Infectious mononucleosis treated by an antihistamine: a comparison of the efficacy of ranitidine (Zantac) vs placebo in the treatment of infectious mononucleosis.

This study investigated whether the course of infectious mononucleosis was influenced by medication with ranitidine (Zantac). A double-blind, placebo-controlled study enrolled 117 patients and either ranitidine 300 mg or placebo were given twice daily for 2 wk. Patients were examined on day 5, 10, 15 and 30. Efficacy variables included severity and duration of fever, scores of cervical lymph node size and tonsil size, eating problems, fatigue, influence on general condition, the use of analgesics and blood analyses. Results were analysed in 91/117 patients. Small differences were found between treatment groups in favour of the active drug. However, they were not statistically significant. After 2 wks of treatment abnormal 'liver enzymes' (ALAT/ASAT) were found in 13/48 (0.27) of the ranitidine group in contrast with 18/36 (0.50) of the placebo group (P = 0.03). The conclusion is that the course of infectious mononucleosis is little influenced by ranitidine treatment for 2 wks. The faster normalization of the 'liver enzymes' may reflect modulation of the immune system by ranitidine.

Stapes surgery: complications and airway infection.

From a group of 1,111 patients who had stapedectomy or stapedotomy performed in a 10-year period, a thorough investigation was made of 11 patients who had a total hearing loss and 8 patients who developed a partial sensorineural hearing loss after operation. The data obtained indicate that postoperative infection with influenza virus may be responsible for unexpected complications following stapedectomy. A close relation was found between the appearance of complications and periods of epidemics of influenza.

Traumatic lesions of the middle ear: aetiology and results of treatment.

A retrospective investigation of the aetiology and results of treatment for traumatic, conductive hearing loss was performed in 122 patients treated from 1979 to 1983. The mean age at the time of the trauma was 25 years. The average treatment delay was 7 years. The patients were grouped according to the nature of the injury. The group with head injury (40 patients) was characterized by a frequent combination of young men and traffic accidents. Among direct trauma (16 patients) lesions to the tympanic membrane and/or the middle ear were caused by ear syringing or by the introduction of swabs or other instruments into the auditory canal. In the group exposed to indirect trauma (57 patients) the dominant single cause of the trauma in the present material consisted of a blow to the ear and was most often seen among young women. A subgroup exposed to blasts contained more young men. The dominant operative findings were rupture of the tympanic membrane, luxation of the incus, partial bone necrosis and fracture of the auditory ossicles. Ear surgery consisted of closure of the ruptured tympanic membranes and restoration of the sound-transmitting function of the ossicular chain. Normal hearing was restored in 78%, and hearing improved in another 10%. The hearing remained unchanged or deteriorated in 9% of the patients, a group often characterized by a long treatment delay and/or the development of chronic otitis.

Histiocytosis X. Recurrent otitis media as a presenting symptom in children with special references to cholesteatoma.

Ten children with histiocytosis X and recurrent otitis media as a presenting symptom were compared to children with otitis media complicating cholesteatoma. When radiography and biopsy findings were not diagnostic a low age (less than 3 years) and a remaining elevated ESR were characters that most effectively separated the histiocytosis X group from the cholesteatoma group.

Otitis media in childhood. Sociomedical aspects with special reference to day-care conditions.

To assess the effect of day-care conditions on the occurrence of middle ear infection, 681 children, aged 3-4 yr, were investigated. The investigation comprised an interview with one of the parents, a case history was taken, and a physical examination including tympanometry. At that time 76% of the children had been in day-care away from their homes and half of these were younger than 6 months old. The two groups of children, those in day-care and those looked after at home, were comparable with respect to sex, housing conditions, parents' social status and smoking habits. An increased occurrence of otitis media was found among children in day-care Measurements of middle ear pressure revealed a significantly larger number of children with flat curves (secretory otitis) and thus poorer hearing among those in day-care than those at home. Among the children in day-care there was also a significantly larger number with a history of adenoidectomy than among those looked after at home. These differences could not be explained by sex, housing conditions, social status or parents' smoking habits. It is concluded that the apparently greater occurrence of middle ear infection among children in day-care, compared to those looked after at home is due to an increased risk of contamination from children of their own age.

Role of fixation in the treatment of nasal fractures.

Following the reduction of nasal fractures, fixation was performed in 3 ways: 1 Packing for 72 h and plaster cast for 1 week. 2 Packing for 72 h and adhesive tape for 1 week. 3 Adhesive tape for 1 week. At follow-up 3 months after the reduction, these groups were compared with a group of patients with nasal fractures which had not needed treatment and with a group of normals. It was concluded that among the group fixed with packing and plaster cast, significantly fewer patients were dissatisfied than in the other groups, and fewer complained of deformity. The physical examination showed an appreciable number of minor deformities in all groups including the normal group. A significantly higher frequency of nasal obstruction was found in the group of patients operated upon compared to the non-operated group and the normal group by physical examination, but not by the questionnaire. The present study does not support the point of view that a high percentage of cases of nasal fracture have to be operated upon by open reduction. Radiology has no medical or legal value in patients with nasal fractures and should not be used.

The effect of age and hearing loss on the identification of synthetic /b, d, g/-stimuli.

A series of speech identification tests using 15 synthetic consonant-vowel syllables with variations in second and third formant transitions were conducted in different age groups with normal hearing and a group of older subjects with a sensorineural hearing loss. Varying degree of categorical perception of three distinct phoneme categories /b, d, g/ was observed in all groups. Responses were depending on start frequency and gliding direction of second and third formant transitions. In the group of 60-80-year-old persons with a hearing loss response percentages were significantly lower and error frequency high. Furthermore, category shift boundaries changed as compared with the group of 20-40 years old. Results in a group of children age 8-15 years, were rather similar to those in the 20-40-year-old group. Both age and age-induced sensorineural hearing loss seemed to influence elderly people's ability to identity the synthetic speech stimuli.

The role of temporal factors in auditory perception of consonants and vowels. A study of different age groups.

Two series of speech identification tests were conducted in different age groups, the first test consisting of 11 synthetic speech stimuli varying in vowel length, the second test being composed of 30 natural speech stimuli varying in length of the initial consonant. Categorical perception of different phonemes was demonstrated in both experiments in all age groups. Persons more than 65 years of age showed significantly lower response percentages in both tests than did younger subjects. In the test where natural speech stimuli were used, boundaries of phoneme-category shift were dislocated in the older when compared with results of the younger subjects. Furthermore, speech discrimination was poorer in monaural than in binaural listening condition in the groups of more than 65-year-old persons with signs of age-induced sensorineural hearing loss; in this age group women showed clearly better results than men. These differences could not be demonstrated in the younger age groups.