[The possibilities for the treatment of exudative otitis media in the children presenting with chronic adenoiditis].

The objective of the present study was to improve the effectiveness of medicamental therapy of exudative otitis media in the children with recurrent and chronic adenoiditis. It was shown that the use of fluifort (carbocysteine lysine salt) for the treatment of exudative otitis media in the children presenting with chronic adenoiditis is a more effective approach in comparison with the expectant management. It is concluded that the application of carbocysteine lysine salt in combination with the mometasone furoate nasal spray ensures the rapid elimination of the symptoms of adenoiditis and significantly accelerates the resolution of exudative otitis media compared with the monotherapeutic treatment.

Surgery for glue ear: the English epidemic wanes.

OBJECTIVES: To describe the progress of the epidemic of surgery for glue ear since 1983 and trends in the use of different operative procedures. DESIGN: Analysis of routine hospital data. SETTING: Thirteen health districts in the Oxford and East Anglian regions. MAIN MEASURES: Annual rates of surgery in children under 10 years of age. RESULTS: The rate of surgery for glue ear reached a peak in 1986 since when it has declined by 12.6%. The rate peaked in all 13 districts but at different times over a six year period (1984-1989/90). Following the peak, district rates plateaued in eight districts and declined in five. These changes have been accompanied by: an increase in the proportion of operations confined to the tympanic membrane since 1983 (from 40% to 60%); an increase in the use of grommets after myringotomy (from 50% to 94% since 1980); and an increased use of day surgery for ear-only operations (from about 10% in the late 1970s to 50% in 1987/88). CONCLUSIONS: The previously reported epidemic of surgery for glue ear is waning. This seems to be a result of changes in the clinical judgment of general practitioners and surgeons as to its use and possibly of a reduced demand from parents.

Glue ear: the new dyslexia?

Several factors have led to the current epidemic of surgery for glue ear in children, including the widespread introduction of audiometry; greater recognition of the presence of fluid in the middle ear by general practitioners; the availability of more otolaryngologists; and technical advances such as the availability of antibiotics to treat postoperative infections and of flanged tympanostomy tubes (grommets). The need of surgeons to fill the vacuum caused by the decline in the number of adenotonsillectomies, and the fact that a diagnosis of glue ear legitimises the continued use of these operations, may also have contributed to the increase. Finally, glue ear may provide parents with a medical explanation of their children's poor educational performance, as the term dyslexia did in the past. The high social and public costs of this operation demand a reappraisal of its increasing use.

Otitis media in Greenland children: acute, chronic and secretory otitis media in three- to eight-year-olds.

The middle ear status was examined in 142 children aged three to eight years from Sukkertoppen and Kangamiut in Greenland. The investigation is based on social-pediatric and otologic histories and on objective examination using otomicroscopy and tympanometry. Three-fourths of the small children had a previous history of otitis, some with repeated instances. Otomicroscopic findings revealed suppurative, chronic otitis in 6% and sequelae of chronic otitis in 13%. Tympanometry disclosed a reduced middle ear pressure in another 26% of the ears examined. Comparison of children with healthy ears with the groups with affections of the middle ear showed a tendency to an increased risk of otitis in families at a low social stratum, whereas the mode of habitation seemed insignificant. Finally, a large milk intake both in connection with breast-feeding and later in life seemed to reduce the frequency of otitis. The investigation showed that acute otitis and chronic otitis media in particular are more prominent in Greenland than in Denmark. Attention is drawn to the handicap associated with a high incidence of chronic otitis media and the concomitant hearing loss to a population isolated in point of language. The successful achievements of a health information campaign and an active therapeutic program, which has reduced the prevalence of chronic otitis among the Innuit population native to Alaska and Canada, provides the rationale for an increased otologic effort in Greenland.

Epidemiology of otitis media and the role of the general practitioner in management.

Acute otitis media and otitis media with effusion are common diseases of children. Though related to each other, they are clinically separate entities. In order to assess the effectiveness of medical interventions it is important to know the epidemiology of the condition. This paper reviews the incidence, natural history and risk factors for otitis media. In most cases acute otitis media and otitis media with effusion are self-limiting disorders. Complications and an abnormal course are rare. There are, however, subgroups of otitis-prone children, identifiable on the basis of risk factors. These children need special attention from the general practitioner, for example a more frequent use of medical interventions and surveillance. It is important to realize that individual and family factors have more influence on the outcome of otitis media than do the various available medical interventions.