The Bayesian approach to the evaluation of risk factors in acute and recurrent acute otitis media

A multivariant modelling method was used to analyse the risk, associated with 22 different factors, of contracting acute otitis media (AOM) in a prospective cohort of 1294 urban children followed up to the age of 17-32 (mean 25) months. By far the most important risk factor was the caring of the child at a day-care centre. The importance of this factor further increased with increasing recurrence of the attacks. Next in order came the existence of sibling(s) with AOM attacks during the follow-up. Prolongation of breastfeeding increased the protection against AOM during the first year of life. The frequency of AOM attacks was lowest around midsummer and highest in early winter.

Pneumococcal middle ear fluid antibodies after pneumococcal acute otitis media in infants

Forty-one infants, who during their first (initial) acute otitis media (AOM) had culturable S. pneumoniae (Pn) in 57 middle ear fluids (MEFs) which prolonged or recurred during the follow-up, were observed for 7-15 months for the presence of Pn, Pn-antigens (Pn-ags) and initial-type/group Pn-antibodies (Pn-abs) in these MEFs. Initially, Pn-abs were found in only 3 MEFs. During the follow-up a total of 20 ears (35%) were, at various time-intervals, positive for Pn-abs; they belonged to all three major Ig-classes, but were often slight in quantity. Most regularly, and often with distinct positivity, Pn-abs were found to type 3, 9N and 14. Secretory abs were detected in 5 ears. Within one month after initial AOM, Pn-abs appeared in 9 of the 41 ears with MEF (22%); six of them cleared soon after that. MEFs with Pn-abs usually did not show initial-type Pn/Pn-ag, but new Pn/Pn-ag could later be simultaneously present in recurrent MEF. So, pneumococcal AOM may cause a local and/or systemically mediated immune response in the middle ear in infants. The response may protect the ear from homologous, but still be present in apparently non-homologous otitis media.

The prevalence of handicapping hearing loss in a middle-aged population in Finland

Screening audiometry was performed during the years 1973-1978 in a total of 11,744 subjects aged 35-50 years. The incidence of those persons having a mean hearing threshold of 30 dB or more at 0.5-2 kHz or of 50 dB or more at 2 kHz varied from 0.3% to 2.7% in males of different age subgroups. The results for females were about two-thirds of those for males. Overall, 1.5% of the Finnish population aged 35-54 years were found to be candidates for hearing rehabilitation.

High frequency audiometry in facial paralysis

High frequency (10-21 kHz) hearing thresholds were measured in 54 patients with Bell's palsy. In 25 (46%) of the patients the high frequency hearing was worse in the affected side, and in 16 (30%) better. The differences in the mean threshold between the two ears varied from 17.1 to 3.8 dB, being statistically significant at half of the frequencies measured. The findings support the idea that facial palsy is one manifestation of a lesion which extends beyond the VIIth cranial nerve.

Incidence of acute otitis media up to the age of 1 1/2 years in urban infants

The object of this prospective cohort investigation of 1,642 infants was to study the incidence of acute otitis media (AOM) in urban children during the first 18 months of life. The monthly incidence of AOM was greatest at the age of 10 months, and the largest proportion of children with AOM was also found in this 10-month age group. Before the age of 18 months, 56.7% of the infants had had at least one episode of AOM, while 26.9% had had one or two episodes and 29.8% three or more. The corresponding figures before the age of 12 months were: 45.3%; 26.8%; 18.5%, and before the age of 9 months: 30.5%; 22.1%; 8.4%. The AOM incidence, particularly as regards recurrent AOM, was rather higher in boys than in girls.

C-reactive protein in acute otitis media

Serum C-reactive protein (CRP) levels were studied in 79 children with acute otitis media (AOM), aged from 4 months to 5 years. The CRP was less than 10 mg/l in 27 children, greater than or equal to 20 mg/l in 34, and greater than or equal to 40 mg/l in 17 children, 25 of the 41 attacks caused by S. pneumoniae or H. influenzae showed a CRP of greater than or equal to 20 mg/l and 15 CRP greater than or equal to 40 mg/l, in 38 cases without major otitis pathogens, the respective figures were 9 (p less than 0.01) and 2 (p less than 0.001). Although statistically significant correlations between otitis-related clinical parameters and CRP levels were rare, there was a tendency toward higher CRP values among those with a more severe clinical picture. All five attacks with CRP greater than or equal to 100 mg/l were bilateral, caused by major pathogens, and preceded by a respiratory infection. They also tended to have high fever and a large amount of fluid in myringotomy. However, even in these the general course of AOM and other morbidity was not different from the others.

Finnish approach to the treatment of acute otitis media. Report of the Finnish Consensus Conference

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.

Long-term safety and efficacy of budesonide nasal aerosol in perennial rhinitis. A 12-month multicentre study

A long-term safety study of intranasally administered budesonide, a topical glucocorticoid, has been performed. 104 patients with perennial rhinitis, allergic or non-allergic, participated in a multicentre study in seven ENT-clinics utilising an identical protocol. A budesonide dosage of 400 micrograms/day was used as starting dose, but the patients were at liberty to reduce the daily dose to 200 micrograms. The patients were observed at intervals up to 12 months. At the entry and follow-up visits the following parameters were recorded: rhinoscopic findings, nasal symptom scores, blood chemistry, hematology, urinalysis and determination of plasma cortisol levels before and after stimulation with ACTH (Synacthen). Nasal biopsies taken from 50 of the patients at the beginning and completion of the study were examined in a blinded way by an independent pathologist. The analysis revealed no histopathological changes of the nasal mucosa. At rhinoscopy no signs of atrophy or candida were reported. Lividity of the nasal mucosa was significantly reduced during the trial, which was also the case for nasal congestion and secretion. All nasal symptom parameters assessed by the patients were significantly reduced from baseline during the follow-up period. No clinically significant changes in the hematological and blood chemistry parameters were observed. Plasma cortisol analysis before and after challenge with ACTH revealed no influence on the hypothalamic pituitary adrenal axis. No tachyphylaxis was observed; on the contrary, there was a clear tendency for reduction of the daily dose of budesonide necessary to keep the patients symptom-free.(ABSTRACT TRUNCATED AT 250 WORDS)

New clinical finding in vestibular neuritis: high-frequency audiometry hearing loss in the affected ear

Twenty-one patients with established vestibular neuronitis were examined otoneurologically and audiologically. High-frequency audiometry up to 20,000 Hz was performed on all the patients. In 17 cases a high-frequency hearing loss was greater in the ear with vestibular neuritis. The mean hearing loss difference varied from 14 dB to 24 depending on the frequency. Our results reveal that in most cases of vestibular neuritis there are no isolated vestibular lesions, but most cases also involve an auditory end-organ lesion. This finding is in unison with the anatomic conditions of the cochlea and the vestibular end-organ.

Pneumococcal bacteriology after pneumococcal otitis media with special reference to pneumococcal antigens

Fifty-four ears with evidence of pneumococcus (Pn) in the first acute otitis media (AOM) in 38 infants and with prolongation or recurrence of the MEF during the follow-up were observed for 7-22 months for the presence of Pn by culture or of pneumococcal antigen (Pn-ag) by counterimmunoelectrophoresis or latex agglutination methods in their MEFs. During the first three 1-month observation periods, Pn and/or Pn-ags were detected in 24% to 9% of these ears, always of the initial type/group. Later on new Pn types/groups appeared also. In two of the 9 MEFs persisting for greater than or equal to 3 months, initial Pn-ag, with culturable Pn, was repeatedly found but not for longer than 5 months. Of the 12 ears resulting in secretory otitis media (SOM) only one showed initial Pn-ag (and Pn) in the MEF of SOM. Pneumococcal type/group pattern associated with prolongation or recurrence of infection did not differ from that of initial AOM. In another series of 151 SOM ears in 97 children, Pn-ags were detected in 7 MEFs. Four of them grew Pn, each of the corresponding group. Our studies suggest that the persistence of Pn-ags in the middle ear after AOM is limited and their occurrence in the MEFs of SOM is rare. Thus, the role of the persistence of Pn-ags in prolonged, recurrent or secretory otitis media seems questionable.

Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children

The factors affecting the occurrence and recurrence of acute otitis media (AOM) were studied among 471 2-3-year-old children in two cities in Finland. Of these children, 188 had experienced greater than or equal to 3 attacks of AOM, 76 had had 1-2 attacks and 207 no otitis attacks (= control group). The study showed that the risk of recurrent AOM was increased among those children attending day-care nurseries as well as among those who had several siblings. Proneness to rhinorrhea and exposure to passive smoking at home was associated with an increased risk of AOM, while prolonged breast-feeding (greater than 6 months) seemed to reduce it. No correlation was found between the risk of recurrent AOM and the place of residence or type of housing, the parental otitis history, or atopic diathesis of a child. Thus the study suggested that to protect a young child from AOM we should promote breast-feeding and home-care for babies as well as avoid smoking in the home.

Transdermal scopolamine for peripheral vertigo (a double-blind study)

Transdermal scopolamine medication has been evaluated in 30 cases of acute peripheral vertigo. The double blind study revealed favourable effects, e.g. in Menière's disease. The best compromise between effect and side-effects was one active medication patch. The side-effects were those described for scopolamine, such as blurred vision and dryness of the mouth. Transdermal scopolamine seems to offer an alternative form of medication in acute peripheral vertigo.

Prevention of otitis media in children by pneumococcal vaccination

A total of 3,340 infants, 95 per cent of them 7 to 9 months old, were randomly vaccinated in a double-blind fashion with either the 14-valent pneumococcal (Pn) polysaccharide vaccine or a saline placebo in three urban areas in Finland. The second dose of the vaccine was given 5 months later. Age and sex distribution, recruitment of infants, and their otitis-related treatment and follow-up were similar in the study areas. Side effects after vaccination were mild and fewer than among older children. Antibody responses to vaccine polysaccharides varied from type to type, but were generally poor, especially to types most prevalent in otitis media. After the first dose of vaccine, the occurrence of otitis visits among the Pn-vaccinated, as compared with controls, showed inter-area differences, but ranged from not more than a 30 per cent reduction at its best to an increase in some areas and in some clinical categories. The respective figures for children with acute otitis media were similar between the vaccination groups and the study areas. The effect of the vaccine on acute otitis media caused by specific Pn types/groups represented in the vaccine was variable but generally poor. Group 6 attacks especially seemed to behave problematically. The second dose of the vaccine did not give additional benefit serologically or clinically. The efficacy of currently available pneumococcal vaccine against otitis media seemed poor in infants.

Branhamella catarrhalis in acute otitis media

A total of 5217 middle ear fluid (MEF) samples obtained from 1203 children with otitis media, aged 3 months to 6 years, were studied for the presence of Branhamella catarrhalis (Br) between Oct. 1977 and Sept. 1981. Br grew in 10.2% of 3497 MEFs of acute otitis media (AOM), with almost the same frequency in the very first and subsequent attacks. During the first 4 years of life the percentage did not vary much; among older children it seemed to decrease. The overall prevalence of Br in AOM did not change during the study period. Br alone grew in 72.4% of acute MEFs with Br; with other bacteria the respective figure was 82.9% (p less than 0.001). Acute attacks with bilateral Br were found in 22.8% of attacks with Br. In 1720 non-acute MEFs obtained at postacute control visits, Br was isolated in only 7.0%. The proportion of beta-lactamase-producing strains among the 2419 otitis-Br strains tested in two laboratories of the two study regions showed an increase from 27.1% and 21.1% in 1980 to 57.6% and 38.6% in 1983, respectively (p less than 0.001).

Prevalence of handicapping hearing loss in an aging population

The mean hearing thresholds of 369 Finnish inhabitants, 65 years, and born in 3 consecutive years on two elected days each year, were studied in high standard measurement conditions. Eighty-nine of these subjects were reexamined 3 years later. They represented a typical partly industrialized white population with a high standard of living. With the criteria for hearing rehabilitation for presbycusis set at a mean hearing threshold of 30 dB or worse at 500 to 1,000 to 2,000 Hz, and/or 50-dB hearing loss at 2,000 Hz, the prevalence of rehabilitation need was 3.2%. Conductive hearing losses were found in 6% of the subjects.

Audiological and vestibular findings in 219 cases of meningitis

The audiological and electronystagmographic follow-up results of 219 children with different forms of meningitis are presented. The findings for hearing loss are roughly comparable with those of earlier reports. There have been no previous systematic studies on children with meningitis. Our electronystagmographic results show continuous nystagmus, evenly distributed in different aetiological groups, in 26 patients (12%), directional preponderance in 11 patients (5%) and canal paresis in three patients (1.5%). Disconjugate eye movements indicating a possible brain-stem lesion were observed in seven patients (3%). Eye movements were registered individually for both eyes. None of our patients had clinically significant vertigo. The electronystagmographic findings did not appear with hearing loss, indicating that vestibular disorders may develop independently. Our results support the view that electronystagmography should be performed routinely on every child who has had meningitis.

A method to break the cognitive barrier between a deaf child and a hearing parent

A deaf child actively uses about 1000 concepts in common with the hearing world. The rest of his up to 10,000 concepts belong to sign language and cannot be accurately translated into written language. This makes it difficult for the deaf to understand a normal written text, especially its abstractions. We have developed a new communication system in order to break the barrier between the hearing and the deaf. In this system a deaf child speaks with a writing hand-piece terminal through an FM route to a small unlimited text-to-speech synthesizer carried by the parent. The parent answers similarly to a 48-grapheme alphanumerical display carried by the child on a rack in front of him. The parent's unit with a speech synthesizer weighs about 2 kg and its size is about 7 X 20 X 25 cm; the size of the child's unit is one half of that and it weighs, with the display, 2 kg. Even a 4-year-old child carries the apparatus easily; nevertheless a still lighter unit is under construction. The system takes the learning process to everyday situations and makes it possible for a deaf child to converse in the normal written and spoken language. Thus, his concept capacity in the spoken language can be increased.

Pneumococcal vaccine and otitis media in infancy

This is a review of present knowledge about the chances of preventing otitis media (OM) by vaccination. Studies of experimental pneumococcal OM in the chinchilla, and observations on serum antipneumococcal antibody levels in children in connection with OM morbidity suggested that protective immunity could be achieved by vaccination. On the other hand, many of the pneumococcal polysaccharides--including those four types that are most common in OM--are not highly immunogenic in infants younger than 2 years. The highest incidence of OM coincides with that very age of low responsiveness. Four large field studies in USA and Finland have shown that vaccination with 14-valent pneumococcal vaccine does prevent recurrent as well as first-time OM caused by species to which good immune response is obtained. Because the most common pneumococci do not belong to this category, the overall protective effect of such vaccination remains low (10 to 15% in the studies reported). Thus the present vaccine cannot be recommended for prevention of OM in infants younger than 2 years. The data strongly encourages efforts in vaccine development, in ways that improve immunogenicity in infants.

Haemophilus influenzae in acute otitis media

We studied the occurrence of Haemophilus influenzae (Hi) in 2625 middle ear fluid (MEF) specimens obtained from 523 children with otitis media, aged 3 months to 6 years, between October 1977 and May 1979. In clinically acute cases 12.3% of the MEFs grew Hi; 6.3% (13/206) of the strains were of type b and 4.9% (10/206) were beta-lactamase producing. In the very first acute case of a child 8.0% (21/263) of the MEFs grew Hi, but in acute recurrences it was cultured in 17.0% (184/1082) (p less than 0.001). In non-acute persistent MEFs obtained during control visits Hi was found in no less than 21.7% (198/913); as many as 12.6% (25/198) of them were beta-lactamase producing. Both of these figures, but not the proportion of type b strains (8.6%), were significantly (p less than 0.001 and p less than 0.01, respectively) greater than in clinically acute MEFs. Hi was grown in 13.1% of the acute MEFs taken from children less than 4 years old, but in only 8.6% of the older children (p less than 0.05). The annual survey of all the 1816 Hi strains isolated from the MEFs of acute or subacute cases of otitis media in one laboratory in 1976-81 showed the proportion of beta-lactamase producing strains of all Hi strains to be gradually increasing from 8.0% (17/212) in 1976 to 15.2% (16/105) in 1981 (p less than 0.05).

Occurrence and recurrence of acute otitis media among children

The occurrence and recurrence of acute otitis media among 37 570 Finnish children at risk who were under 15 years of age were studied. During a one-year period, 4 337 of the children experienced a total of 6 249 attacks of acute otitis media, giving an annual incidence rate of 16.6%. The highest incidence, 75.5%, was found among infants 6--11 months old. 50% of Finnish children had experienced at least one ear infection before their third birthday and 75% before the age of 10, and among this latter group the total number of otitis attacks per child-year during a lifetime was 0.71. Among children under 10, half of the index attacks were recurrences, and among children under 16, 28% of the index attacks were followed by recurrences during the study year. The highest relative recurrence rate was found during the second year of life. Before the second birthday both incidence and recurrence rates were significantly (p less than 0.001) higher among boys. Acute otitis media was most common in the higher social class families and the lowest incidence and recurrence rates were found among children of farmers.

Inflammatory cells in mucoid effusion of secretory otitis media

Inflammatory cells were studied in 269 mucoid middle ear effusions of 202 patients with secretory otitis media (SOM). Although the effusions contained inflammatory cells in all cases, the number of cells, the proportion of viable cells and the proportions of different cell types showed marked heterogeneity. However, the effusions formed a sliding scale with regard to the above cellular parameters. We suggest that these differences in the cellular picture might reflect differences in immune mechanisms and responses in the different effusions, possibly representing different phases of the course of an established SOM. In the subgroups of patients with cleft palate (22) or atopy (16) the cellular picture resembled that seen in the other patients (164), with the exception that the effusions of the cleft palate patients were somewhat more lymphocytic. Thus, from the immunological point of view, the effusions in established SOM seem to behave similarly, irrespective of the differences in the etiological background of SOM.