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Collins A, Beswick R, Driscoll C, Kei J, Traves L. Otolaryngology outcomes of infants with conductive hearing loss identified through universal newborn hearing screening. Int J Pediatr Otorhinolaryngol 2024; 181:111970. [PMID: 38733945 DOI: 10.1016/j.ijporl.2024.111970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE Infants and children diagnosed with a conductive hearing loss (CHL) are often referred for otolaryngology assessment. Although this is also a regular occurrence for infants diagnosed with a CHL through Universal Newborn Hearing Screening (UNHS), less is known about these infants and their outcomes. Using a cohort of infants diagnosed with CHL through UNHS and referred to otolaryngology, this study aimed to investigate the relationship between specific demographic or clinical characteristics and 1) triage category 2) middle ear diagnosis and intervention and, 3) service-related factors at otolaryngology. METHODS Retrospective analysis through clinical chart review was performed on all infants born between January 2014 and December 2017 who referred on UNHS, diagnosed with a CHL and referred to the Queensland Children's Hospital. Descriptive analysis and Chi squared analysis was conducted on data from 95 records. RESULTS Analysis between all infants referred from UNHS and those who referred, diagnosed with CHL and then referred to otolaryngology suggest that bilateral referrals/medical exclusion, preterm and infants with ≥1 risk factors are more readily associated with referral to otolaryngology for CHL. Nearly all (92.86 %) infants who were referred to otolaryngology had a primary diagnosis of OM and most infants (89.66 %) received grommets as an intervention. The average age of first appointment at otolaryngology was 427 days, the average age of intervention was 579 days and the average occasions of service at otolaryngology was 6.72. CONCLUSION This paper provides a snapshot into the journey and outcomes of infants referred from UNHS, diagnosed with CHL, and referred to otolaryngology. Further investigation in both general and UNHS populations is needed to better understand and apply these findings.
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Affiliation(s)
- Alison Collins
- Hearing Research Unit for Children, Division of Audiology, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 4072; Children's Health Queensland Hospital and Health Service, Child and Youth Community Health Service, 10 Chapel Street, Nundah, Queensland, Australia, 4012.
| | - Rachael Beswick
- Children's Health Queensland Hospital and Health Service, Child and Youth Community Health Service, 10 Chapel Street, Nundah, Queensland, Australia, 4012.
| | - Carlie Driscoll
- Hearing Research Unit for Children, Division of Audiology, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 4072.
| | - Joseph Kei
- Hearing Research Unit for Children, Division of Audiology, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 4072.
| | - Lia Traves
- Queensland Children's Hospital, Audiology Department, 501 Stanley Street, South Brisbane, QLD, 4101, Australia
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Rakhmanova IV, Tumanova EL, Matroskin AG, Korchagina NS, Kotov RV, Ishanova YS. [Morphological changes in the epithelium of the auditory tube with prolonged respiratory support in children of the first year of life]. Vestn Otorinolaringol 2023; 88:17-21. [PMID: 36867139 DOI: 10.17116/otorino20228801117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To analyze the condition of the epithelium of the cartilaginous part of the auditory tube in premature and full-term infants with prolonged respiratory support using noninvasive assisted ventilation (continuous positive airway pressure - CPAP) and artificial lung ventilation (ventilator). MATERIAL AND METHODS All the obtained material is distributed relative to the gestation period into the main and control groups. The main group (25 children) is represented by premature and full-term live-born children who were on respiratory support for a period of several hours to 2 months, the average gestation period of which was 30 weeks and 40 weeks, respectively. The control group (8 children) is represented by stillborn newborns with an average gestation period of 28 weeks. The study was conducted posthumously. RESULTS Prolonged use of respiratory support in premature and full-term children, regardless of the type (CPAP or ventilator), leads to a violation of the row of cilia of the ciliated epithelium, various inflammatory processes, as well as to the expansion of the ducts of the mucous glands of the epithelium of the auditory tube, which affects its drainage system. CONCLUSION Prolonged respiratory support causes destructive changes in the epithelium of the auditory tube, which make it difficult to evacuate the mucous discharge from the tympanic cavity. This negatively affects the ventilation function of the auditory tube and in the future may lead to the development of chronic exudative otitis media.
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Affiliation(s)
- I V Rakhmanova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E L Tumanova
- Pirogov Russian National Research Medical University, Moscow, Russia.,N.F. Filatov Children's City Clinical Hospital, Moscow, Russia
| | - A G Matroskin
- Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - N S Korchagina
- N.F. Filatov Children's City Clinical Hospital, Moscow, Russia.,Research Institute of Healthcare Organization and Medical Management, Moscow, Russia
| | - R V Kotov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Morozovskaya Children's City Clinical Hospital, Moscow, Russia
| | - Yu S Ishanova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Zloczower E, Bartov N, Allon R, Sokolov M, Lahav Y, Shoffel-Havakuk H. The impact of birth weight and gestational age on acute mastoiditis in children. Eur Arch Otorhinolaryngol 2022; 280:2133-2139. [PMID: 36153783 DOI: 10.1007/s00405-022-07672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Previous data correlate preterm and low birth weight (LBW) with acute otitis media, but there is a gap concerning the relations with acute mastoiditis (AM). This study investigates the effect of LBW and preterm birth on AM disease severity, neuro-otological complications, and recurrence. STUDY DESIGN Retrospective cohort. SETTING Tertiary medical center. METHODS The cohort is retrospective in nature consisting of 294 children with AM admitted between 1999 and 2020. Data collection included: patient gestational age and birth weight, signs and symptoms, physical examination, laboratory tests, imaging findings, and long-term outcomes. RESULTS 294 cases of AM were included, 41/281 (15%) had LBW (< 2500 g), and 46/294 (15.7%) were preterm (gestational age < 37 weeks). We found no significant differences in laboratory tests, imaging studies (CT), rate of mastoidectomy performed, or late complications between LBW and normal birth weight (NBW) and between preterm and normal gestational age children. LBW children tended to develop AM at an older age compared with NBW children, 2.28 + 1.64 Vs. 1.84 + 1.4 years, respectively (p-value = 0.016). Additionally, preterm children were more prone to develop a second event of AM, with a shorter interval between these episodes. CONCLUSIONS LBW and preterm birth are not independent risk factors for disease severity, need for intervention, or future complications in AM. Yet, LBW children present with AM at an older age, and preterm children are more prone for recurrent episodes of AM with a shorter interval between episodes suggesting a distinct disease course in these populations.
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Affiliation(s)
- Elchanan Zloczower
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Noam Bartov
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Raviv Allon
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Meirav Sokolov
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Lahav
- Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Hadassah Medical School, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Hagit Shoffel-Havakuk
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel
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50 Years Ago in TheJournalofPediatrics: Neonatal Otitis Media: Diagnostic Difficulties and Outcomes. J Pediatr 2021; 238:180. [PMID: 34702495 DOI: 10.1016/j.jpeds.2021.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Anthropometry: A clue for Otorhinolaryngology surgical indications in children. Int J Pediatr Otorhinolaryngol 2020; 139:110421. [PMID: 33035803 DOI: 10.1016/j.ijporl.2020.110421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are reports in literature concerning the relation between some maternal and neonatal factors and future risk of disease, including atopy, recurrent infections and obstructive sleep disturbances, three common pathologies eliciting surgery in children. OBJECTIVE To evaluate if maternal and neonatal factors can relate to Otorhinolaryngology surgical indications in a cohort of children treated in a tertiary referral center. MATERIAL AND METHODS A retrospective analysis of data from children submitted to primary Otorhinolaryngology surgery in the pediatric ambulatory unit of Centro Hospitalar Universitário do Porto between March 2016 and March 2020 was performed. Children with orofacial congenital anomalies were excluded and 1256 children met the eligibility criteria. The associations between maternal and neonatal factors and the development of atopy, recurrent infections and obstructive sleep apnea were analyzed. RESULTS Atopic children showed higher birth weight percentile (p < 0,001) and birth weight-for-length index (p < 0,001) compared with non-atopic. Weight-at-surgery was also higher in atopic patients (p = 0,002). Maternal atopy significantly increased the risk of children atopic disease (p < 0,001; Odds Ratio 4,359). Children indicated for surgery for recurrent infections showed lower birth weight-for-length index (p = 0,038) and lower probability of atopic disease (p < 0,001). Recurrent acute otitis media related to both lower birth weight-for-length index (p = 0,002) and birth body mass index (p = 0,023). There was not a significant higher incidence of sleep apnea in preterm infants (p = 0,488). Obstructive sleep apnea patients showed lower weight-at-surgery percentile (p = 0,045). CONCLUSION This work suggests an association between birth anthropometric measurements and atopic and infectious diseases later in life, irrespective of gestational age. There was no consistent association between perinatal parameters and obstructive sleep apnea, but the impact of disordered breathing in childhood anthropometry was significative.
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Beyea JA, Nguyen P, Hall SF. Clinical predictors of multiple tympanostomy tube placements in Ontario children. Laryngoscope 2017; 128:991-997. [PMID: 28895152 DOI: 10.1002/lary.26889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To characterize risk factors that predict the need for multiple tympanostomy tube (TT) procedures. STUDY DESIGN Retrospective population-based cohort study of children aged 18 years and younger in Ontario, Canada, who underwent at least one TT placement between January 1, 1994, and October 31, 2013. METHODS The relative risk (RR) of need for multiple TT procedures was determined using log-binomial regression. RESULTS There were 193,880 children who underwent TT insertion included in this cohort. Of these, 28.58% underwent at least two separate TT procedures. Over time, the RR of undergoing multiple TT procedures is decreasing for all children. In general, the younger the child was at the first TT procedure, the more likely the child was to undergo multiple TT procedures. Significantly higher RR for multiple TT procedures also was associated with male sex, the second-highest neighborhood income quintile, asthma or reactive airways, gastrointestinal disease, prematurity, or cleft lip and/or palate. Significantly lower RR for multiple TT procedures was associated with adenoidectomy or tonsillectomy (with or without adenoidectomy) at first TT placement or within 3 years prior. Furthermore, the benefit of adjuvant adenoidectomy or tonsillectomy was present for children aged under 4 years, in addition to those aged 4 years and older. CONCLUSION Among Ontario children who have had TT placement, more than one in four will have multiple sets placed. These identified risk factors permit improved preoperative counseling and enable identification of children who need closer follow-up. LEVEL OF EVIDENCE 2b. Laryngoscope, 128:991-997, 2018.
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Affiliation(s)
- Jason A Beyea
- Department of Otolaryngology, Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada
| | - Paul Nguyen
- Institute for Clinical Evaluative Sciences (ICES), Queen's University, Kingston, Ontario, Canada
| | - Stephen F Hall
- Department of Otolaryngology, Hotel Dieu Hospital, Queen's University, Kingston, Ontario, Canada
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Abstract
BACKGROUND Age at exposure to acute otitis media (AOM) risk factors such as day care attendance, lack of breastfeeding and tobacco smoke is little studied but important for targeting AOM prevention strategies. Moreover, studies are typically restricted to clinically diagnosed AOM, while a significant subset can occur outside the health care system, depending on the country setting. This study aims to determine risk factor exposure and effect of its timing within the first year of life on parent-reported AOM symptom episodes. METHODS In the WHeezing and Illnesses STudy LEidsche Rijn birth-cohort study, 1056 children were prospectively followed during their first year of life. Group day care attendance, breastfeeding and tobacco smoke exposure were recorded monthly and parent-reported AOM symptoms daily. Generalized estimating equations were used to estimate the association between the time-varying risk factors and AOM symptom episodes, while correcting for confounding by indication. RESULTS The first-year incidence rate of parent-reported AOM was 569/1000 child-years [95% confidence interval (CI): 523-618]. Children who attended day care had higher odds of developing AOM symptom episodes compared with those not attending (odds ratio: 5.0; 95% CI: 2.6-9.6). Tobacco smoke exposure and (a history of) breastfeeding were not associated with AOM. Test for interaction revealed that the effect of day care increased with each month younger in age. CONCLUSIONS First-year day care attendance is a major risk factor for AOM symptom episodes among infants in the community. This adjusted effect estimate is higher than previously reported and is age-dependent. AOM prevention strategies in day care facilities should therefore focus in particular on the youngest age groups.
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Kørvel-Hanquist A, Koch A, Niclasen J, Dammeye J, Lous J, Olsen SF, Homøe P. Risk Factors of Early Otitis Media in the Danish National Birth Cohort. PLoS One 2016; 11:e0166465. [PMID: 27851778 PMCID: PMC5113063 DOI: 10.1371/journal.pone.0166465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/28/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess risk factors of otitis media (OM) in six-months-old children. METHOD The sample consisted of 69,105 mothers and their children from the Danish National Birth Cohort. The women were interviewed twice during pregnancy and again 6 months after birth. The outcome "one or more" maternal reported episodes of OM at age six months. In total 37 factors were assessed, covering prenatal, maternal, perinatal and postnatal factors. RESULTS At age six months 5.3% (95% CI 5.1-5.5) of the children had experienced one or more episodes of OM. From the regression analysis, 11 variables were associated with a risk of OM. When a Bonferroni correction was introduced, gender, prematurity, parity, maternal age, maternal self-estimated health, taking penicillin during pregnancy, and terminating breastfeeding before age six months, was associated with a risk of early OM. The adjusted ORs of OM for boys versus girls was 1.30 (95% CI 1.18-1.44). The OR having one sibling versus no siblings was 3.0 (95% CI 2.64-3.41). If the woman had been taking penicillin during pregnancy, the OR was 1.35 (95% CI 1.15-1.58). Children born before 38th gestational week had an increased OR for early OM of 1.49 (95% CI 1.21-1.82). Children of young women had an increased OR of early OM compared to children of older women. Additionally, children of women who rated their own health low compared to those rating their health as high, had an increased OR of 1.38 (95% CI 1.10-1.74). Finally, children being breastfeed less than 6 months, had an increased OR of 1.42 (95% CI 1.28-1.58) compared to children being breastfeed beyond 6 months. CONCLUSION These findings indicate that prenatal factors are of less importance regarding early OM before the age of six months. Postnatal risk factors seem to pose the main risk of early OM.
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Affiliation(s)
- Asbjørn Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
- * E-mail:
| | - Anders Koch
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Janni Niclasen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Center for Collaborative Health, Aarhus University, Aarhus, Denmark
| | - Jesper Dammeye
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Lous
- Research Unit for General Practice Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sjurdur Frodi Olsen
- Department of Epidemiology Research, Centre for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Association of Gestational Age at Birth with Reasons for Subsequent Hospitalisation: 18 Years of Follow-Up in a Western Australian Population Study. PLoS One 2015; 10:e0130535. [PMID: 26114969 PMCID: PMC4482718 DOI: 10.1371/journal.pone.0130535] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 05/22/2015] [Indexed: 12/02/2022] Open
Abstract
Background Preterm infants are at a higher risk of hospitalisation following discharge from the hospital after birth. The reasons for rehospitalisation and the association with gestational age are not well understood. Methods This was a retrospective birth cohort study of all live, singleton infants born in Western Australia between 1st January 1980 and 31st December 2010, followed to 18 years of age. Risks of rehospitalisation following birth discharge by principal diagnoses were compared for gestational age categories (<32, 32–33, 34–36, 37–38 weeks) and term births (39–41weeks). Causes of hospitalisations at various gestational age categories were identified using ICD-based discharge diagnostic codes. Results Risk of rehospitalisation was inversely correlated with gestational age. Growth-related concerns were the main causes for rehospitalisation in the neonatal period (<1 month of age) for all gestational ages. Infection was the most common reason for hospitalisation from 29 days to 1 year of age, and up to 5 years of age. Injury-related hospitalisations increased in prevalence from 5 years to 18 years of age. Risk of rehospitalisation was higher for all preterm infants for most causes. Conclusions The highest risks of rehospitalisation were for infection related causes for most GA categories. Compared with full term born infants, those born at shorter GA remain vulnerable to subsequent hospitalisation for a variety of causes up until 18 years of age.
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Hoffman HJ, Daly KA, Bainbridge KE, Casselbrant ML, Homøe P, Kvestad E, Kvaerner KJ, Vernacchio L. Panel 1: Epidemiology, natural history, and risk factors. Otolaryngol Head Neck Surg 2013; 148:E1-E25. [PMID: 23536527 DOI: 10.1177/0194599812460984] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The First International Symposium on Recent Advances in Otitis Media (OM) with Effusion was held in Columbus, Ohio, in 1975. The symposium has been organized in the United States every 4 years since, followed by a research conference to (a) assess major research accomplishments, (b) identify important research questions and opportunities, (c) develop consensus on definitions and terminology, and (d) establish priorities with short- and long-term research goals. One of the principal areas reviewed quadrennially is Epidemiology, Natural History, and Risk Factors. OBJECTIVE To provide a review of recent literature on the epidemiology, natural history, and risk factors for OM. DATA SOURCES AND REVIEW METHODS A search of OM articles in English published July 2007 to June 2011 was conducted using PubMed and related databases. Those with findings judged of importance for epidemiology, public health, and/or statistical methods were reviewed. RESULTS The literature has continued to expand, increasing understanding of the worldwide burden of OM in childhood, complications from treatment failures, and comorbidities. Novel risk factors, including genetic factors, have been examined for OM susceptibility. Population-based studies in Canada, the United States, and other countries confirmed reductions in OM prevalence. Although most studies concentrated on acute OM (AOM) or OM with effusion (OME), a few examined severe chronic suppurative OM (CSOM), a major public health problem in developing countries and for certain indigenous populations around the world. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Recent publications have reinforced earlier epidemiological findings, while extending our knowledge in human population groups with high burden of OM.
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Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, Maryland 20892, USA.
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Clinical features and outcome of acute otitis media in early infancy. Int J Infect Dis 2013; 17:e317-20. [DOI: 10.1016/j.ijid.2012.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 11/05/2012] [Accepted: 11/09/2012] [Indexed: 11/17/2022] Open
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McAfee JS, Demarcantonio M, Fine BR, Beydoun H, Derkay CS. Prevalence of ventilation tubes in children with a tracheostomy tube. Int J Pediatr Otorhinolaryngol 2013; 77:65-8. [PMID: 23131201 DOI: 10.1016/j.ijporl.2012.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/20/2012] [Accepted: 09/22/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To estimate the prevalence of operative ear disease in pediatric patients with tracheostomy tubes, as well as to identify risk factors predictive of operative otologic interventions in this patient cohort. METHODS We hypothesize that the prevalence of operative middle ear disease in patients with a tracheostomy tube is greater than that of the population at large. To validate our anecdotal observations, we queried the CHCA hospital database (PHIS) regarding the association between tympanostomy tube placements in children with tracheostomies. To further investigate, a retrospective chart review was undertaken at our regional tertiary care children's hospital to determine the frequency at which tympanostomy tubes were placed in children who have a tracheostomy. Risk factors were analyzed, applying independent samples t-tests and Pearson's Chi-square test. Univariate and multivariate logistic regression models were constructed to estimate odds ratios (OR) and 95% confidence intervals (CI) for predictors of operative ear disease. Institutional review board (IRB) approval was obtained. RESULTS Of a population of 181 patients with tracheostomies, 37 (or 20%, 95% CI 15-26%) have undergone placement of ventilation tubes in the past 3 years. No statistically significant difference was noted with regards to gender or race. The operative group had an average age of 23.0 months at the time of tracheostomy, compared to 52.5 months in the non-operative group (p=0.0022). In addition, home living situation, term birth, and craniofacial abnormalities were more frequently observed in the operative versus the non-operative group. Multivariate logistic regression models revealed the same factors as predictors of operative ear disease. CONCLUSION The presence of a tracheostomy is associated with an increased risk of requiring ventilation tube placement over the population at large. Risk factors for operative middle ear disease among these children include age at time of the tracheostomy, craniofacial abnormalities, term birth, and home living situation.
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Affiliation(s)
- J Seth McAfee
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, United States
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Zou Y, Jin HX, Wang RS, Li HF, Jin PG. Comparison of risk factors for recurrent respiratory infections between urban and rural preschool children in Yiwu, China. World J Pediatr 2012; 8:145-50. [PMID: 22573425 DOI: 10.1007/s12519-012-0352-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 10/10/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Many studies have shown an association between the risk of increased recurrent respiratory infections and socioeconomic and fostering factors, but often only a few risk factors have been studied. This study aimed to identify and compare such factors between urban and rural preschool children. METHODS Case control studies were conducted in Yiwu urban and rural areas respectively in Zhejiang Province. A structured questionnaire was used to collect information on influencing factors such as socioeconomic factors, fostering factors, and housing conditions. The chi-square test was used to compare the distribution of some health related factors between urban and rural children. Risk factor analyses were also made in urban and rural children respectively. Univariate and multivariate analyses were made using the binary logistic regression. RESULTS Multivariate analysis showed that maternal age (OR=0.94, 95%CI: 0.89-0.99), asthma (OR=2.34, 95%CI: 1.22-4.48), rickets (OR=5.03, 95%CI: 2.10-12.05), snack (OR=1.62, 95%CI: 1.19-2.20), traffic mode (OR=1.38, 95%CI: 1.03-1.86), living with patients with chronic respiratory system disease (OR=1.79, 95%CI: 1.02-3.15), and indoor passive smoking (OR=1.46, 95%CI: 1.02-2.10) were the influencing factors for recurrent respiratory infections in urban children. Rickets (OR=3.77, 95% CI: 1.13-12.65) and passive smoking (OR=2.33, 95% CI: 1.17-4.65) were the influencing factors for recurrent respiratory infections in rural children. CONCLUSIONS Public health measures against risk factors should be taken to prevent the occurrence of recurrent respiratory infections in urban and rural children respectively.
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Affiliation(s)
- Yan Zou
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
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Abstract
Acute otitis media is frequently encountered by general practitioners and pediatricians. In the neonatal period acute otitis media may present as an isolated local infection or as part of septicemia. Diagnosis of the condition by otoscopy is difficult. Considering the wide spectrum of middle ear disorders (acute otitis media, otitis media with effusion, chronic suppurative otitis media) one can appreciate why opinions on the management of the condition are diverse. This is a review of the literature on clinical presentation, etiology, risk factors, treatment and prevention of acute otitis media in neonatal life.
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Affiliation(s)
- A Syggelou
- 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
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Bluestone CD, Swarts JD. Human evolutionary history: consequences for the pathogenesis of otitis media. Otolaryngol Head Neck Surg 2010; 143:739-44. [PMID: 21109071 DOI: 10.1016/j.otohns.2010.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/23/2010] [Accepted: 08/13/2010] [Indexed: 10/18/2022]
Abstract
The pathogenesis of otitis media is multifactorial, but the role of evolution on its development has not been addressed. We posit that the high prevalence of middle-ear disease is most likely restricted to humans, in contrast to other wild species, because the associated hearing loss would have reduced the fitness of affected individuals as a result of predation. We present here the possible consequences of two human adaptations that may have resulted in ubiquitous otitis media: the interaction of bipedalism and increased brain size, and the loss of facial prognathism resulting from speech or cooking. As a consequence of our adaptation for bipedalism, the female pelvic outlet is constricted, which, in the context of a rapidly enlarging brain, results in humans being born 12 months too soon. Significantly, immature eustachian tube structure and function, in conjunction with an immature immune system, helps to explain the high incidence of otitis media in the first year of life. But the persistence of middle-ear disease beyond this stage is not explained by "immaturity." The morphology of the palate changed with the adaptations that produced facial flattening, with concomitant effects on eustachian tube function. These changes resulted in relatively poor human physiologic tubal function in comparison to the nonhuman primate.
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Affiliation(s)
- Charles D Bluestone
- Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA.
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