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McKenna Benoit M, Henry KS, Orlando M, Wong S, Allen P. Tone in Noise Detection in Children with a History of Temporary Conductive Hearing Loss. J Assoc Res Otolaryngol 2022; 23:751-758. [PMID: 36280641 PMCID: PMC9789224 DOI: 10.1007/s10162-022-00871-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/25/2022] [Indexed: 01/06/2023] Open
Abstract
Children with a history of temporary conductive hearing loss (CHL) during early development may show long-term impairments in auditory processes that persist after restoration of normal audiometric hearing thresholds. Tones in noise provide a simplified paradigm for studying hearing in noise. Prior research has shown that adults with sensorineural hearing loss may alter their listening strategy to use single-channel energy cues for tone-in-noise (TIN) detection rather than rove-resistant envelope or spectral profile cues. Our objective was to determine the effect of early CHL on TIN detection in healthy children compared to controls. Children ages 4-7 years, with and without a history of CHL due to otitis media with effusion (OME) before age 3 years, participated in a two-alternative forced choice TIN detection task. Audiometric thresholds were normal at the time of testing. Thresholds for detection of a 1000 Hz tone were measured in fixed-level noise and in roving-level noise that made single-channel energy cues unreliable. Participants included 23 controls and 23 with a history of OME-related CHL. TIN thresholds decreased with increasing age across participants. Children in both groups showed similar TIN sensitivity and little or no threshold elevation in the roving-level condition compared to fixed-level tracks, consistent with use of rove-resistant cues. In contrast to older listeners with sensorineural hearing loss, there was no detectable change in TIN sensitivity with roving level for children with a history of OME-related CHL.
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Affiliation(s)
- Margo McKenna Benoit
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA.
| | - Kenneth S Henry
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
| | - Mark Orlando
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
| | - Stephanie Wong
- Department of Otolaryngology, Virginia Commonwealth University, Virginia, USA
| | - Paul Allen
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
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Stephens JH, O’Keefe M, Schembri M, Baghurst PA. Parents Need More Support: A Qualitative Study of the Experiences of Australian Parents Who Are Waiting for Surgical Intervention for Their Children With Otitis Media. J Patient Exp 2020; 7:717-725. [PMID: 33294607 PMCID: PMC7705822 DOI: 10.1177/2374373519883495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, expectations, and motivations of parents/caregivers of children with otitis media who were booked to undergo tympanostomy tube insertion. METHOD A cross-sectional cohort study was conducted using semistructured interviews with 39 parents. Interviews were conducted via telephone and analyzed for key themes. RESULTS Three themes emerged that incorporated a range of subthemes: (1) the impact of the child's underlying condition on the family, (2) the cues and prompts that influenced parents to seek intervention, and (3) the parents' expectations of the health-care system. The child's otitis media disrupted the day-to-day functioning of the family and the child's well-being, but despite this, the families found ways to adapt and cope. Parents were influenced by their friends, family, and medical practitioners when making treatment decisions and had differing expectations of the health-care system. CONCLUSION Parents need support during their child's illness to help with pressures placed on the family and also in making health-care decisions for their child. Clinicians should consider these issues when discussing treatment options with parents.
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Affiliation(s)
- Jacqueline H Stephens
- Discipline of Paediatrics, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maree O’Keefe
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Schembri
- Ear, Nose and Throat Department, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Peter A Baghurst
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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McKenna Benoit M, Orlando M, Henry K, Allen P. Amplitude Modulation Detection in Children with a History of Temporary Conductive Hearing Loss Remains Impaired for Years After Restoration of Normal Hearing. J Assoc Res Otolaryngol 2018; 20:89-98. [PMID: 30341699 DOI: 10.1007/s10162-018-00699-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/20/2018] [Indexed: 12/22/2022] Open
Abstract
Otitis media with effusion (OME) is considered a form of relative sensory deprivation that often occurs during a critical period of language acquisition in children. Animal studies have demonstrated that hearing loss during early development can impair behavioral sensitivity to amplitude modulation (AM), critical for speech understanding, even after restoration of normal hearing thresholds. AM detection in humans with a history of OME-associated conductive hearing loss (CHL) has not been previously investigated. Our objective was to determine whether OME-associated CHL in children ages 6 months to 3 years results in deficits in AM detection in later childhood, after restoration of normal audiometric thresholds. Children ages 4 to 7 years with and without a history of OME-associated CHL participated in an AM detection two-alternative forced-choice task at 8 and 64 Hz modulation frequencies using a noise carrier signal and an interactive touch screen interface. Thirty-four subjects were studied (17 with a history of OME-related CHL and 17 without). Modulation detection thresholds improved with age and were slightly lower (more sensitive) for the 64 Hz modulation frequency for both groups. Modulation detection thresholds of children with a history of OME-associated CHL were higher than control thresholds at 5 years, but corrected to expected levels between ages 6-7. OME-associated CHL results in impaired AM detection, even when measured years after restoration of normal audiometric thresholds. Future studies may shed light on implications for speech and language development and academic success for children affected by OME and associated conductive hearing loss.
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Affiliation(s)
- Margo McKenna Benoit
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA.
| | - Mark Orlando
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
| | - Kenneth Henry
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
| | - Paul Allen
- Department of Otolaryngology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 629, Rochester, NY, 14642, USA
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Pedersen TM, Mora-Jensen ARC, Waage J, Bisgaard H, Stokholm J. Incidence and Determinants of Ventilation Tubes in Denmark. PLoS One 2016; 11:e0165657. [PMID: 27875554 PMCID: PMC5119727 DOI: 10.1371/journal.pone.0165657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/26/2016] [Indexed: 11/18/2022] Open
Abstract
Background and objectives Many children are treated for recurrent acute otitis media and middle ear effusion with ventilation tubes (VT). The objectives are to describe the incidence of VT in Denmark during 1997–2011 from national register data, furthermore, to analyze the determinants for VT in the Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010) birth cohort. Methods The incidence of VT in all children under 16 years from 1997–2011 were calculated in the Danish national registries. Determinants of VT were studied in the COPSAC2010 birth cohort of 700 children. Results Nationwide the prevalence of VT was 24% in children aged 0 to 3 three years, with a significant increase over the study period. For all children 0–15 years, the incidence of VT was 35/1,000. In the VT population, 57% was male and 43% females. In the COPSAC2010 birth cohort, the prevalence of VT during the first 3 years of life was 29%. Determinants of VT were: maternal history of middle ear disease; aHR 2.07, 95% CI [1.45–2.96] and siblings history of middle ear disease; aHR 3.02, [2.11–4.32]. Paternal history of middle ear disease, presence of older siblings in the home and diagnosis of persistent wheeze were significant in the univariate analysis but the association did not persist after adjustment. Conclusion The incidence of VT is still increasing in the youngest age group in Denmark, demonstrating the highest incidence recorded in the world. Family history of middle ear disease and older siblings are the main determinants for VT.
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Affiliation(s)
- Tine Marie Pedersen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved; Denmark
| | - Anna-Rosa Cecilie Mora-Jensen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved; Denmark
| | - Johannes Waage
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Naestved Hospital, Naestved; Denmark
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Gkiousias V, Butler CC, Shepherd V, Kilgour JM, Waldron CA, Thomas-Jones E, Francis N. Parental perceptions and understanding of information provision, management options and factors influencing the decision-making process in the treatment of children with glue ear. Int J Pediatr Otorhinolaryngol 2016; 89:6-12. [PMID: 27619020 DOI: 10.1016/j.ijporl.2016.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Otitis media with effusion (OME) is a common cause of hearing loss and possible developmental delay in children, and there are a range of 'preference sensitive' treatment options. We aimed to evaluate the attitudes and beliefs of parents of affected children to treatment options including watchful-waiting, hearing aids, grommets, and, oral steroids with the intention of developing our understanding of decision-making and the factors influencing it, sources of parental information, and satisfaction with information provision. DESIGN We recruited a convenience sample of twelve parents of eleven children with OME at a single ENT department of a teaching hospital into a qualitative research study. The children of the parents interviewed had already been recruited into the Oral Steroids for the Resolution of Otitis Media with effusion In Children (OSTRICH) study. Semi structured interviews were audio recorded, transcribed and then coded using an inductive, thematic approach. RESULTS Parents were satisfied with the verbal provision of information during the treatment consultation, although many were keen to receive supplementary printed information. Discussion with family and friends helped the decision-making process, whereas insufficient information and a paternalistic approach were viewed as obstacles. Parents were particularly influenced by the following: the immediacy of the treatment option effect, perceived efficacy, perceived risks and adverse effects, social implications (especially with hearing aids) and past personal and informant experience. CONCLUSIONS Parents appreciate clinicians tailoring information provision to parents' information needs and preferred format. Clinicians should also elicit parental attitudes towards the different management options for OME and the factors influencing their decisions, in order to optimise shared-decision making and ultimately provide a better standard of clinical care.
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Affiliation(s)
- Vasileios Gkiousias
- School of Medicine, Cardiff University, University Hospital of Wales, Heath Park Campus, Cardiff, CF 14 4XW, United Kingdom.
| | - Christopher Collett Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, United Kingdom
| | - Victoria Shepherd
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
| | - James Michael Kilgour
- School of Medicine, Cardiff University, University Hospital of Wales, Heath Park Campus, Cardiff, CF 14 4XW, United Kingdom
| | - Cherry-Ann Waldron
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
| | - Emma Thomas-Jones
- South East Wales Trials Unit (SEWTU), Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
| | - Nick Francis
- Division of Population Medicine, Cardiff University, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom
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Abstract
Otitis media (OM) or middle ear inflammation is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME; 'glue ear') and chronic suppurative otitis media (CSOM). OM is among the most common diseases in young children worldwide. Although OM may resolve spontaneously without complications, it can be associated with hearing loss and life-long sequelae. In developing countries, CSOM is a leading cause of hearing loss. OM can be of bacterial or viral origin; during 'colds', viruses can ascend through the Eustachian tube to the middle ear and pave the way for bacterial otopathogens that reside in the nasopharynx. Diagnosis depends on typical signs and symptoms, such as acute ear pain and bulging of the tympanic membrane (eardrum) for AOM and hearing loss for OME; diagnostic modalities include (pneumatic) otoscopy, tympanometry and audiometry. Symptomatic management of ear pain and fever is the mainstay of AOM treatment, reserving antibiotics for children with severe, persistent or recurrent infections. Management of OME largely consists of watchful waiting, with ventilation (tympanostomy) tubes primarily for children with chronic effusions and hearing loss, developmental delays or learning difficulties. The role of hearing aids to alleviate symptoms of hearing loss in the management of OME needs further study. Insertion of ventilation tubes and adenoidectomy are common operations for recurrent AOM to prevent recurrences, but their effectiveness is still debated. Despite reports of a decline in the incidence of OM over the past decade, attributed to the implementation of clinical guidelines that promote accurate diagnosis and judicious use of antibiotics and to pneumococcal conjugate vaccination, OM continues to be a leading cause for medical consultation, antibiotic prescription and surgery in high-income countries.
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Affiliation(s)
- Anne G. M. Schilder
- evidENT, Ear Institute, University College London, Royal National Throat Nose and Ear Hospital, 330 Grays Inn Road, London, WC1X 8DA UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tasnee Chonmaitree
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas USA
| | - Allan W. Cripps
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Queensland Australia
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York USA
| | | | - Mark P. Haggard
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bruce I, Harman N, Williamson P, Tierney S, Callery P, Mohiuddin S, Payne K, Fenwick E, Kirkham J, O'Brien K. The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation. Health Technol Assess 2016; 19:1-374. [PMID: 26321161 DOI: 10.3310/hta19680] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate. OBJECTIVES To identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies. DESIGN The management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP. SETTING The survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients' homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting. PARTICIPANTS Clinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association. RESULTS The clinician survey revealed that care was predominantly delivered via a 'hub-and-spoke' model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research. CONCLUSIONS There exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered. FUNDING The National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
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Affiliation(s)
- Iain Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children's Hospital, Manchester, UK
| | - Nicola Harman
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
| | - Paula Williamson
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK.,Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Syed Mohiuddin
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Jamie Kirkham
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, UK
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Abstract
Chronic rhinitis involves inflammation of the upper airways. An association with comorbid conditions, such as rhinosinusitis, asthma, and chronic obstructive pulmonary disease, has been commonly observed in epidemiologic studies. The underlying pathogenesis of these disorders may be similar. Complications of rhinitis include sleep disturbances, learning impairment, and decreased quality of life. It is vital to recognize the complications of rhinitis so that treatment strategies can address rhinitis as well as its comorbidities and complications in a coordinated manner.
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Affiliation(s)
- Anjeni Keswani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University Medical Center, 1821 Hillandale Road, Durham, NC 27705, USA.
| | - Anju T Peters
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E Huron St, Chicago, IL 60611, USA
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Glue ear: how good is the information on the World Wide Web? The Journal of Laryngology & Otology 2016; 130:157-61. [DOI: 10.1017/s0022215115003230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This paper objectively evaluates current information available to the general public related to glue ear on the World Wide Web.Methods:The term ‘glue ear’ was typed into the 3 most frequently used internet search engines – Google, Bing and Yahoo – and the first 20 links were analysed. The first 400 words of each page were used to calculate the Flesch–Kincaid readability score. Each website was subsequently graded using the Discern instrument, which gauges quality and content of literature.Results:The websites Webmd.boots.com, Bupa.co.uk and Patient.co.uk received the highest overall scores. These reflected top scores in either readability or Discern instrument assessment, but not both. Readability and Discern scores increased with the presence of a marketing or advertising incentive. The Patient.co.uk website had the highest Discern score and third highest readability score.Conclusion:There is huge variation in the quality of information available to patients on the internet. Some websites may be accessible to a wide range of reading ages but have poor quality content, and vice versa. Clinicians should be aware of indicators of quality, and use validated instruments to assess and recommend literature.
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Harman NL, Bruce IA, Kirkham JJ, Tierney S, Callery P, O'Brien K, Bennett AMD, Chorbachi R, Hall PN, Harding-Bell A, Parfect VH, Rumsey N, Sell D, Sharma R, Williamson PR. The Importance of Integration of Stakeholder Views in Core Outcome Set Development: Otitis Media with Effusion in Children with Cleft Palate. PLoS One 2015; 10:e0129514. [PMID: 26115172 PMCID: PMC4483230 DOI: 10.1371/journal.pone.0129514] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/08/2015] [Indexed: 11/25/2022] Open
Abstract
Background Approximately 75% of children with cleft palate (CP) have Otitis Media with Effusion (OME) histories. Evidence for the effective management of OME in these children is lacking. The inconsistency in outcome measurement in previous studies has led to a call for the development of a Core Outcome Set (COS). Despite the increase in the number of published COS, involvement of patients in the COS development process, and methods to integrate the views of patients and health professionals, to date have been limited. Methods and Findings A list of outcomes measured in previous research was identified through reviewing the literature. Opinion on the importance of each of these outcomes was then sought from key stakeholders: Ear, Nose and Throat (ENT) surgeons, audiologists, cleft surgeons, speech and language therapists, specialist cleft nurses, psychologists, parents and children. The opinion of health professionals was sought in a three round Delphi survey where participants were asked to score each outcome using a bespoke online system. Parents and children were also asked to score outcomes in a survey and provided an in-depth insight into having OME through semi-structured interviews. The results of the Delphi survey, interviews and parent/patient survey were brought together in a final consensus meeting with representation from all stakeholders. A final set of eleven outcomes reached the definition of “consensus in” to form the recommended COS: hearing; chronic otitis media (COM); OME; receptive language skills; speech development; psycho social development; acute otitis media (AOM); cholesteatoma; side effects of treatment; listening skills; otalgia. Conclusions We have produced a recommendation about the outcomes that should be measured, as a minimum, in studies of the management of OME in children with CP. The development process included input from key stakeholders and used novel methodology to integrate the opinion of healthcare professionals, parents and children.
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Affiliation(s)
- Nicola L. Harman
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Iain A. Bruce
- Central Manchester University Hospitals NHS Foundation Trust, Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Jamie J. Kirkham
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Stephanie Tierney
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Peter Callery
- School of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Manchester, United Kingdom
| | - Kevin O'Brien
- The Healing Foundation Cleft and Craniofacial Clinical Research Centre, School of Dentistry, University of Manchester, Manchester, United Kingdom
| | | | - Raouf Chorbachi
- North Thames Cleft Service and the Department of Audiological Medicine/ Audiology/Cochlear implants. Great Ormond Street Hospital for Children, London, United Kingdom
| | - Per N. Hall
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Anne Harding-Bell
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Victoria H. Parfect
- Cleft Net East, Cambridge University Hospital NHS Trust, Hills Road, Cambridge, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, Department of Health & Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Debbie Sell
- North Thames Cleft Service, Speech and Language Therapy, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ravi Sharma
- North West, Isle of Man and North Wales Cleft Lip and Palate Network, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
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Praveen K, Davis EE, Katsanis N. Unique among ciliopathies: primary ciliary dyskinesia, a motile cilia disorder. F1000PRIME REPORTS 2015; 7:36. [PMID: 25926987 PMCID: PMC4371376 DOI: 10.12703/p7-36] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Primary ciliary dyskinesia (PCD) is a ciliopathy, but represents the sole entity from this class of disorders that results from the dysfunction of motile cilia. Characterized by respiratory problems appearing in childhood, infertility, and situs defects in ~50% of individuals, PCD has an estimated prevalence of approximately 1 in 10,000 live births. The diagnosis of PCD can be prolonged due to a lack of disease awareness, coupled with the fact that symptoms can be confused with other more common genetic disorders, such as cystic fibrosis, or environmental insults that result in frequent respiratory infections. A primarily autosomal recessive disorder, PCD is genetically heterogeneous with >30 causal genes identified, posing significant challenges to genetic diagnosis. Here, we provide an overview of PCD as a disorder underscored by impaired ciliary motility; we discuss the recent advances towards uncovering the genetic basis of PCD; we discuss the molecular knowledge gained from PCD gene discovery, which has improved our understanding of motile ciliary assembly; and we speculate on how accelerated diagnosis, together with detailed phenotypic data, will shape the genetic and functional architecture of this disorder.
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12
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Lang-Roth R. Hearing impairment and language delay in infants: Diagnostics and genetics. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2014; 13:Doc05. [PMID: 25587365 PMCID: PMC4273166 DOI: 10.3205/cto000108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This overview study provides information on important phoniatric and audiological aspects of early childhood hearing and language development with the aim of presenting diagnostic and therapeutic approaches. The article first addresses the universal newborn hearing screening that has been implemented in Germany for all infants since January 2009. The process of newborn hearing screening from the maternity ward to confirmation diagnostics is presented in accordance with a decision by the Federal Joint Committee (G-BA). The second topic is pediatric audiology diagnostics. Following confirmation of a permanent early childhood hearing disorder, the search for the cause plays an important role. Hereditary hearing disorders and intrauterine cytomegalovirus (CMV) infection, probably the most common cause of an acquired hearing disorder, are discussed and compared with the most common temporary hearing disorder, otitis media with effusion, which in some cases is severe enough to be relevant for hearing and language development and therefore requires treatment. The third topic covered in this article is speech and language development in the first 3 years of life, which is known today to be crucial for later language development and learning to read and write. There is a short overview and introduction to modern terminology, followed by the abnormalities and diagnostics of early speech and language development. Only some aspects of early hearing and language development are addressed here. Important areas such as the indication for a cochlear implant in the first year of life or because of unilateral deafness are not included due to their complexity.
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Affiliation(s)
- Ruth Lang-Roth
- Department of Otorhinolaryngology, Cologne University Hospital. Köln, Germany
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Schang L, De Poli C, Airoldi M, Morton A, Bohm N, Lakhanpaul M, Schilder A, Bevan G. Using an epidemiological model to investigate unwarranted variation: the case of ventilation tubes for otitis media with effusion in England. J Health Serv Res Policy 2014; 19:236-44. [PMID: 25074279 DOI: 10.1177/1355819614536886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate unwarranted variation in ventilation tube insertions for otitis media with effusion in children in England. This procedure is known to be 'overused' from clinical audits, as only one in three ventilation tube insertions conforms to the appropriateness criteria of the National Institute for Health and Care Excellence (NICE); but audits cannot identify the scale of 'underuse' - i.e. patients who would benefit but are not treated. METHODS To explore both 'underuse' and 'overuse' of ventilation tubes for otitis media with effusion, we developed an epidemiological model based on: definitions of children with otitis media with effusion expected to benefit from ventilation tubes according to NICE guidance; epidemiological and clinical information from a systematic review; and expert judgement. A range of estimates was derived using Monte Carlo simulation and compared with the number of ventilation tubes provided in the English National Health Service in 2010. RESULTS About 32,200 children in England would be expected to benefit from ventilation tubes for otitis media with effusion per year (between 20,411 and 45,231 with 90% certainty). The observed number of ventilation tubes for otitis media with effusion-associated diagnoses was 16,824. CONCLUSIONS The expected population capacity to benefit from ventilation tubes for otitis media with effusion based on NICE guidance appeared to exceed, by far, the number of ventilation tubes provided in the English National Health Service. So, while there is known 'overuse', there also may be substantial 'underuse' of ventilation tubes for otitis media with effusion if NICE criteria were applied. Future investigations of unwarranted variation should, therefore, not only focus on the patients who are treated but also consider the potential for benefit at the population level.
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Affiliation(s)
- Laura Schang
- Doctoral Student, Department of Management, London School of Economics and Political Science, England, UK
| | - Chiara De Poli
- Research Assistant, Department of Management, London School of Economics and Political Science, England, UK
| | - Mara Airoldi
- Fellow, Department of Management, London School of Economics and Political Science, England, UK
| | - Alec Morton
- Professor of Management Science, Department of Management Science, Strathclyde Business School, University of Strathclyde, Scotland, UK
| | - Natalie Bohm
- Clinical Academic Lecturer, Ear Institute, University College London, England, UK
| | - Monica Lakhanpaul
- Professor of Integrated Community Child Health, General and Adolescent Paediatrics Unit, UCL Institute of Child Health, England, UK
| | - Anne Schilder
- NIHR Research Professor and Professor of Paediatric Otorhinolaryngology, Ear Institute, University College London, England, UK
| | - Gwyn Bevan
- Professor of Policy Analysis, Department of Management, London School of Economics and Political Science, England, UK
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Gene mutations in primary ciliary dyskinesia related to otitis media. Curr Allergy Asthma Rep 2014; 14:420. [PMID: 24459089 DOI: 10.1007/s11882-014-0420-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Otitis media with effusion (OME) is the most common cause of conductive hearing loss in children and is strongly associated with primary ciliary dyskinesia (PCD). Approximately half of the children with PCD require otolaryngology care, posing a major problem in this population. Early diagnosis of PCD is critical in these patients to minimise the collateral damage related to OME. The current gold standard for PCD diagnosis requires determining ciliary structure defects by transmission electron microscopy (TEM) or clearly documenting ciliary dysfunction via digital high-speed video microscopy (DHSV). Although both techniques are useful for PCD diagnosis, they have limitations and need to be supported by new methodologies, including genetic analysis of genes related to PCD. In this article, we review classical and recently associated mutations related to ciliary alterations leading to PCD, which can be useful for early diagnosis of the disease and subsequent early management of OME.
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Risk factors for failing the hearing screen due to otitis media in Dutch infants. Eur Arch Otorhinolaryngol 2011; 269:2485-96. [PMID: 22207529 PMCID: PMC3491190 DOI: 10.1007/s00405-011-1896-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 12/15/2011] [Indexed: 11/03/2022]
Abstract
Hearing loss from otitis media (OM) can affect young children's development. Some children with persistent OM-related hearing loss and associated problems can benefit from treatment, but researchers and clinicians are still unclear on how to identify them best. The present study aims to determine which factors are most related to the hearing loss in OM, as a first step towards an effective case-finding instrument for detecting infants with persistent OM-related hearing loss. The full PEPPER ('Persistent Ear Problems, Providing Evidence for Referral') item pool includes a wide range of risk factors for OM in a single questionnaire, and is easily completed by parents or guardians. The questionnaire was sent to all children invited for the universal hearing screen at age 9 months in Limburg, The Netherlands. Repeatedly failing of the hearing screen was used as outcome marker indicative of OM-related chronic hearing loss. Univariate analyses were conducted to determine statistically significant risk factors predicting 'fail' cases at this hearing screen. Five items were found as individually predictive of hearing screen failure and subsequent referral: 'having severe cold symptoms', 'attending day care with >4 children', 'having siblings', 'severe nasal congestion' and 'male gender'. Suitably worded parental questions document risk factors for OM-related hearing loss in infants, broadly consistent with past general literature on OM risk factors, but more focused. The findings justify further optimising and evaluation of an additive or multiplicative combination of these questions as a means for selecting and routing an infant with diagnosed or suspected OM to further care.
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Selecting infants with OM that need referral and further assessment: creating a case-finding instrument. Int J Pediatr Otorhinolaryngol 2011; 75:1301-7. [PMID: 21840067 DOI: 10.1016/j.ijporl.2011.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 07/12/2011] [Accepted: 07/16/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In the Netherlands, many children are surgically treated for OM. Recent publications question the need for surgical treatment in common uncomplicated OM, although there is certainly a subgroup of infants that do need further assessment and possible treatment. The present study explores the possibility of using known and presumed risk factors for OM as an instrument for selecting and routing an infant with OM to further care. METHODS Two questionnaires were used. A questionnaire embracing a wide range of OM-related factors was sent to 6531 children aged nine months that were routinely invited for the hearing screen at nine months. In a second stage, a structured history questionnaire regarding ear and/or hearing problems, subsequent referral and/or treatment, was sent to all parents of children at age 21 months, responding to the first questionnaire. Univariate analysis was performed for identification of potential predictors for surgical treatment of OM for the whole sample as well as for 4 different subsets. Multivariable regression analysis with stepwise backward deletion was applied to arrive at a model for optimal prediction of tube insertion. A ROC (receiver operating characteristic) curve and the accompanying sensitivity and specificity values were analyzed to determine cut off values. RESULTS Univariate analysis found 10 items predicting surgical treatment for OM. Multivariable regression analysis resulted in a model with a ROC curve having an area of 0.801 and estimated coefficients for risk factors which were used to calculate a OM-score for each case. CONCLUSION The developed scoring sheet, e.g., to be used in combination with physical examinations and/or tympanometry looks promising as a predictor for those children that might benefit from further assessment and eventually surgically treatment for OM.
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Gunasekera H, O'Connor TE, Vijayasekaran S, Del Mar CB. Primary care management of otitis media among Australian children. Med J Aust 2010; 191:S55-9. [PMID: 19883358 DOI: 10.5694/j.1326-5377.2009.tb02928.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 08/24/2009] [Indexed: 11/17/2022]
Abstract
Acute otitis media (AOM) is diagnosed on the basis of acute onset of pain and fever; a red, bulging tympanic membrane; and middle ear effusion. AOM is managed with analgesia (paracetamol or non-steroidal anti-inflammatory drugs). Antibiotic therapy is minimally effective for most patients; it is most effective for children < 2 years with bilateral otitis media and for children with discharging ears. National guidelines recommend antibiotic therapy for Indigenous children with AOM. Evidence for corticosteroids, topical analgesia and xylitol are scant. Otitis media with effusion (OME) is diagnosed as the presence of middle ear effusion (type B tympanogram or immobile tympanic membrane on pneumatic otoscopy) without AOM criteria. Well children with OME with no speech and language delays can be observed for the first 3 months; perform audiological evaluation and refer to an ear, nose and throat (ENT) specialist if they have bilateral hearing impairment > 30 dB or persistent effusion. Children with effusions persisting longer than 3 months can benefit from a 2-4-week course of amoxycillin. Chronic suppurative otitis media is a chronic discharge through a tympanic membrane perforation. It is managed with regular ear cleaning (dry mopping or povidone-iodine [Betadine] washouts) until discharge resolves; topical ear drops (eg, ciprofloxacin); audiological evaluation; and ENT review.
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Morris PS, Richmond P, Lehmann D, Leach AJ, Gunasekera H, Coates HLC. New horizons: otitis media research in Australia. Med J Aust 2010; 191:S73-7. [PMID: 19883362 DOI: 10.5694/j.1326-5377.2009.tb02932.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 09/21/2009] [Indexed: 11/17/2022]
Abstract
Otitis media affects nearly all children worldwide. Despite an enormous amount of research, our understanding of this common condition continues to be challenged. New pathogens involved in otitis media are still being identified. The importance of interactions between viral and bacterial infection and the role of new vaccines need to be clarified. The proposal that bacteria can become more resistant to therapy through biofilm formation and intracellular infection could have important implications for treatment. The most important clinical research findings have been summarised in systematic reviews. In developed countries, research supporting "watchful waiting" of otitis media with effusion and acute otitis media have had most impact on evidence-based clinical practice guidelines. Indigenous Australian children remain at risk of more severe otitis media. Research programs targeting this population have been well supported. Unfortunately, interventions that can dramatically improve outcomes have remained elusive. For children at high risk of otitis media, health care services should concentrate on accurate diagnosis, antibiotic treatment of suppurative infections, and scheduled follow-up of affected children. Despite the lack of recent studies, strategies to minimise the impact the hearing loss associated with otitis media are important. Improvements in education, hygiene practices, and living conditions are likely to reduce the incidence and severity of otitis media. Studies of these types of interventions are needed.
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Affiliation(s)
- Peter S Morris
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia.
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Management of otitis media with effusion in children with primary ciliary dyskinesia: a literature review. Int J Pediatr Otorhinolaryngol 2009; 73:1630-8. [PMID: 19796826 DOI: 10.1016/j.ijporl.2009.08.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Revised: 08/20/2009] [Accepted: 08/23/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Primary ciliary dyskinesia is an autosomal recessively inherited group of disorders of ciliary ultrastructure. Otolaryngologists are frequently involved in the management of some of the most common symptoms of primary ciliary dyskinesia including chronic rhinitis, sinusitis and otitis media with effusion. A dilemma for otorhinolaryngologists is whether ventilation tubes are of benefit in children with primary ciliary dyskinesia and otitis media with effusion and what effective alternatives exist. This paper aims to address this issue via a literature review and case presentation. METHODS An extensive review of the literature was undertaken and a discussion of the advantages and disadvantages of ventilation tubes in the management of otitis media with effusion in these children is presented and compared with that of the general population. We present a case of a 9 months old boy with Kartagener's Syndrome and chronic bilateral otitis media with effusion to illustrate our findings. RESULTS Eight papers were identified, all with small study numbers. The main outcome measures were hearing, otorrhoea and tympanic membrane structural changes. The natural history of otitis media with effusion and hearing loss in primary ciliary dyskinesia appears to be fluctuant into adulthood. Therefore, otitis media with effusion in primary ciliary dyskinesia does not resolve by the age of 9 years, regardless of treatment, as previously assumed. Ventilation tube insertion improves hearing in primary ciliary dyskinesia, but may lead to a higher rate of otorrhoea when compared to the general population. Tympanic membrane changes were clinically insignificant. Our patient eventually underwent successful insertion of bilateral ventilation tubes with a marked improvement in hearing and language with minimal otorrhoea. CONCLUSION/DISCUSSION The highest level of evidence found for the management of otitis media with effusion in children with primary ciliary dyskinesia was level IV. Currently, the evidence is inconclusive and conflicting. Whilst our results are promising, clearly higher quality research on a larger number of patients is required to definitively evaluate the management options for otitis media with effusion in these children.
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Abstract
Otitis media (OM) is a common illness in young children. OM has historically been associated with frequent and severe complications. Nowadays it is usually a mild condition that often resolves without treatment. For most children, progression to tympanic membrane perforation and chronic suppurative OM is unusual (low-risk populations); this has led to reevaluation of many interventions that were used routinely in the past. Evidence from a large number of randomized controlled trials can help when discussing treatment options with families. Indigenous children in the United States, Canada, Northern Europe, Australia, and New Zealand experience more OM than other children. In some places, Indigenous children continue to suffer from the most severe forms of the disease. Communities with more than 4% of the children affected by chronic tympanic membrane perforation have a major public health problem (high-risk populations). Higher rates of invasive pneumococcal disease, pneumonia, and chronic suppurative lung disease (including bronchiectasis) are also seen. These children will often benefit from effective treatment of persistent (or recurrent) bacterial infection.
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Grammatikos AP, Mantadakis E, Falagas ME. Meta-analyses on Pediatric Infections and Vaccines. Infect Dis Clin North Am 2009; 23:431-57. [DOI: 10.1016/j.idc.2009.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
Upper respiratory tract infections (including otitis media) are the most common illnesses affecting children. Most illnesses are mild and resolve completely without specific treatment, but the frequency of infection and association with fever and constitutional symptoms creates significant distress for the child and the family. By understanding the evidence available from high-quality studies, the clinician can advise the families on appropriate action. The goal of this article is to support clinicians in answering the following questions: (1) What happened to children with these conditions when no additional treatment was provided? (2) Which interventions have been assessed in well-designed studies? (3) Which interventions have been shown to improve outcomes? (4) How large is the overall benefit?
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Affiliation(s)
- Peter S Morris
- Child Health Division, Menzies School of Health Research, Casuarina, NT 0811, Darwin, Australia.
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Lehmann D, Weeks S, Jacoby P, Elsbury D, Finucane J, Stokes A, Monck R, Coates H. Absent otoacoustic emissions predict otitis media in young Aboriginal children: a birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia. BMC Pediatr 2008; 8:32. [PMID: 18755038 PMCID: PMC2538518 DOI: 10.1186/1471-2431-8-32] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 08/28/2008] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Otitis media (OM) is the most common paediatric illness for which antibiotics are prescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a younger age, is more common and more likely to result in hearing loss than in non-Aboriginal children. Absent transient evoked otoacoustic emissions (TEOAEs) may predict subsequent risk of OM. METHODS 100 Aboriginal and 180 non-Aboriginal children in a semi-arid zone of Western Australia were followed regularly from birth to age 2 years. Tympanometry was conducted at routine field follow-up from age 3 months. Routine clinical examination by an ENT specialist was to be done 3 times and hearing assessment by an audiologist twice. TEOAEs were measured at ages <1 and 1-2 months. Cox proportional hazards model was used to investigate the association between absent TEOAEs and subsequent risk of OM. RESULTS At routine ENT specialist clinics, OM was detected in 55% of 184 examinations in Aboriginal children and 26% of 392 examinations in non-Aboriginal children; peak prevalence was 72% at age 5-9 months in Aboriginal children and 40% at 10-14 months in non-Aboriginal children. Moderate-severe hearing loss was present in 32% of 47 Aboriginal children and 7% of 120 non-Aboriginal children aged 12 months or more. TEOAE responses were present in 90% (46/51) of Aboriginal children and 99% (120/121) of non-Aboriginal children aged <1 month and in 62% (21/34) and 93% (108/116), respectively, in Aboriginal and non-Aboriginal children at age 1-2 months. Aboriginal children who failed TEOAE at age 1-2 months were 2.6 times more likely to develop OM subsequently than those who passed. Overall prevalence of type B tympanograms at field follow-up was 50% (n = 78) in Aboriginal children and 20% (n = 95) in non-Aboriginal children. CONCLUSION The burden of middle ear disease is high in all children, but particularly in Aboriginal children, one-third of whom suffer from moderate-severe hearing loss. In view of the frequently silent nature of OM, every opportunity must be taken to screen for OM. Measurement of TEOAEs at age 1-2 months to identify children at risk of developing OM should be evaluated in a routine health service setting.
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Affiliation(s)
- Deborah Lehmann
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Australia
| | - Sharon Weeks
- Professional Hearing Services, South Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Australia
| | - Dimity Elsbury
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Australia
| | - Janine Finucane
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Australia
| | - Annette Stokes
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Australia
| | - Ruth Monck
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Australia
| | - Harvey Coates
- School of Paediatrics and Child Health, the University of Western Australia, Australia
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