Is Otalgia be a symptom of anxiety in children?

One of the common causes of ear pain (Otalgia) in children is the pain felt in the temporomandibular region due to bruxism, usually accompanied by stress and anxiety. The diagnosis and treatment of anxiety at an early age will affect the future lives of children. Our aim in the study was to investigate the presence and subtypes of anxiety in children with otalgia due to bruxism. In our study, 86 children aged between 6 and 16 years old who had ear pain and whose pain and tenderness were detected in the temporomandibular joint area and 40 healthy children were included as the control group. The children in both study groups were administered the Spence Children's Anxiety Scale (SCAS) test by the clinical psychologist. There was no statistical correlation between the children with bruxism and normal children (p > 0.05). While anxiety rate was 82% in children with bruxism, this rate was found to be 12.5% in normal children, this result was also statistically significant (p < 0.01). According to the SCAS test, when the subscales of anxiety detected in children with bruxism were evaluated, According to the SCAS test, when the subscales of anxiety detected in children with bruxism were evaluated, it was observed that the performance anxiety was high in the 6-12 and 12-16 age group. However, obsessive symptoms were mostly observed in the 12-16 age group while separation anxiety was detected in children in the 6-12 age group.

What Happened to the US Diplomats in Havana? Mitchell Valdés MD PhD Director, Cuban Neuroscience Center

He was born in Chicago, Illinois, USA, but his family is Cuban. After 1959, they returned to the island, where Dr Mitchell Valdés received his medical degree at the University of Havana in 1972. He went on to study clinical neurophysiology, earning his PhD with a dissertation on the auditory system's sensory physiology.

Assessing stress associated with temporomandibular joint disorder through Fonseca's anamnestic index among the Saudi physicians

The study aims to investigate signs and symptoms of temporomandibular disorders (TMD) among physicians in a tertiary health-care center. It has estimated the level of symptomatology, determined the association with demographic data, and identified the related occupational risk factors. A cross-sectional survey was used, and physicians of genders, all age groups, and nationalities from King Abdulaziz Medical City in Riyadh, Saudi Arabia, were recruited. Subjects who had rheumatic arthritis, osteoarthritis, trigeminal neuralgia, or temporomandibular joint (TMJ) trauma were excluded. The data were collected through a self-administered questionnaire that measured TMD severity and oral parafunctional behaviors. Fonseca's anamnestic index (FAI) and an oral validated behavior checklist were used to assess the signs and symptoms of TMD. A total of 282 physicians participated in the study, and the prevalence of TMD signs among physicians was 37% (106); among them, 88 (83%) were within the light dysfunction category. Female physicians reported significantly higher FAI than males for side-to-side mandibular movement (12% vs. 5%, P = 0.04), reporting ear pain (18% vs. 10%, P = 0.04), and noticing clicking when chewing or opening the mouth (35% vs. 20%, P = 0.006). Younger practitioners (28-31 years old) who reported clicking while chewing or opening the mouth tended to have reported higher TMD dysfunction (35%) than those aged 40 and above (13%; P = 0.007). Self-reported signs of TMD were 37% among our population. Information collected from FAI is useful in early diagnosis and prevention of TMD.

Dried salted plum consumption ameliorates hyperbaric oxygen therapy-induced otalgia severity at the first chamber session: a prospective randomized controlled study

PURPOSE

One of the most common complications of hyperbaric oxygen (HBO₂) therapy is middle ear barotrauma (MEB), occasionally causing otalgia. The objective of this study was to evaluate the effect of dried salted plum consumption on MEB and otalgia associated with HBO₂ therapy.

MATERIALS AND METHODS

Patients undergoing the first chamber session of HBO₂ therapy were included in the present prospective randomized controlled trial. The Valsalva maneuver was administered to all patients before HBO₂. The patients were randomly divided into two groups: one that ate a dried salted plum during HBO₂ treatment and the other that did not. An otoscopic examination was performed after HBO₂ therapy. The MEB was graded according to Teed scores. The degree of otalgia was recorded using the Visual Analog Scale (VAS).

RESULTS

Ninety patients were enrolled. The overall incidence of MEB (Teed score grade 1~4) was 39.6% (21 of 53) for patients administered a dried salted plum versus 37.8% (14 of 37) for the control group (P=1.000). The incidence of mild MEB (Teed score grade 1~2) and severe MEB (Teed score Grade 3~4) between the two groups was not significantly different. Otalgia was present in 5.7% (3 of 53) of patients administered a dried salted plum versus 18.9% (7 of 37) for the control group (P=.085). No patients administered a dried salted plum had a VAS score ≥4 for otalgia versus 10.8% (4 of 37) for the control group (P=.026).

CONCLUSIONS

Dried salted plum consumption does not decrease the incidence of MEB, but may ameliorate the severity of first chamber session HBO₂-induced otalgia.

Acute Illness Among Surfers After Exposure to Seawater in Dry- and Wet-Weather Conditions

Rainstorms increase levels of fecal indicator bacteria in urban coastal waters, but it is unknown whether exposure to seawater after rainstorms increases rates of acute illness. Our objective was to provide the first estimates of rates of acute illness after seawater exposure during both dry- and wet-weather periods and to determine the relationship between levels of indicator bacteria and illness among surfers, a population with a high potential for exposure after rain. We enrolled 654 surfers in San Diego, California, and followed them longitudinally during the 2013–2014 and 2014–2015 winters (33,377 days of observation, 10,081 surf sessions). We measured daily surf activities and illness symptoms (gastrointestinal illness, sinus infections, ear infections, infected wounds). Compared with no exposure, exposure to seawater during dry weather increased incidence rates of all outcomes (e.g., for earache or infection, adjusted incidence rate ratio (IRR) = 1.86, 95% confidence interval (CI): 1.27, 2.71; for infected wounds, IRR = 3.04, 95% CI: 1.54, 5.98); exposure during wet weather further increased rates (e.g., for earache or infection, IRR = 3.28, 95% CI: 1.95, 5.51; for infected wounds, IRR = 4.96, 95% CI: 2.18, 11.29). Fecal indicator bacteria measured in seawater (Enterococcus species, fecal coliforms, total coliforms) were strongly associated with incident illness only during wet weather. Urban coastal seawater exposure increases the incidence rates of many acute illnesses among surfers, with higher incidence rates after rainstorms.

Effects of bomb blast injury on the ears: The Aga Khan University Hospital experience

OBJECTIVE

To evaluate the frequency and effects of blast-related otologic injuries.

METHODS

his retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised charts of patients who were victims of bomb explosions between January 2011 and July 2013. Frequency and percentages were reported using cross tabulation with size of bomb, distance of person from blast and the presence of victim in open or closed space. Association of associated variables were also analysed.

RESULTS

Of the 100 patients, 81(81%) were men and 19(19%) were women. Besides, 68(68%) patients were aged <30 years. Also, 78(78%) subjects were exposed to < 80kg of explosives and 68(68%) were at a distance of>10m. Furthermore, 61(61%) patients were exposed to explosion in openspace. The prevalence of ear injuries was 21(21%). The odds of experiencing various symptoms of ears was high in those who were exposed to >80 kg of explosives (odds ratio: 3.38; 95% confidence interval, 1.16, 9.91). The odds of hearing loss in those who were within 10m was 8.62 (95% confidence interval: 2.72, 27.28) times than those who were >10 m from the site of explosion.

CONCLUSIONS

Otologic injuries were frequently associated with large blasts.

The incidence and health burden of earaches attributable to recreational swimming in natural waters: a prospective cohort study

BACKGROUND

Earaches and outer ear infections are commonly associated with swimming. In this study, we estimated the excess risk and health burden of earaches due to swimming in natural fresh and marine waters using results from a survey of over 50,000 beachgoers at nine beaches across the United States.

METHODS

Prospective cohort studies were conducted at four freshwater and five marine sites in the United States and Puerto Rico. Beach visitors were enrolled on summer weekends and holidays. Ten to twelve days after the beach visit, respondents answered questions about health symptoms, including earaches or ear infections experienced since the beach visit. Economic and physical burdens were also obtained. Fixed slope, random intercept (beach site) multivariate logistic regression models were used to estimate the relationship between head immersion swimming exposure and earaches. Model results were used to calculate excess risk for earaches attributable to swimming.

RESULTS

The overall incidence of self-reported earache was 1.6% in the 10-12 days after the beach visit. Earaches were more frequent in head immersion swimmers compared to non-swimmers for all beach sites and age groups. Earaches were unassociated with water sample measures of fecal contamination and turbidity. After adjustment for covariates, we calculated 7.12 excess earaches among head immersion swimmers per 1,000 swimming events. Twenty-four percent of those with earache reported missing their regular activities; 28% visited a doctor; 4% visited the emergency room; and 31% and 40% used prescription and non-prescription medications, respectively.

CONCLUSIONS

There are at least 128 million swimming events in natural waters annually. Such frequent exposures could result in 900,000 excess earaches, 260,000 visits to the doctor, 39,900 visits to the emergency room, nearly $4 million dollars in out-of-pocket expenditures on prescription and over-the-counter medications, and close to 75,000 hours of clinician time. More accurate estimates of swimming exposure are needed to improve population burden and associated cost estimates.

Prevalence of otomycosis in Ibadan: a review of laboratory reports

Otomycosis has typically been described as fungal infection of the external auditory canal with infrequent complications involving the middle ear. Because of the dearth of data on the prevalence of Otomycosis in this environment and increased rate of immunosuppression, this study was aimed at finding the prevalence and fungal etiological agents responsible for this condition. Aretrospective review of the laboratory reports of ear swabs of patients that presented with signs and symptoms suggestive of fungal infections of the ear like otorrhoea, otalgia and aural fullness were done. The diagnosis of otomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae and fruiting bodies under microscopy. The swabs were cultured on the Sabouraud Dextrose agar kept at room temperature (27-30 degrees C). Fungi growth occurred within 48 hours to 3 weeks. The data collected were analyzed with the aid of SPSS version 12.0 computer software. Level of significance was set at p<0.05. A total of 53 patients with documented diagnosis of otomycosis were included in the analysis and consisted of 31 (58.5%) females and 22 (41.5%) males. The ages at diagnosis ranged from 2 to 68 years (Mean: 28.9 yrs; Median: 30.0 yrs). Otalgia and otorrhoea were the most common symptoms, followed by hearing loss and aural fullness. The prevalence of otomycosis among the patients in this hospital was 39.6%. Candida albicans was the most common fungal isolate in these patients as it occurred in 28.3% (15/53). Other isolates in order of frequency were Aspergillus fumigatus (5.7%), A. niger (1.9%), Penicillium spp. (1.9%) and Mucor spp.(1.9%). Candida albicans was also the most common fungus identified in all age group. There was no statistical significance associated between age of presentation and types of fungi isolated (p = 0.054). Even though, there was no statistical significance between sex and fungi isolated (p > 0.05), it was noted that all the fungi were commonly isolated from female gender irrespective of their age. Candida albicans and Aspergillus species were the most commonly identified fungal pathogens of otomycosis in U.C. H., Ibadan, Nigeria. High index of suspicion should be demonstrated by General practitioners and Otorhinolaryngologists. Patients' specimens should be sent to the laboratory as early as possible for prompt diagnosis.

Tacrolimus: A New Option in Therapy-Resistant Chronic External Otitis

OBJECTIVE

To evaluate the efficacy of the novel topical immune modulator tacrolimus in chronic uninfectious otherwise therapy-resistant external otitis (EO).

STUDY DESIGN

Prospective clinical study.

PATIENTS AND METHODS

There were 53 patients aged 5 to 83 years. An ear wick containing 0.1% tacrolimus ointment (Protopic) was inserted into the external auditory canal every 2nd to 3rd day. Altogether, the wick was changed three times. The pre-, intra- and posttherapeutic state of the clinical parameters otalgia, edema, otorrhea, erythema, pruritus, and desquamation was rated by means of a 6-point score system. Treatment efficiency was evaluated on the basis of follow-up investigations at 3-month intervals, a standardized findings sheet, and photograph documentation.

RESULTS

The short-term results showed a clear improvement in 85% of the patients and significant reductions of the severity levels for all clinical parameters investigated (P < .001). Concerning the long-term results, a one-time treatment cycle led to complete healing in 46% of the patients throughout a follow-up of 10 to 22 months. Of the patients, 54% had recurrent EO events with significantly extended mean symptom-free intervals. Reapplied tacrolimus treatment patterns attenuated the relapsing course of disease and significantly reduced the number of EO episodes. Within the observation period, no relevant side effects were observed, except for a local feeling of heat, occasional skin burning, and itching.

CONCLUSIONS

The topical application of 0.1% tacrolimus ointment in the outer ear canal appears to be an effective and well-tolerated new option in corticosteroid-free treatment of chronic therapy-resistant EO.

Characteristics of children consulting for cough, sore throat, or earache

BACKGROUND

GPs are often consulted for respiratory tract symptoms in children.

AIM

To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache.

DESIGN OF STUDY

Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire.

SETTING

Children aged 0-17 years registered with 122 GPs in Dutch general practice.

METHOD

Characteristics of patients and their GPs were derived from the DNSGP-2 health interview and a questionnaire, respectively. Characteristics of the illness symptoms and GP consultation were acquired by means of an additional questionnaire. Data were analysed using multivariate logistic regression.

RESULTS

Of all children who completed the questionnaire, 550 reported cough, sore throat, or earache in the 2 weeks preceding the interview with 147 of them consulting their GP. Young children more frequently consulted the GP for respiratory symptoms, as did children with fever, longer duration of symptoms, those reporting their health to be 'poor to good', and living in an urban area. When parents were worried, and when a child or their parents were cued by someone else, the GP was also consulted more often. GP-related determinants were not associated with GP consultation by children.

CONCLUSION

This study emphasises the importance of establishing the reasons behind children with respiratory tract symptoms consulting their GP. When GPs are aware of possible determinants of the decision to consult a GP, more appropriate advice and reassurance can be given regarding these respiratory symptoms, which are generally self-limiting.

Five-year follow-up of temporomandibular disorders and other musculoskeletal symptoms in dental students

AIM

The aim of this epidemiologic study was to evaluate the intensity and variation of temporomandibular disorders and other musculoskeletal symptoms in a population of dental students during the five years of Dental School.

METHODS

A 0-to-3 numeric scale questionnaire (0=absence of the symptom, 1=mild intensity, 2=moderate intensity, 3=severe intensity) was submitted to all the students enrolled in the first year of the Dental School at the University of Saint Joseph (Beirut, Lebanon). The same questionnaire was filled out by the same students every year until they reached the fifth (last) year.

RESULTS

Temporomandibular disorders and musculoskeletal symptoms were generally of mild intensity and fluctuating in time. No significant differences were found among years in the intensity of earache, headache, face pain, arm symptoms, neck pain, and toothache. Ear stuffiness decreased from the first to the third and fifth year. Temporomandibular joint pain, temporomandibular joint sounds, upper back pain, and lower back pain showed a similar trend generally increasing from the first and second years to the third year, and then decreasing until the fourth and fifth years.

CONCLUSION

A higher risk of developing such symptoms associated with dental work in the laboratory can be hypothesized in case of improper ergonomics.

Prevalence, intensity, and correlation of different TMJ symptoms in Lebanese and Italian subpopulations

AIM

The aim of this study was to compare self reported joint related temporomandibular disorder (TMD) symptoms in Lebanese and Italian dental and non-dental students and to detect any correlation between different symptoms.

METHODS AND MATERIALS

A questionnaire was distributed in Sardinia (Italy) to dental and psychology students and in Lebanon to dental, physical therapy, and biology students to investigate the prevalence, intensity, and correlation of four temporomandibular joint (TMJ) symptoms.

RESULTS

Prevalence of earache varied among the groups from 10.1% to 29.2%, ear stuffiness from 22.5% to 30.8%, TMJ pain from 13.2% to 21.2%, and TMJ sounds from 18.4% to 46.2%.

DISCUSSION

Different prevalence and intensity of earache and TMJ sounds were found in the examined sub-populations diverse in cultural background and education. However, prevalence and intensity of ear stuffiness and TMJ pain were similar. Association between TMJ sounds and TMJ pain was detected in selected sub-populations, and correlation between one symptom on one side of the head with the same symptom on the contralateral side were noted suggesting most of these symptoms are bilateral.

CONCLUSION

The results of the study might be useful to anticipate the possible occurrence of associated symptoms or the same symptom on both sides of the head. Correlations with cultural background and education are difficult to establish.

The prevalence of allodynia, osmophobia and red ear syndrome in the juvenile headache: preliminary data

The aim of the study was to determine the frequency of clinical allodynia, osmophobia and red ear syndrome in a young population. Medical records of the children admitted for headache between 1 December 2004 and 31 March 2005 were consecutively studied. A questionnaire was used to find the prevalence of allodynia, osmophobia and red ear syndrome. We visited 96 children with headache. The range of age was 6–18 years. We classified migraine in 57%, other primary headaches in 25% and secondary headaches in about 18%. The presence of ipsilateral clinical allodynia was 14.5% in migraine, osmophobia in 20% of migraine and red ear syndrome in about 24% of migraine cases and they were absent in the other two headache groups. Our study shows that features like osmophobia, allodynia and red ear syndrome are not uncommon in migraine while they are absent in other types of headache.

Ear, nose, and throat manifestations of Sjögren's syndrome: retrospective review of a multidisciplinary clinic

OBJECTIVE

To assess the otolaryngologic manifestations of Sögren's syndrome (SS).

DESIGN

A retrospective case study.

SETTING

The Toronto Hospital.

METHOD

Case note review of 196 patients evaluated in a multidisciplinary clinic for this disease. Patients were retrospectively classified according to the revised international classification.

MAIN OUTCOME MEASURES

The prevalence of subjective and objective audiologic and otorhinolaryngologic abnormalities.

RESULTS

One hundred eleven patients were diagnosed with primary and 26 with secondary SS, leaving 60 with unclassified sicca syndrome. There was minimal otologic pathology. There was a mildly increased prevalence of sensorineural deafness in secondary SS (41-60 years, 36%; 61-80 years, 70%). Approximately 50% of patients in each group complained of nasal symptoms, but only 20% had abnormal findings on rhinoscopy. Similarly, 60 to 70% in each group complained of throat symptoms, but only 20% had abnormal findings on indirect laryngoscopy. Thirty-eight percent of primary patients had parotid gland symptoms, and 25% had abnormally swollen glands, with eight subsequently diagnosed with lymphoma. No patients in the other two groups had abnormal parotid glands.

CONCLUSIONS

SS does not appear to be associated with increased otologic or audiologic disease, except perhaps in conjunction with systemic autoimmunity. Nose and throat symptoms are common in SS, but the complications of mucosal dryness on examination are unusual (approximately 20%). Primary SS can cause serious parotid morbidity secondary to inflammation and infection. There is also a significant risk of lymphomas that often present as parotid masses, necessitating long-term follow-up.

[Naturopathic therapy for acute otitis media. An alternative to the primary use of antibiotics]

BACKGROUND

First line antibiotic treatment of uncomplicated acute otitis media has been questioned.

PATIENTS AND METHODS

In an prospective, open, controlled study, 390 children aged 1-10 years were treated either conventionally (free combinations of decongestant nose drops, mucolytics, analgesics and antibiotics) or alternatively with Otovowen, supplemented by conventional medications when considered necessary.

RESULTS

Patients treated conventionally took more antibiotics (80.5% vs 14.4%) and analgesics (66.8% vs 53.2%). The time to recovery (5.3 vs 5.1 days) and absence from school or pre-school nursery (both 1.7 days) were not significantly different between groups. Pain resolution was slightly better with conventional treatment (-5.8 vs -5.2 score points). The alternative treatment was judged both by doctors, and parents, to be significantly better tolerated.

CONCLUSION

In uncomplicated acute otitis media of childhood, an alternative treatment strategy with the natural medicine Otovowen may substantially reduce the use of antibiotics without disadvantage to the clinical outcome.

Recurrent tinnitus and associated ear symptoms in adults

This study aimed to reveal in general population the prevalence, associations, and statistical model of recurrent tinnitus by means of a mailed questionnaire. The study sample consisted of 1720 randomly selected adults who were classified into three subgroups: recurrent (once a month or more often), occasional (less often than once a month), and no tinnitus. According to age and gender standardized prevalence, recurrent tinnitus was reported in 15% of the sample. It was statistically highly significantly associated with earache, fullness of ears shoulder pain, the 25-years age group, and visits to a physician. The strongest predictor of recurrent tinnitus was fullness of ears followed by earache, shoulder ache, and temporomandibular disorder pain. We conclude that recurrent tinnitus seems to be quite common in adults and associated with earache and fullness of ears In patients with tinnitus without clinical findings, the examination of the stomatognathic system and cervical spine is recommended.

Carcinoma of the tongue: A case series analysis of clinical presentation, risk factors, staging, and outcome

OBJECTIVE

Oral cancer is primarily a disease of epithelial origin. The tongue is the most common site of oral cancer. Oropharyngeal cancer accounts for approximately 2% of all cancer deaths. The purpose of this study was to analyze a case series of patients with tongue cancer.

STUDY DESIGN

The medical records of 322 consecutive patients diagnosed with squamous cell carcinoma (SCC) of the tongue treated from 1979-1994 were reviewed.

RESULTS

Patients had a mean age of 61.1 years and a 1.5:1 male to female ratio. Approximately, half of the cancers were diagnosed at an advanced stage and most involved the base of the tongue. The majority of oral tongue tumors were diagnosed at an early stage and had more well-differentiated cell types than those of the base of the tongue. Localized discomfort was the most common complaint (66.5%), present for up to 6 months in patients prior to diagnosis and were related to the oral tongue in 90% of cases. Symptoms associated with base of tongue lesions included neck masses, dysphagia, ear pain, and weight loss. Seventy-nine percent of the patients smoked, 58% consumed alcohol on a daily basis, and 43% consumed more than 4 alcoholic drinks daily. Primary radiotherapy was the treatment of 49.6% lesions, of which 57% were at an early stage at diagnosis. The mean overall survival was 3 years and 5 months, with a 5-year overall survival of 40%. Patients with stage 1 tumors had a disease-specific survival of over 80%. The 5-year survival of patients with cancer of the oral tongue was 43% and cancer of the base of the tongue was 27%.

CONCLUSION

The prognosis is poorer for patients presenting with advanced stage and with tumors involving the base of the tongue. Symptoms were more common in tumors of the oral tongue, which likely results in earlier diagnosis. Patients with SCC of the base of the tongue presented with advanced stage of disease and were typically poorly differentiated lesions.

Secondhand smoke and earaches in adolescents: the Florida Youth Cohort Study

The association between second-hand smoke exposure and adolescent middle ear problems has not been examined. A random sample stratified by region was drawn from a list that included approximately 40% of all Florida households with children in grades 4-7. A total of 785 Florida adolescents initially enrolled in the 4th-7th grade participated in three telephone interviews conducted over a 24-month period. At the round 3 interview, 10.3% of participants reported one or more earaches within the previous 30 days. Several second-hand smoke exposure questions asked at each of the three interviews were associated with the number of reported earaches. Stepwise polytomous logistic regression indicated that parental smoking inside the home reported at the round 3 interview was associated with the number of reported earaches (OR=3.11, 95% CI=1.70-5.66). Once this variable was selected, none of the other second-hand smoke exposure variables offered additional predictive value (p>.1). None of the non-second-hand smoke exposure variables, including the participant's own history of tobacco use, had any association with the reporting of earaches (p>.05). Second-hand smoke exposure is associated with self-reported earaches in adolescents. These findings should be replicated in a study in which clinical measures of middle ear function are performed.

Characteristics of subjects with secondary otalgia

AIMS

To investigate whether secondary otalgia is associated with cervical spine disorder (CSD), temporomandibular disorders (TMD), or both, and to describe the pain characteristics and the comorbidity of secondary otalgia in subjects with and without CSD and TMD.

METHODS

A mailed questionnaire was sent to a random sample of 2,500 people aged 25 to 65 years. Altogether 1,720 recipients responded. Inclusion criteria were pain inside or around the ear without infection, tumor, or trauma, of 6 or more months duration, and a pain frequency of at least once a month. Altogether 152 respondents fulfilled the criteria, and of these 100 participated in the clinical examinations and interviews.

RESULTS

Based on standardized examinations and interviews, 91 subjects had secondary otalgia and 9 had primary otalgia. Most (85%) of the 91 subjects with secondary otalgia also had signs and symptoms of TMD and/or CSD and were therefore classified into 3 groups: CSD (35%), TMD (20%), or "Combination," ie, signs and symptoms of both TMD and CSD (30%). Subjects without CSD or TMD (15%) reported the same level of intensity and impact of otalgia on daily living and psychological distress as the others but less frequent head and neck pain and fewer sleep-related problems.

CONCLUSIONS

Most of the subjects reporting secondary otalgia also suffered from CSD or TMD or both. Thus, in patients with secondary otalgia, an examination of the cervical spine and the stomatognathic system should be routinely performed.

[Nasal congestion and earache--upper respiratory tract infections in 4-year-old children]

BACKGROUND

Few population-based studies in Norway have addressed upper respiratory infections in children.

MATERIAL AND METHODS

A questionnaire concerning health, diseases and living condition was administered to parents of all four-year-old children in Vestfold county (n = 1912). Participation rate was 79%.

RESULTS

Close to one out of three of the children suffered from recurrent common cold (four episodes or more) during the last year. One third experienced otitis at least once, and one out of twenty experienced four episodes of otitis or more. Day-care centre attendance was the only significant risk factor for recurrent common cold (odds ratio 1.50; 95% CI 1.18-1.92) or otitis (odds ratio 1.42; 95% CI 1.12-1.77). The odds ratios were essentially unchanged after logistic regression analysis, when mother's education, housing, other children in the family, passive smoking, and history of breastfeeding were included in the analysis. Children with otitis or recurrent common cold consulted a doctor almost ten times as often as other children.

INTERPRETATION

Day-care centre attendance has significant influence on the occurrence of upper respiratory infections in four-year-olds, but less influence than reported for younger children. Other environmental differences seem to be of little importance and do not represent any potential for prophylaxis.

Does the supine sleeping position have any adverse effects on the child? I. Health in the first six months. The ALSPAC Study Team

OBJECTIVE

To assess whether the recommendations that infants sleep supine could have adverse health consequences.

DESIGN

A prospective study of infants, delivered before, during, and after the Back to Sleep Campaign in the United Kingdom (UK), followed to 6 months of age. The children were part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Subjects. Singletons born to mothers resident in the three former Bristol-based health districts of Avon in the period June 1991 to December 1992, and for whom questionnaires were completed on sleeping position at 4 to 6 weeks of age (n = 9777); for these infants 8524 questionnaires were also completed at 6 to 8 months of age.

MAIN OUTCOME MEASURES

Subjective measures of health, the presence of specific signs and symptoms, duration of sleep at night, and calling the family doctor to the home.

RESULTS

Of 43 outcomes considered, after adjustment for 12 factors using logistic regression only 2 were associated with raised risk among infants put to sleep on their back (diaper rash and cradle cap). Infants put to sleep prone had increased risk of a number of health outcomes, including cough and possibly pyrexia.

CONCLUSIONS

There is no evidence that putting infants to sleep in the supine position results in increased morbidity, although changes in prevalence of rare disorders would not have been identified.

Audiometric pattern in a group of workers with one ear conductive deafness exposed to continuous noise

BACKGROUND

It is common to find workers in developing countries having residual ear problems from childhood affections. When exposed to continuous noise in industry, they might exhibit different patterns of audiometric findings. The aim of this study was to examine the good ear in a group of workers exposed to continuous noise in textile industry with a perforated drum in the other ear from childhood otitis media.

METHODS

a 1:2 case control design involving a group of 36 cases and 2 matched groups, same age and duration of exposure was performed. A relevant questionnaire was used and each worker was subjected to an audiometric test.

RESULTS

significantly worse hearing threshold levels at the 250 Hz and the 4 kHz frequencies were obtained for the good ears of cases compared to controls. Subjective complaints were also commoner. A different pattern of hearing loss was found adding to the auditory risk of the involved workers.

[Bathing water related diseases: the Carinthian Sentinel Project as the source of epidemiological data]

The federal country of Carinthia is known for its lakes and ponds, which are extensively used for bathing. The water quality is monitored regularly in accordance to the EC-Directive 76/160/EC and especially to the more rigorous Austrian Standard M6230. Since redevelopment measures of the lakes have been nearly finished the water quality found has improved essentially. In spite of these monitored data no effective correlation to data from the concerning ambulant sector of medical care could be established. The Carinthian Sentinel Practice Network started in summer 1994 to retrieve informations about occurrence and frequency of bathing related illness of children up to 16 years old. The 26 participating primary health care and pediatric physicians, having their own independent practices spread all over the country, reported the specific doctor-patient-contracts to the coordinating base. Criteria for inclusion in the medical report were headache, sore throat, otalgia, stomach-ache, nausea, emesis, diarrhoea, fever, rhinitis, cough, cold, moreover conjunctivitis, skin rash and specific dermatitis. In addition physicians reported where, how long and how often the children had been bathing and how long they had been free of symptoms afterwards. Each case was reported to the coordinating base including a presumed diagnosis. Statistic evaluation showed that bathing related illness may be divided into three main groups according to symptom frequency. The frequency of otalgia (32.4%) was significantly higher than any other symptom asked for. Two groups of symptoms correlate with each other: on one hand rhinitis, conjunctivitis, cough and sore throat (36.5%) and on the other hand nausea, emesis, diarrhoea and fever (41.9%). These data underline conclusions drawn by other authors but are not representative enough to correlate to data from water monitoring. First results suggest that conclusions for public health authorities can be drawn from this additional information about the state of the lakes and ponds-providing a sufficient number of data is reported.

Swimming and grommets: a prospective survey

AIM

To assess the incidence of otorrhoea after swimming in patients with grommets in situ, and discover whether protecting the ears from water affects this occurrence.

METHODS

A group of children with bilateral patent grommets were allowed to swim with head under the water with one ear protected, and the other unprotected from water entry. Using a calendar system, each swim was recorded and each episode of otalgia or otorrhoea occasioning medical consultation was recorded with the outcome of the consultation.

RESULTS

Nineteen children completed the survey taking a total of 551 swims with head immersion. One child suffered bilateral otorrhoea one day after a swim. There were three episodes of otalgia sufficiently severe to warrant medical consultation. Two occurred in a protected ear and one in an unprotected ear. On each occasion there was no evidence of infection.

CONCLUSIONS

There appears to be a low incidence of otorrhoea during summer in children who swim with grommets in situ. There is no evidence that protecting the ears from water entry confers any benefit as far as preventing infection in concerned.

Factors affecting resolution of otitis media with effusion in children

There is only limited knowledge of the factors which influence the outcome of otitis media with effusion in children in the long-term. This randomized controlled study assessed the therapeutic effect of adenoidectomy and adenotonsillectomy during a 5-year follow-up. Numerous pre-treatment independent variables concerning the child's upper and lower respiratory tract, atopic status and parental habits were assessed in relation to two dependent outcome measures. These were otoscopic clearance of effusion and no peak/peak tympanometric change. A total of 222 children was studied and reviewed annually for 5 years. Four of 43 independent variables were found to be repeatedly significant in relation to outcome: (a) whether or not adenoidectomy was performed; (b) age at operation; (c) history of earache prior to operation; and (d) parental smoking habits. The results provide further evidence of a beneficial effect of adenoid removal and the importance of the age at which surgery is advised. They also suggest the need to investigate further the relationship of superadded acute suppurative otitis media with otalgia and the outcome of chronic otitis media with effusion. Finally, avoidance of parental smoking will have a beneficial effect on children's middle ear disease.

Tinnitus and vertigo in patients with temporomandibular disorder

The association of tinnitus and vertigo with temporomandibular disorder (TMD) has been debated for many years. The observation that patients with TMD have otologic symptoms is confounded because tinnitus and vertigo are common symptoms in the normal population. The present study was conducted to determine if tinnitus and vertigo are actually more prevalent in patients with TMD than in appropriate age-matched controls. One control group was recruited from patients seeking care for health maintenance and the other from patients seeking routine dental care. We surveyed 1032 patients: 338 had TMD and 694 served as two age-matched control groups. Tinnitus and vertigo symptoms were significantly more prevalent in the TMD group than in either of the control groups. The mechanism of the association of TMD and otologic symptoms is unknown.

Septal manipulation in the neonate: method and results

The septal configuration at birth may be straight (type A) which occurs in 42% cases, bent to one side (type B), or deformed to both sides (type C). There is a close correlation of these types, immediately with nasal obstruction and feeding problems and later with the development of dental abnormalities and respiratory infections of the throat and ear. These symptoms occur most in type B cases and least in type A cases. A total of 284 babies was assessed at birth and then when aged about 5 years. A total of 105 babies, who had minimal trouble and were used as controls and not manipulated, were compared with 179 who had troublesome symptoms and were manipulated. Manipulation greatly reduced the incidence of these problems at a statistically significant level. The physiological reason why type B causes more ear disease than types A or C is described. This involves the normally occurring Bernouilli's phenomenon in the nose. The external nasal deformity which causes minimal physiological changes, and occurs in 4% of births, can be successfully straightened by manipulation.

Telephone encounters in a university pediatric group practice. A 2-year analysis of after-hour calls

The records of off-hours calls received by the University of Colorado Pediatric Group Practice from 4:30 p.m. throughout 8:00 a.m. weekdays and all day Saturday, Sunday, and holidays were audited. An answering service and pageboy system ensured 24-hour, 7-day-a-week accessibility through a single telephone number. The four practices received 2386 after-hours calls from November 1978 to October 1980. An average of 104 calls per month were received with approximately four calls per day on weekday evenings and six calls per day on Saturday, Sunday, and holidays. Five concerns accounted for 49 percent of all after hours calls: fever, vomiting and/or diarrhea, upper respiratory infection (URI), earache, and rash. While 75 percent of families made fewer than four calls per year, 4 percent made at least 12 calls per year, accounting for 18 percent of all calls. Families calling three or more times a month were defined as "frequent users" and accounted for 22 percent of a given month's calls. Most calls from the same families (55%) occurred within a 24-hour period and dealt chiefly with parental concerns about fever, vomiting and diarrhea, URIs, ear infection, accident, and rashes. The additional responsibility that residents assume in taking calls for the Pediatric Group Practice while on other off-hour assignments was not excessively demanding, and cost of the answering service was easily absorbed by group practice revenues.