[Diagnostic image (347). A man with a swelling underneath his tongue]. / Diagnose in beeld (347). Een man met een zwelling onder zijn tong.

A 23-year-old man presented with a painless, growing swelling underneath his tongue due to a ranula, i.e. accumulation of saliva in the drainage canal of the sublingual salivary gland.

Hearing loss in very preterm and very low birthweight infants at the age of 5 years in a nationwide cohort.

In a geographically defined population of very preterm and very low birthweight infants (gestational age < 32 weeks and/or birthweight < 1500 g) hearing was evaluated in 890 children by pure-tone audiometry at the age of 5 years. Hearing loss was conductive/unspecified in 123 (13.8%) and sensorineural in 13 (1.5%) children. The prevalence of sensorineural hearing loss was 15 times as high as in 5-7 year old children in the Dutch population at large. The sensorineural hearing loss prevalence in very low birthweight and extremely low birthweight infants was similar. On account of communication disorders 10 (1.1%) children were classified as disabled and 6 (0.7%) as handicapped, following the definitions of the International Classification of Impairments, Disabilities, and Handicaps of the World Health Organisation. Children with conductive hearing loss had a higher risk of impairments, disabilities and handicaps of language and speech development, than children with normal hearing, the difference being statistically significant. The same holds for children with sensorineural hearing loss; moreover they had a significantly higher risk of impairments, disabilities and handicaps of mental development. Overall comparison of children with and without sensorineural hearing loss proved that the children with sensorineural hearing loss had a significantly less favourable outcome, based on 15 perinatal factors simultaneously. The age at which sensorineural hearing loss in very preterm and/or very low birthweight infants is detected has to be improved.

Validity of tympanometry in the diagnosis of middle ear effusion.

A group of 266 children (515 ears), ranging in age from 5 months to 11 years, was studied. These children were candidates for the insertion of ventilation tubes, or adenoidectomy and/or tonsillectomy with myringotomy. Before surgery, tympanometry was performed. The surgical and tympanometric findings were compared afterwards. Two different tympanometers were used (GSI-27A and TYMP-85TT). This study showed a comparable validity of these two tympanometers. The sensitivity and specificity of tympanometry in the age group of 5 months to 2 years did not show a significant difference from that in the age group of 2-12 years. Otoscopy has limited value for the diagnosis of middle ear effusion in this age group.

Breast-feeding and acute otitis media.

INTRODUCTION: The risk of acute otitis media (AOM) is estimated as a function of a number of covariates, with special emphasis on changes to this risk after breast-feeding is discontinued. MATERIALS AND METHODS: Two hundred eighty-nine children born between July 1987, and October 1988, were studied up to the age of 24 months. The enrollment of the children took place during their regular check-up visits at three different child health care centers. RESULTS: The risk of AOM was significantly decreased until 4 months after breast-feeding was discontinued; then, without the protective effect of breast-feeding, and with increasing months, the children approached the risk level estimated in the group of children who were never breast-fed. Approximately 12 months after breast-feeding was discontinued, the risk was virtually the same as if the child had never been breast-fed. The risk of AOM was also significantly dependent on the infant's number of siblings and socioeconomic status. CONCLUSION: The risk of AOM depends on the number of months an infant is breast-fed and the number of months that pass after breast-feeding is discontinued.

Risk factors for otitis media with effusion in children 0 to 2 years of age.

PURPOSE: To determine the possible risk factors associated with the occurrence of otitis media with effusion. PATIENTS AND METHODS: Two hundred eighty-nine children born between July 1987 and October 1988 were studied up to the age of 24 months. The enrollment of the children took place during their regular check-up visits at three different health-care centers. RESULTS: Having older sibling was the most important risk factor, for both the time elapsed until the first occurrence and for the probability of otitis media with effusion at each visit. Other significant risk factors for the probability at each visit were: having had acute otitis media before the visit or before the previous visit, age, a positive family history of otitis media, and upper respiratory tract infections (URTI). CONCLUSION: Having older siblings is the most important risk factor for otitis media with effusion in this age group.

Otitis media, respiratory tract infections and hearing loss in pre-term and low birthweight infants.

In 1983, 1338 liveborn infants with a gestational age of less than 32 weeks and/or a birthweight of less than 1500 g, were enrolled in a national follow-up study in The Netherlands. At the age of 5 years, 966 children were alive. Of these, 927 (96%) were assessed on a home visit 2-6 weeks after their fifth birthday by three specially trained paediatricians. An assessment of ENT morbidity was made and compared with ENT morbidity in full-term children of the same age group. Markedly preterm birth or very low birthweight does not seem to be a risk factor for developing middle ear disease in childhood, however, the rate of ENT problems seems to be higher than in the general population of Dutch pre-school children.