The attack rate (episodes of otitis media per 2-month period) was 0.81 before erythromycin prophylaxis, 0.18 while receiving erythromycin, and 0.50 after erythromycin prophylaxis. Acute otitis media occurred in eight of 14 (51%) children while receiving sulfisoxazole, and in two of five (40%) children while receiving no prophylaxis. The attack rate (episodes of otitis media per 2-month period) was 0.78 before sulfisoxazole, 0.72 while receiving sulfisoxazole, and 0.56 after sulfisoxazole prophylaxis. Erythromycin antimicrobial prophylaxis for children with recurrent otitis media was superior to no prophylaxis and to sulfisoxazole prophylaxis in this study of patients with recurrent otitis media without persistent middle ear effusion.     

An association between recurrent otitis media in infancy and later hyperactivity

An association between the frequency of otitis media in early childhood and later hyperactivity is reported in this study. The subjects were 67 children referred to a child development clinic for evaluation of school failure. Ranging from 6 to 13 years old, all the children demonstrated specific school learning problems, and 27 were also considered hyperactive by two or more raters. Sixteen of the hyperactive children were treated with central nervous system stimulant medication. In retrospect, there was positive correlation between an increasing number of otitis media infections in early childhood and the presence and severity of hyperactive behavior. Ninety-four percent of children medicated for hyperactivity had three or more otitis infections, and 69 percent had greater than 10 infections. In comparison, 50 percent of non-hyperactive school-failure patients had three or more infections and 20 percent had greater than 10 infections. Twenty-two of 28 children (79%) known to have more than 10 infections experienced recurrent otitis before 1 year of age.     

Course and outcome of otitis media in early infancy: a prospective study

We determined the course of otitis media in a prospective, longitudinal study of infants who were enrolled at birth and followed to age 1 year. Bilateral chronic otitis media with effusion developed in eight of 24 (33%) with onset of otitis media before age 2 months, compared to two of 30 (7%) with later onset (P = 0.012). Infants with bilateral chronic otitis media with effusion could be identified early: eight of 15 (53%) infants with bilateral middle ear effusion at age 2 months subsequently had bilateral chronic otitis media with effusion, compared to two of 55 (4%) infants without bilateral effusions at age 2 months (P = 0.000007). The onset of otitis media was symptomatic in 29 of 54 (54%), and asymptomatic in 25 of 54 (46%). If regular well-child examinations with otoscopy had not been performed in asymptomatic infants, bilateral chronic otitis media with effusion would not have been detected in six of 10 infants. Infants with otitis media in early infancy may be asymptomatic and are at high risk for chronic otitis media with effusion.     

Sulphamethoxazole prophylaxis in the otitis-prone child.

A bedtime dose of sulphamethoxazole was effective in preventing ear infections in otitis-prone young children. Thirty-three such children were studied by means of a random, double-blind, placebo-controlled, cross-over protocol. Nine (27%) of 33 children treated with sulphamethoxazole experienced 10 episodes of acute suppurative otitis media or otitis media with effusion while 19 (58%) of 33 children given a placebo experienced 27 episodes of acute otitis media or otitis media with effusion. No new episode of otitis media was observed in 11 children in whom serial urine samples uniformly had a positive response to Micrococcus lutea bioinhibition test, the method we chose to monitor compliance. Otitis media with effusion (secretory otitis media) was detected less often in the children who were given sulphamethoxazole; this fact suggests that prophylaxis with sulphamethoxazole may prevent persistent middle ear effusion in otitis-prone young children.