Disappearance of middle ear effusion in acute otitis media monitored daily with tympanometry

BACKGROUND

Disappearance of middle ear effusion is one of the most important outcomes in the treatment of acute otitis media (AOM).

AIM

To evaluate the duration of effusion in AOM treated by antimicrobials and to find factors influencing it.

METHODS

Parents of 90 children with AOM monitored daily the disappearance of effusion with tympanometry. The children were randomly allocated to be treated with either oral amoxicillin or cefuroxime-axetil for 10 d. Daily monitoring lasted for 14 d or until the tympanogram was normal (curve A or C) in both ears. Pneumatic otoscopy was carried out every 2 wk.

RESULTS

Normal tympanograms were obtained after a median time of 7.5 d (range 1-58 d) among 75 successfully monitored patients. In two-thirds (69%) of them, effusion resolved in 14 d. The median duration of effusion did not differ significantly between the two treatment groups (8 vs 7 days, p=0.7). The children who had unilateral AOM cured more rapidly than those with bilateral AOM (5 vs 19 d, p<0.001). In logistic regression analysis adjusted for age, bilaterality explained treatment failure at 2 wk with an odds ratio of 28.1 (95% CI 4.6-169.5, p<0.001).

CONCLUSION

The choice of antimicrobials did not influence the duration of middle ear effusion, which was much shorter than had been thought previously. Children with unilateral AOM were cured much more quickly than those with bilateral AOM.

Will hearing healthcare be affordable in the new millennium

Calculations of the needs of healthcare, hearing healthcare included, are usually based on clinical data rather than on valid prevalence figures. According to our recent population study, the number of citizens needing hearing aids in Finland will be twice the figure usually presented, 280 000 for the country as a whole (population 5.1 million). The penetration of hearing aids was only 41%. Taking this and the ageing of the population into account, the economic challenges of hearing healthcare will be alarming in the new millennium.

Do we know the real need for hearing rehabilitation at the population level? Hearing impairments in the 5- to 75-year-old cross-sectional Finnish population

The cross-sectional population sample studied here was randomly selected from the population register of northern Finland. The subjects comprised 10 different age groups between 2 and 75 years of age. Pure tone averages over the frequencies of both 0.5, 1 and 2 kHz and 0.5, 1, 2 and 4 kHz - i.e. better ear hearing levels (BEHL) of BEHL0.5-2kH and BEHL0.5-4kHz - were calculated. The prevalence of various grades of hearing impairment was investigated among the 3518 people who participated in audiometric measurements. Two different classifications were used to grade the hearing impairment. According to the World Health Organization (WHO) classification (1991), 94.3% of the subjects had normal hearing, whereas 3.8% had mild hearing impairment, 1.3% had moderate impairment, 0.4% severe impairment and 0.1% profound impairment. When the more recent EU definition (1996) was used, 85.3% of the subjects had normal hearing. Mild impairment was found in 11.5% of the subjects, moderate impairment in 2.8%, severe impairment in 0.3%, and profound in 0.1%. The difference between the two definitions mentioned above (resulting in different prevalence figures of hearing impairments) is clear. The WHO classification reveals the need for rehabilitation and can thus be used as a basis of resource allocation, whereas the EU proposal reveals even the mildest hearing impairments and hence better illustrates the real prevalence of impairment. The need for the current and future audiological services may be estimated from the prevalence rates of hearing impairments. The proportion of the Finnish elderly - the people most frequently using health services - is expected to increase from today's 15% to 23% within the next 20 years. The same phenomenon is to be expected in other Western societies.

Hearing in 55 to 75 year old people in northern Finland--a comparison of two classifications of hearing impairment

A total of 5,400 persons from different age groups was randomly selected from the population register for the study, and of the 1,620 55 to 75 year old persons invited, 1,233 attended the check-ups (76.1%). Air conduction pure tone thresholds were measured at the frequencies of 0.25, 0.5, 1, 2, 3, 4, 6 and 8 kHz. The findings were interpreted according to both the EU and WHO classifications. According to the WHO classification, 1,046 subjects (85.0%) had normal hearing and 124 persons (10.1%) had a mild hearing impairment, 44 (3.6%) a moderate, 13 (1.1%) a severe and 3 (0.2%) had a profound hearing impairment. According to the EU classification, 758 subjects (61.6%) were found to have normal hearing, a mild impairment was observed in 363 persons (29.5%), a moderate hearing impairment in 96 (7.8%) and a severe impairment in 13 (1.1%) persons. None had a profound hearing impairment. The difference between these classifications is remarkable as is evident in even this small study. A thorough discussion on the role of different gradings for hearing is needed.

Lack of specific symptomatology in children with acute otitis media

Although the symptoms of the acutely ill child are important both in the diagnosis and follow-up of acute otitis media (AOM), data about them are quite limited. We carried out a prospective survey by collecting information on 354 consecutive children visiting a pediatrician, otolaryngologist or general practitioner because of any kind of acute symptoms to compare symptoms of children with acute otitis media with those of children with other acute infectious diseases. The symptoms and signs observed at home were recorded by the parents before the visit and the findings in the physical examination were recorded later by the physician. AOM was diagnosed in 191 patients (54.0%). The most important symptoms increasing the likelihood of AOM significantly were ear-related symptoms, such as earache (relative risk (RR) 5.4; P < 0.001), rubbing of the ear (RR 5.0; P < 0.001) and feeling of blocked ear (RR 4.5; P < 0.05). However, only 67.7% of children younger than 2 years of age with AOM had any ear-related symptoms. The children with tympanostomy tubes had earache (47.8%) and rubbing of the ear (58.8%) of the same magnitude as did children without tubes. Rhinitis increased the likelihood of AOM (RR 2.3; P < 0.001) as did excessive crying in children older than 2 years of age (RR 3.0; P < 0.001). Fever, earache or excessive crying was present in 90.1% of patients with AOM but also in 72.4% of patients without AOM.(ABSTRACT TRUNCATED AT 250 WORDS)

Left-right asymmetries in hearing threshold levels in three age groups of a random population

The average asymmetry between the hearing threshold levels in the left and right ears was analyzed in a random population (n = 3487) representing a normal population. Males and females of age groups 5-10 years, 15-50 years and over 50 years were analyzed separately. A significant average inferiority of the hearing in the left ear was found at high frequencies, especially at 3-6 kHz, among adult males and females but not among children. A slight but statistically significant average superiority of the left ear at low frequencies was noted in all age groups. At corresponding hearing threshold levels at 4 kHz, the average inferiority of the left ear in the male population was significantly greater among subjects aged 15-50 years than among older subjects. In conclusion, the inferiority of hearing in the left ear at 4 kHz seems to be associated more with noise damage than with presbyacusis. The average interaural difference at 4 kHz was significantly more marked among subjects aged 15-50 years than among older subjects when analyzed at the corresponding threshold levels. These findings indicate a pathophysiological difference between noise damage and presbyacusis.

Hearing asymmetry among left-handed and right-handed persons in a random population

The possible effect of handedness on hearing threshold asymmetry was analysed in a large random population representing a normal population. The left ear was on an average slightly but significantly poorer than the right ear at high frequencies, especially at 4 kHz, while at low frequencies the right ear was on average poorer than the left ear. A matched control group of the right-handed subjects was formed for 211 left-handed subjects. Among the left-handed subjects the average ear asymmetry resembled the ear asymmetry of the whole population, the right-handed subpopulation, and of the matched control group. In conclusion, it seems that handedness cannot be responsible for the average inferiority of hearing in the left ear at 4-kHz or for the average slight superiority of the left ear at 0.125-0.5 kHz. However, this analysis does not rule out possible minor effects of handedness on ear asymmetry.

Hearing asymmetry among occupationally noise-exposed men and women under 60 years of age

Interaural asymmetry of hearing thresholds at 4 kHz was analysed in four populations exposed to occupational noise. The left ear was found to be on average significantly worse than the right ear, among both the male and female subjects. In the male population the left ear was twice as often the worse ear as the right one. In the female population the corresponding ratio was 1.5. The average inferiority of the left ear increased as a function of the hearing threshold level. Among subjects with abundant shooting (reindeer herders) the average inferiority of the left ear was close to the average of all male subjects. Interaural difference increased as a function of the hearing threshold level, both among subjects with the left ear and subjects with the right ear being the worse one. In the male population the interaural difference was significantly greater in the former than in the latter group of subjects.