Childhood health as reflected in adult urban and rural samples from medieval Denmark.

This study examines the evidence of three skeletal markers relating to childhood health that leave permanent observable changes in the adult skeleton. Two are well known to paleopathology, namely Harris lines (HL) and linear enamel hypoplasia (LEH). The third skeletal marker is less commonly used; the permanent changes in the temporal bones, induced by chronic or recurrent infectious middle ear disease (IMED) in childhood. A total of 291 adult skeletons from an urban (n = 109) and a rural (n = 182) cemetery, from the Danish medieval period (1050-1536 CE) were included. The markers were examined for their co-occurrence, and differences between the two samples. No statistically significant difference for the three skeletal markers between the two samples was found. A trend was nevertheless apparent, with greater frequencies for all three skeletal markers for the urban population. A statistically significant relationship was found only between IMED and HL. This positive relation was very low (rɸ = 0.307, 0.275) and may be considered non-existent. The lack of co-occurrence is interpreted as if an individual was exposed to conditions that could cause the osteological expression of all three markers this could be a life-threatening health condition, during developing years.

Did one ear infection in France change the history of Britain? The illness and death of Francis II (1544-60).

The middle ear has long been considered a continuum of the upper respiratory tract and modern physicians recognize the impact of upper respiratory tract pathology on the middle ear and are familiar with the possible neurosurgical complications of any resultant chronic or acute middle ear infection. In the 16th century, lack of this knowledge may have led to a sequence of events and one of the most important turning points for the British monarchy. This paper on the illness and death of King Francis II of France uncovers interesting aspects of ENT practice from the French Renaissance period and the intrigue surrounding this royal patient's well-documented but little discussed illness.

Consideraciones sobre la otitis media aguda y la medicina basada en evidencias: ¿Cuál otitis media aguda; cuál medicina y cuáles evidencias? / Otitis media and evidence based medicine: what acute otitis media?; what medicine and which evidences?

A pesar de que la otitis media es una enfermedad de alta incidencia y prevalencia, hay diferencias significativas en las estrategias de tratamiento. Los tratamientos -basados en evidencias estadísticas- han fluctuado desde el uso masivo de antibióticos a tratamiento sintomático sin uso de antibióticos, hasta el momento actual en que se intenta definir quiénes se benefician del uso de ellos y en qué forma y circunstancias. En este artículo se revisan las tendencias cambiantes de tratamiento y se sugieren alternativas de abordaje. Entre otras, se destaca un examen físico adecuado, y el proveer a los pacientes en forma individual con el tratamiento más adecuado para ellos en particular. Se considera a la otitis como una enfermedad multifactorial no susceptible a esquemas únicos y rígidos de tratamiento, y se hace un llamado a los médicos a no aceptar estadísticas a priori sino que a ejercer en todo momento un análisis crítico de las publicaciones y a usar sentido común.

Although otitis media has a high incidence and prevalence, there are significant differences in treatment strategies. Evidence based treatments have fluctuated from universal use of antibiotics to symptomatic treatment without antibiotics, to the present moment of defining who would benefit from their use and under which circumstances. This article reviews these treatment strategies and suggests some approaches in order to deal with this changing situation. Among others, an adequate clinical examination is recommended, along with providing individual patients with the most adequate treatment for them in particular. Since otitis media is a multifactorial disease, it is considered non susceptible to rigid forms of treatment. Physicians are urged not to accept statistical studies without a critical analysis of the data. The use of common sense is recommended.

Stuart Gatehouse: a personal appreciation.

Stuart Gatehouse worked in the MRC Institute of Hearing Research Scottish Section for 29 years until his untimely death in 2007. The former director records a personal appreciation but also an explanation, for those who did not know him well, of the mixture of qualities that made him an outstanding applied scientist.

Acute otitis media guidelines: review and update.

In 2004, the Subcommittee on Management of Acute Otitis Media of the American Academy of Pediatrics and American Academy of Family Physicians published evidence-based clinical practice guidelines on the "Diagnosis and Management of Acute Otitis Media." The guidelines included a definition of acute otitis media (AOM) that included three components: 1) a history of acute onset of signs and symptoms; 2) the presence of middle-ear effusion; and 3) signs and symptoms of middle-ear inflammation. An option to observe selected children with AOM for 48 to 72 hours without initial antibiotic therapy was proposed. This option was based on age, severity of illness, and certainty of diagnosis. Despite the changing prevalence of bacterial pathogens and increasing resistance of Streptococcus pneumoniae, amoxicillin remains the first-line antibiotic for initial antibacterial treatment of AOM. The guideline also addresses the management of otalgia, choice of antibiotics after initial treatment failure, and methods for preventing AOM.

Otitis media in Greenland. Studies on historical, epidemiological, microbiological, and immunological aspects.

This thesis describes the different aspects of otitis media (OM) in the population of Greenland viewed in a historical and modern clinical perspective. Chapter 1 outlines the addressed problems and aims while chapters 2 and 3 deal with historical studies and an evaluation of the present knowledge based on the literature. Physical anthropological studies, using skeletal samples of adult Eskimo crania from before and after the colonization of Greenland in 1721 and information about modern living Eskimos (Inuit), have shown that OM sequelae of the temporal bones were significantly less common in pre-colonization Eskimos and that the mean area size of the pneumatized cell system in the temporal bone was significantly larger in pre-colonization Eskimos. These findings indicated an increase in OM after the colonization most likely caused by the social, cultural, habitary, and dietary changes due to increased contact with the outside world. Historical reports after the colonization confirm a high prevalence of OM especially in children. Modern epidemiological studies from the 1960's to 1980's in the Arctic region of Alaska, Canada, and Greenland along with reports from visiting consultant otologists in Greenland almost uniformly mention prevalent OM problems in children as well as in adults. The aim was therefore to further describe the epidemiological pattern of the different OM disease entities (acute OM (AOM), chronic OM (COM), COM with suppuration (CSOM), secretory OM (SOM), and cholesteatoma) and investigate the potentially associated risk factors in especially Greenlandic children because these diseases are primarily established and problematical in childhood. Chapter 4 describes the definitions used in the thesis and chapter 5 describes the studies included. Section 5.1 describes a study of cholesteatoma in Greenlanders. The study revealed an almost similar incidence of hospital treated children with cholesteatoma (6.6 per 100,000) as seen in comparable studies from other parts of the world. Furthermore, childhood cholesteatomas were the most aggressive. The frequency of residuals or recurrences after otosurgical treatment was high with a trend for better results when using the extensive canal wall-down procedure. It could be concluded that these patients urgently need close follow-up for at least five years postoperatively, if not lifelong. Section 5.2 describes a hearing screening survey of 167 school children using school registration charts. A high prevalence of hearing loss (HL) was found. A total of 43% of the children had hearing thresholds exceeding 20 dB at one or more frequencies between 250-8000 Hz in one or both ears, and 19% had the same type of HL in the frequencies 500-2000 Hz. HL was significantly associated with episodes of OM. These findings were in accordance with reports from Alaska and Canada. It is therefore concluded that a hearing screening programme of school children is important and that OM seems to have an impact on hearing in school children in Greenland. In section 5.3 an epidemiological survey is described concerning the prevalence of the different OM disease entities. The survey was carried out in Nuuk and Sisimiut and involved 740 children aged 3, 4, 5, and 8 years. A total of 591 children participated and selection bias was not found when controlling for age, sex, and episodes of AOM. The survey revealed that 52% of children in Nuuk and 54% in Sisimiut had some kind of pathological affection of their middle ear. COM and CSOM were found in 9%, but more prevalent among children in Sisimiut (12%) than in Nuuk (7%). Middle ear effusion (MEE) diagnosed by tympanometry was found in 23% in Nuuk and 28% in Sisimiut while simple tubal dysfunction (STD) was found in 13% and 8%, respectively. MEE and STD were associated with young age. Sequelae of OM was apparent in 11% in both towns. When comparing the results with a 10-year-older, almost similar survey of 142 children, it was evident that the OM situation had not changed in the period between the studies. The survey underlines the need for increased focus on the different OM entities in Greenlandic children. Section 5.4 deals with microbiological aspects. The nasopharyngeal microflora and ear discharge microflora of potential pathogens were evaluated in 54 children with AOM and in 201 control children without AOM. Very high carriage rates expressed qualitatively and semiquantitatively of potentially pathogenio bacteria were found in the nasopharynx of children with AOM (98%) but also in that of the control children (91%) and even in children denoted as being very healthy (94%). However, the same bacterial species were cultured from the nasopharynx and ear discharge as in comparable studies world-wide. Only S. pneumoniae was carried significantly more often in the nasopharynx of AOM children compared with age matched control children. Chlamydiae, M. pneumoniae, adenovirus, respiratory syncytial virus, parainfluenza- type 1, 2, and 3 virus, and influenza- type A and B virus were not major pathogens. In contrast, entero- and rhinoviruses were detected significantly more frequent in nasopharyngeal specimens from AOM children (59%) compared with age matched controls (33%) and also in 29% of the examined ear discharge specimens. It is therefore concluded that the potentially pathogenic bacterial load is early and massive. This alone or in interplay with entero- and rhinovirus infection and occasionally with other viruses may play an important role in the high prevalence of OM among children in Greenland. Section 5.5 deals with an examination of potential risk factors for AOM, recurrent AOM (rAOM), and COM in the same 591 children as studied in section 5.3. Early age at first AOM episode was associated with rAOM episodes (> or = 5 episodes since birth). Thus, the relative risk of developing rAOM was eight times higher if the first episode of AOM occurred before 7 months of age than after 24 months of age. Furthermore, compared with studies elsewhere in the world, a high proportion (40%) of the children in this survey had their first AOM episode during their first year of life and 41% of these children developed rAOM. It was also found that children had an increased risk of AOM, rAOM, or COM when both parents were born in Greenland, when parents also have had OM, when living in very crowded households, and when having experienced a long period of exclusive breast feeding, or when recalling of breast feeding was not possible. Gender, type, and size of housing, insulation standard of housing, daycare, exposure to passive cigarette smoking, and dietary habits were not associated with AOM, rAOM, or COM in the surveyed children. It is concluded that early onset of AOM occurs frequently in Greenlandic children and that a high proportion of these children develop rAOM. The study confirms that AOM is a highly multifactorial disease determined by a number of genetic and environmental factors. Finally, section 5.6 is a hypothesis generating study attempting to explain the high prevalence of early episodes of AOM in community-based children in Nuuk. The hypothesis is based on a possible association between findings of mannose-binding lectin genotypes, early Epstein-Barr virus infections and episodes of AOM, rAOM, or nasopharyngeal colonization with potentially pathogenic bacteria. However, the study does not support any of this hypothesis. In chapter 6, future studies are suggested and chapter 7 presents concluding remarks.

Chronic otitis media sequelae in skeletal material from medieval Denmark.

OBJECTIVES: Chronic otitis media sequelae (COMS) have been identified in archaeological skeletal materials from various ages. COMS reflecting episodes of upper respiratory tract infection may be used as a paleopathological indicator of general health. Estimation of the frequency of COMS may be useful in the gross evaluation of general standard of living. MATERIALS AND METHODS: Temporal bones and auditory ossicles from 659 individuals from two Danish medieval rural parish cemeteries, dated to 1050-1200 and 1150-1350, respectively, were examined otomicroscopically. RESULTS: Osseous fistulae from mastoid abscesses, remodelling of the hypotympanon, and erosion of the incus were among the convincing indications of COMS. A minimum frequency of COMS of 1% to 7% was found. The youngest material displayed the highest frequency of pathological changes. CONCLUSION: Indications of a rising incidence of infectious middle ear disease in early medieval Denmark were found. This may reflect a deterioration of living conditions from the 11th through the 14th centuries.

[Tympanoplasty and Sourdille]. / La tympanoplastie et Maurice Sourdille.

In his article published earlier in 1929, Maurice Sourdille proposed two innovations in middle ear surgery: the tympanomeatal flap and surgery of chronic otitis. Those events were not only the starting point of a new era of modern tympanoplasty but also led to the way to the development of middle ear exploration with purposeful resection of the tympanic framework for accessing to the windows and for sealing a perforated tympanic membrane.

[A century in the history of chronic ear surgery]. / Un siècle d'histoire de la chirurgie d'otite chronique.

Although some advocated surgery of the tympanic membrane and stapes as early as early as the end of the nineteenth century, it took a long time for widespread development. Mastoid surgery had just been born and was to be greatly improved over the next century. Preservation of the tympano-ossicular its later reconstruction gradually came into use with the creation of the tympanomeatal flap and the recent development of middle ear surgery, followed by posterior tympanotomy and myringoplasty, thus allowing closed tympanoplasty. Likewise, the ventilation tube, forgotten for more than half a century, has found an important place in the treatment of chronic otitis with a closed ear drum.

Pneumococcal otitis media and pneumococcal vaccines, a historical perspective.

Although pneumococcal otitis media was recognized in the 19th century, the illness stimulated little interest in prophylaxis until recently. Whole cell vaccines of killed pneumococci, developed to prevent pneumonia, were replaced by vaccines of capsular polysaccharides following demonstration of their antigenicity in adults. Failure of the latter to stimulate antibodies in infants and young children and demonstration of the efficacy of capsular polysaccharide-protein conjugate vaccines in preventing infection with Hemophilus influenzae type b has led to the development of polyvalent pneumococcal polysaccharide-protein conjugate vaccines. Preliminary studies have shown them to be highly effective in preventing invasive pneumococcal disease in the first 2 years of life, and studies of their impact on otitis media are currently in progress.

Acute otitis media: the evolution of surgical management.

OBJECTIVE: Acute suppurative otitis media has been a common disease since time immemorial and, until the late nineteenth century, was followed by a high complication rate, major morbidity, and frequent mortality. Since then, the overall incidence of the disease has changed little; however, in less than a century, progressively more sophisticated surgery and the introduction of antimicrobials have reduced the mortality, at least in developed countries, to a rarity. Complications such as chronic perforation of the tympanic membrane or cholesteatoma, although much less frequent than in the past, are not uncommon. The evolution of mastoid surgery into the antibiotic era is reviewed. CONCLUSION: There is concern that with the increasing frequency of bacterial resistance to antibiotics and the decreasing familiarity of family practitioners with the clinical presentation of complicated otitis media that we may be faced with a resurgence of mastoid disease.

Overlay versus underlay tympanoplasty. Part I: historical review of the literature.

The history of otology is the history of the successful treatment of infections of the middle ear and the eardrum. Otologists have sought to restore hearing lost to infections of the eardrum since the 1600s. The development of instruments, techniques, and materials to treat infection is fascinating because of the serendipitous nature of the discoveries and the insight of the discoverers. This historical review describes the history of the treatment of infections of the ear and the development of modern techniques of ear surgery. Two contemporary methods of tympanic membrane repair are then described.