Otitis media with effusion during the first three years of life and development of speech and language.

To determine the association between time spent with middle ear effusion and development of speech and language, 205 three-year-old children were studied. Each child had been followed prospectively from birth to record the number of episodes of middle ear disease and to document time spent with middle ear effusion. Standardized tests of speech and language were administered at age 3 years to children who had spent much time with middle ear effusion and to children who had spent little or no time with middle ear effusion. Children who had spent prolonged periods of time with middle ear effusion had significantly lower scores when compared with those who had spent little time with middle ear disease. The correlation was strongest in children from higher socioeconomic strata. Time spent with middle ear effusion in the first 6 to 12 months of life was most strongly associated with poor scores.

Serious bacterial infections in febrile infants and children selected for lumbar puncture.

Lumbar puncture (LP) is performed frequently in pediatric emergency departments to diagnose meningitis in infants and young children with fever. Children selected to have LP who do not have meningitis may, however, have other serious bacterial infections. We surveyed lumbar punctures performed in the Boston City Hospital Pediatric Emergency Department and monitored the incidence of meningitis and other serious bacterial infections. Meningitis was diagnosed in 8% of children who underwent LP. An additional 10.5% of children who underwent LP and had normal cerebrospinal fluid had positive cultures of blood (3.1%), urine (4.1%) or stool (3.3%). The decision to perform lumbar puncture identifies children at risk of having not only meningitis but other serious bacterial illnesses. Those children 2 years of age and younger with normal cerebrospinal fluid should be considered for cultures of blood, urine and possibly stool.

Acoustic reflectometry for assessment of hearing loss in children with middle ear effusion.

We sought associations between acoustic reflectometry and hearing loss in ears with and without middle ear effusion in 137 New Zealand children ages 3 to 16 years. Reflectometry was significantly associated with conductive hearing loss. These associations were present in the entire sample; correlation coefficients varied between 0.31 at 2000 Hz (P less than 0.001) and 0.55 for a three frequency pure tone average (P less than 0.001). The associations persisted for the sample of ears deemed to be filled entirely by effusion; correlation coefficients varied between 0.27 at 4000 Hz (P = 0.026) and 0.47 at 500 Hz (P less than 0.001). Using a reflectivity of 6.0 or greater to detect a three frequency pure tone average loss of 30 dB or more, the sensitivity was 88% and the specificity was 44%. The technique of acoustic reflectometry should be explored and extended to permit rational decisions about management of middle ear effusions.

The microbiology of chronic middle ear effusions in children.

Serous otitis media is the most common cause of hearing loss in childhood. Traditionally, this entity has been felt to be a sterile process. This study was undertaken to determine the incidence of infected middle ear fluid in patients with asymptomatic middle ear effusions. The external auditory canal, nasopharynx and middle ear fluids of 57 patients undergoing myringotomy were cultured. Of 57 patients, 26 had positive cultures; 67% of patients less than 36 months of age had positive culture, with a bacterial flora closely resembling that of acute otitis media. Further investigation is required to determine the significance of such infection together with the optimum therapy for chronic effusions of the middle ear in young children.

Isolation of viruses and mycoplasmas from middle ear effusions: a review.

Reports of studies of middle ear effusions (MEE) obtained by needle aspiration are reviewed in this paper; viruses were isolated from 29 of 663 patients (4.4%) and respiratory syncytial virus was isolated most frequently (22 patients); only one mycoplasma, M. pneumoniae, was recovered from the MEE of 771 patients. Viruses were also sought from the throat or nasopharynx of 249 patients with MEE; 59 patients (23.7%) had a respiratory virus present. M. pneumoniae was isolated from the throat or nasopharynx in three of 116 patients. Although these results indicate that viruses and mycoplasmas are uncommonly found in effusions associated with acute or chronic otitis media, few studies have been attempted in recent years. The discovery of additional respiratory viruses and development of new techniques for isolation and identification of viruses indicate that the present results may be incomplete.

Persistent effusions of the middle ear. Cultures for anaerobic bacteria.

Recent reports of isolation of bacteria from effusions of the middle ear taken from asymptomatic children have suggested a possible role for persistent bacterial infection in the etiology of prolonged effusions. To investigate the significance of anaerobic bacteria in such effusions, we obtained 51 samples of middle ear effusion (MEE) from 30 children. After careful cleansing of the tympanic membrane with 70% alcohol, we performed tympanocentesis prior to performing a myringotomy. Fastidious bacteriologic methods failed to yield a single anaerobic isolate from any of these specimens. We conclude that anaerobic infection of MEE is exceedingly uncommon.

Epidemiology of otitis media in children.

To determine the epidemiology of otitis media (OM) during the first three years of life, physicians participating in the Greater Boston Collaborative Otitis Media Program followed prospectively from birth 2,565 children. At every visit we recorded results of pneumatic otoscopy and epidemiology data. By three years of age 71% of the children had had one or more episodes of acute otitis media including 33% who had three or more episodes. Features associated significantly with first episode of OM were: sibling with recurrent OM, race (white > black), and sex (male > female). Having a sibling with allergy disposed propositi to first episode. Features associated significantly with recurrent OM (greater than or equal to three episodes) were those noted above. A parent with recurrent OM disposed propositi to recurrent OM. Middle ear effusion (MEE) persisted for prolonged periods after OM; after the first episode of OM, 70% of children still had MEE at two weeks, 40% had fluid at one month, 20% had fluid at two months, and 10% had fluid at three months. The sole feature associated significantly with persistent effusion in the middle ear after the first episode of OM was the practice of giving a child a bottle in bed.

Chickenpox immunisation in New Zealand.

PREVENTION: The appropriate use of varicella vaccine, effective in the prevention of chickenpox, has been considered by a Ministry of Health Working Party in 1996 and 1997, including discussion at a workshop held in Wellington, 26-27 June 1996. The introduction of varicella vaccine into the routine childhood immunisation schedule was not supported at this stage. The use of the only varicella vaccine for which the Minister of Health has given consent for distribution in New Zealand, Varilrix (SmithKline Beecham Limited), in healthy children aged nine months to 13 years inclusive, was supported. Consent has not been given for the use of Varilrix in immunocompromised people or in adults. This report discusses other groups that could be candidates for vaccination, such as children with deteriorating renal function and susceptible health care workers who regularly come into contact with especially vulnerable patients. In these cases, the vaccine would need to be administered on a named patient basis. The use of Varilrix in immunocompromised people was not supported. SURVEILLANCE: Enhanced surveillance of chickenpox and zoster are required in New Zealand. Adverse reactions to Varilrix should be carefully monitored. OUTBREAK CONTROL: There are insufficient data at present to support the use of Varilrix in outbreak control. The frequency, cost and current management of nosocomial outbreaks should be ascertained. This information may also assist in the decision whether to incorporate a varicella vaccine into the routine childhood immunisation schedule in the future.

Strategies to control recurrent acute otitis media in infants and children.

Recurrent AOM is a plague in many societies. The considerable attendant morbidity is best reduced through extended periods of antimicrobial prophylaxis. Children who are not helped by this intervention and who are experiencing sufficiently severe disease become candidates for surgical management with tympanostomy tubes. Should both strategies fail, then an adenoidectomy should be considered. In every case, the practitioner must weigh the severity of the recurrent illness against the real costs and risks of surgery.

Infectious disease problems in indochinese refugees.

It is necessary to systematically anticipate and sympathetically address a number of both emotional and physical problems with which Indochinese refugees commonly enter our society. Their infectious medical problems are generally common rather than exotic, although unusual diagnoses must occasionally be considered. If diagnosed, they are generally amenable to treatment. They pose little risk to the public health, and the little danger that they do represent can largely be obviated by attention to principles of infection control, personal hygiene, and public sanitation. Table 9 summarizes the screening and management recommendations appropriately applied to clinical care of this population.