Increase in paediatric acute otitis media diagnosed by primary care in two Finnish municipalities--1994-5 versus 1978-9.
In recent decades, several epidemiological studies have been published on acute otitis media (AOM), indicating that the occurrence of AOM is increasing. However, the comparison between the surveys is complicated and biased by several factors, e.g. variable study demography and design and dissimilar diagnostic criteria. The present study was performed with an identical set-up in 1978-9 and 1994-5 to find out potential changes in the occurrence of AOM. All the attacks of AOM among children under 10 years diagnosed by a physician during the 12-month periods 1 June, 1978 to 31 May 1979 and 1 June 1994 to 31 May 1995 were registered retrospectively in two Finnish municipalities. The incidence rate (total number of AOM attacks per 100 child years) was 19 (95% CI 18-21) in 1978-9 and 32 (95% CI 30-34) in 1994-5. The increase in the occurrence of AOM was 68% (95% CI 53-79%, P < 0001). (+info)
Outer membrane protein profiles of paired nasopharyngeal and middle ear isolates of nontypable Haemophilus influenzae from Mexican children with acute otitis media.
We studied nontypable Haemophilus influenzae (NTHi) isolates from simultaneous cultures of nasopharyngeal exudates (NEs) and middle ear fluids (MEFs) obtained by tympanocentesis from 57 children with acute otitis media (AOM). Preparations of outer membrane proteins (OMPs) from 14 pairs of NTHi strains recovered from NEs and MEFs from 10 children with unilateral AOM and four with bilateral AOM were subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis. The NTHi subtypes were determined by comparing the OMP profiles of the isolated strains with those of eight reference NTHi subtypes. Of the 14 pairs, 10 (71%) were identical, and one (8%) was different; three strains isolated from NEs (21%) did not correspond to any of the reference subtypes (nonsubtypable). Subtypes 4, 6, 5, 3, and 8 were isolated in the present study, thereby showing that their distribution is similar to that of subtypes isolated from children with AOM in the United States and suggesting that common otogenic strains are widely distributed in North America. (+info)
Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research.
BACKGROUND: Two recent reviews have assessed the effect of parental smoking on respiratory disease in children. METHODS: The results of the systematic quantitative review published as a series in Thorax are summarised and brought up to date by considering papers appearing on Embase or Medline up to June 1998. The findings are compared with those of the review published recently by the Californian Environmental Protection Agency (EPA). Areas requiring further research are identified. RESULTS: Overall there is a very consistent picture with odds ratios for respiratory illnesses and symptoms and middle ear disease of between 1.2 and 1.6 for either parent smoking, the odds usually being higher in pre-school than in school aged children. For sudden infant death syndrome the odds ratio for maternal smoking is about 2. Significant effects from paternal smoking suggest a role for postnatal exposure to environmental tobacco smoke. Recent publications do not lead us to alter the conclusions of our earlier reviews. While essentially narrative rather than systematic and quantitative, the findings of the Californian EPA review are broadly similar. In addition they have reviewed studies of the effects of environmental tobacco smoke on children with cystic fibrosis and conclude from the limited evidence that there is a strong case for a relationship between parental smoking and admissions to hospital. They also review data from adults of the effects of acute exposure to environmental tobacco smoke under laboratory conditions which suggest acute effects on spirometric parameters rather than on bronchial hyperresponsiveness. It seems likely that such effects are also present in children. CONCLUSIONS: Substantial benefits to children would arise if parents stopped smoking after birth, even if the mother smoked during pregnancy. Policies need to be developed which reduce smoking amongst parents and protect infants and young children from exposure to environmental tobacco smoke. The weight of evidence is such that new prevalence studies are no longer justified. What are needed are studies which allow comparison of the effects of critical periods of exposure to cigarette smoke, particularly in utero, early infancy, and later childhood. Where longitudinal studies are carried out they should be analysed to look at the way in which changes in exposure are related to changes in outcome. Better still would be studies demonstrating reversibility of adverse effects, especially in asthmatic subjects or children with cystic fibrosis. (+info)
Spontaneous CSF otorrhea caused by abnormal development of the facial nerve canal.
In two patients with surgically proved CSF fistula through the facial nerve canal, MR and CT examinations showed smooth enlargement of the geniculate fossa with CSF signal. In the clinical setting of CSF otorrhea or rhinorrhea, the presence of an enlarged labyrinthine facial nerve canal and enlarged geniculate fossa on CT scans and CSF intensity on MR images strongly suggests a CSF fistula through the facial nerve canal. (+info)
Intranasally inoculated Mycoplasma hyorhinis causes eustachitis in pigs.
Specific-pathogen-free pigs were experimentally inoculated with Mycoplasma hyorhinis, Pasteurella multocida, or both bacterial isolates to evaluate the role of these bacteria in the pathogenesis of otitis media. Six pigs were inoculated intranasally with 4.4 X 10(8) colony-forming units (CFU) of M. hyorhinis. Twenty-one days later, three of these six pigs were inoculated intranasally with 5.0 X 10(8) CFU of P. multocida. Three additional pigs were also inoculated intranasally at the time with P. multocida alone. Two pigs served as uninoculated controls. Seven days later, all pigs were euthanatized. Histologically, subacute inflammation was found in 10 auditory tubes of six pigs and two tympanic cavities of two pigs inoculated with M. hyorhinis. Immunohistochemically, M. hyorhinis antigens were detected on the luminal surface of eight of 10 inflamed auditory tubes, and ultrastructural examination confirmed mycoplasmal organisms in two pigs. M. hyorhinis was isolated from the inflamed tympanic cavities of two pigs. None of the pigs inoculated only with P. multocida had otitis, and P. multocida was not isolated from the tympanic cavity. These findings indicate that M. hyorhinis can cause eustachitis but rarely otitis media in specific-pathogen-free pigs. (+info)
Pneumococcal conjugate vaccine primes for polysaccharide-inducible IgG2 antibody response in children with recurrent otitis media acuta.
Children with frequent recurrent episodes of otitis media may have a deficient IgG2 antibody response to polysaccharide antigens. Five otitis-prone children were vaccinated with heptavalent pneumococcal conjugate vaccine. While all had an IgG1 antibody response to all pneumococcal serotypes included in the conjugate vaccine, the IgG2 response, especially to serotypes 6B, 9V, 19F, and 23F, was poor. However, vaccination with a 23-valent polysaccharide vaccine 6 months after conjugate vaccination induced an 11.5- to 163-fold increase in IgG2 anti-polysaccharide antibody titers. Thus, an IgG2 polysaccharide antibody deficiency can be overcome by priming with a pneumococcal conjugate vaccine followed by a booster with a polyvalent polysaccharide vaccine. (+info)
Antibiotic treatment of acute otitis media in children under two years of age: evidence based?
BACKGROUND: Appropriate use of antibiotics is one of the major issues in medicine today. In most countries, acute otitis media in children is treated with antibiotics; however, the efficacy of antibiotic use in every acute otitis media is a controversial issue. It may be worthwhile looking for special risk groups that benefit more from antibiotic treatment for acute otitis media. Children under two years of age with acute otitis media are at risk of poor outcome. AIM: To assess whether the current high prescription rates of antibiotics for acute otitis media in children under two years of age (being a risk group for poor outcome) are based on an established increased efficacy. METHOD: Systematic literature review and a quantitative analysis with an assessment of the methodological quality of published trials, comparing antibiotic treatment with non-antibiotic treatment in acute otitis media in children aged under two years. RESULTS: Six trials were included. Trials from before 1981 had a poor methodological quality. Four were suitable for the quantitative analysis. Only two of them were truly placebo-controlled. Of these two, one included only recurrent acute otitis media and the other included only non-severe episodes. With these restricted data, no statistically significant difference was found between antibiotic-treated children and controls under two years of age with acute otitis media, judged on the basis of clinical improvement within seven days (common odds ratio = 1.31; 95% CI = 0.83-2.08). CONCLUSION: The current high prescription rates of antibiotics among children under two years of age with acute otitis media are not sufficiently supported by evidence from published trials. New randomized placebo-controlled trials using reliable methodology are needed in this young age group. (+info)
Larch arabinogalactan: clinical relevance of a novel immune-enhancing polysaccharide.
Larch arabinogalactan is composed of greater than 98-percent arabinogalactan, a highly branched polysaccharide consisting of a galactan backbone with side-chains of galactose and arabinose sugars. Larch arabinogalactan is an excellent source of dietary fiber, and has been approved as such by the FDA. It has been shown to increase the production of short-chain fatty acids, principally butyrate and propionate, and has been shown to decrease the generation and absorption of ammonia. Evidence also indicates human consumption of larch arabinogalactan has a significant effect on enhancing beneficial gut microflora, specifically increasing anaerobes such as Bifidobacteria and Lactobacillus. Larch arabinogalactan has several interesting properties which appear to make it an ideal adjunctive supplement to consider in cancer protocols. Experimental studies have indicated larch arabinogalactan can stimulate natural killer (NK) cell cytotoxicity, enhance other functional aspects of the immune system, and inhibit the metastasis of tumor cells to the liver. The immune-enhancing properties also suggest an array of clinical uses, both in preventive medicine, due to its ability to build a more responsive immune system, and in clinical medicine, as a therapeutic agent in conditions associated with lowered immune function, decreased NK activity, or chronic viral infection. (+info)