The prevalence of otitis media with effusion among Inuit children.

PURPOSE: Studies over the past 30 years have shown a decline in the prevalence of chronic otitis media in some parts of the Arctic, presumably largely due to more prompt treatment, preventing acute infections from becoming chronic. In contrast, some researchers have suggested that the prevalence of otitis media with effusion has increased. The purpose of this study was to determine the prevalence of otitis media with effusion among children aged 6-17 years in Sanikiluaq, an Inuit community in the Keewatin District of the Northwest Territories. METHODS: A cohort of 126 children at the local community school was examined and assessed by otoscopy, audiometry, and impedance testing. RESULTS: Four percent of children were found to have otitis media with effusion causing significant hearing loss. An additional 17% had otitis media with effusion, with minimal or no detectable hearing loss. Thus, the prevalence of otitis media with effusion in Sanikiluaq school-age children is 4% to 21%. There are few previously published data with which to compare these findings. In the past, otitis media with effusion was infrequently reported among the Inuit. Therefore, our results may suggest an increasing prevalence over the past several decades. If these results are representative of other communities, otitis media with effusion is a significant health problem among the Inuit.

Bilateral sensorineural deafness and hydrocephalus due to foramen of Monro obstruction in sibs: a newly described autosomal recessive disorder.

We identified a Canadian-Mennonite family in which a brother and sister have hydrocephalus due to obstruction at the foramen of Monro and profound bilateral sensorineural deafness. This appears to be a unique combination of anomalies and, to our knowledge, has not been reported previously. Both parents and a brother are phenotypically normal. The parents are second cousins. Thus, on the basis of consanguinity, affected sibs of both sexes, and in the absence of evidence for intrauterine infections or other adverse perinatal events, this syndrome is likely inherited in an autosomal recessive fashion.

Adult-acquired laryngeal stenosis: a study of prognostic factors.

We reviewed cases of adult-acquired laryngeal stenosis treated at the Health Sciences Centre in Winnipeg, Manitoba, over a 15-year period. We studied the influence of various factors on the final outcome including age, sex, etiology, associated conditions, length and diameter of the stenotic segment, as well as its anatomic site. We found a total of 32 patients ranging in age from 16 to 73 years. Fifty-five percent were caused by intubation and 16% by external trauma. Other causes included inflammatory diseases, irradiation, and burns. The subglottis was involved in 82% of the total number of cases reviewed. We studied the probability of decanulation over time by using the Kaplan-Meier survival curves. We then identified the independent factors affecting the probability and time of decanulation by using the Cox Proportional Hazards model. External trauma was found to have the best outcome when compared to other etiologies. The anatomic site of stenosis and its length were independent determinants of outcome, while its diameter was not. Involvement of the glottis in subglottic stenosis led to a significantly poorer outcome. We recommend the use of the length and site of stenosis as primary prognostic factors in the assessment of acquired laryngeal stenosis in the adult population.

Laryngeal carcinoma associated with human papillomavirus type 16.

The advent of molecular hybridization technology has provided evidence supporting human papillomavirus as an etiologic agent of laryngeal carcinoma. Using Southern blot analysis, we identified human papillomavirus type 16 DNA associated with an invasive laryngeal carcinoma. The virus genome did not appear to be integrated into the host genome, as is often the case with anogenital tumors. Laryngeal carcinoma usually arises on the true vocal cords of individuals who demonstrate demographic and lifestyle risk factors for this cancer. The patient, an adult male, has no identifiable risk factors for laryngeal carcinoma other than papillomavirus infection. Our finding suggests that the application of hybridization analysis to all cases of laryngeal cancer would promote understanding of the association between human papillomavirus and laryngeal carcinoma.

Auditory brainstem responses in patients with global cerebral insults.

Seventeen patients with global cerebral insults were tested with the auditory brainstem response (ABR) in order to determine the technical feasibility of this test in an intensive care unit (ICU) and to assess its value as a prognostic tool. Some difficulty with artifact was encountered, but interpretable responses were obtained in 23 out of 24 tests performed on these patients. A prognosis based on the ABR was possible in 16 patients and was correct in 14. A prognosis based on a clinical evaluation was possible in only four patients and was accurate in three of those four cases. ABRs appear technically feasible in an ICU environment and yield valuable prognostic information on comatose patients.

Preservation of auditory-evoked brainstem responses in anaesthetized children.

In a series of six anaesthetized children we have been unable to demonstrate any effect of anaesthetic concentrations of halothane or thiopentone on the brainstem auditory-evoked response. The results imply preservation of brain stem function during anaesthesia with these drugs and suggest future application of anaesthesia to the testing of hearing disabilities in children, as well as application of evoked response audiometry to neurological critical care.

Clinical experience with brain stem audiometry performed under general anesthesia.

Hearing tests were given to 22 difficult-to-test children using brain stem audiometry performed under general anesthesia. The effect of halothane and sodium thiopental on the brain stem response was assessed as well as the feasibility of using this technique with a difficult-to-test population. No effect on brain stem responses was observed to various levels of anesthesia. Successful hearing tests were carried out on all the children and results were helpful in their management. Brain stem audiometry perfromed under general anesthesia appears to be an effective and helpful technique for testing challenging diagnostic cases.

Granulocytopenia in hospitalized patients. II. A prospective comparison of two antibiotic regimens in the empiric therapy of febrile patients.

The results of empiric antibiotic therapy in 126 hospitalized patients with fever during 192 episodes of granulocytopenia were studied. Febrile granulocytopenic patients were randomly allocated to receive either carbenicillin, methicillin and gentamicin, or carbenicillin and cephalothin. The response rate for the two antibiotic regimens was similar, 49 (60 per cent) of 81 responded to the former and 42 (54 per cent) of 78 to the latter. The response rate in patients receiving other antibiotics because of specific indications or counterindications was 19 (58 per cent) of 33. Thirty-nine (35 per cent) of 110 patients who responded to initial antibiotic therapy had an increase in circulating granulocytes of one log10 or more compared to only 10 (12 per cent) of 79 nonresponders with such an increase. The mortality rate in adult patients receiving carbenicillin, methicillin and gentamicin was eight (16 per cent) of 51, compared to 18 (37 per cent) of 49 in those receiving cephalothin and carbenicillin (P less than 0.05). The significance of this difference in the initial response rate or mortality rate between patients treated with the two antibiotic regimens when only patients with documented bacterial infection were considered. Patients who responded to their initial antibiotic regimen, and patients for whose fever no explanation was found, had the best prognosis.

Clinical evaluation of amikacin in treatment of infections due to gram-negative aerobic bacilli.

The efficacy and safety of amikacin were evaluated in 42 patients with infections presumed to be due to gram-negative rods. The dosage of 7.5 mg of amikacin/kg every 12 hr was administered intramuscularly to 32 patients and intravenously to seven patients; three patients with renal impairment were given a modified regimen. The duration of treatment was three to 51 days (mean, 9.6 days). Of 19 patients with acute pyelonephritis, five had positive blood culture results. Ten patients had chronic urinary infection, and isolates of Pseudomonas aeruginosa from four of these patients acquired resistance to amikacin during therapy. Of seven patients with gram-negative bacteremia from sources other than the urinary tract, four showed satisfactory and three had less than optimal responses to therapy with amikacin. Two patients with chronic osteomyelitis or soft tissue infection improved but subsequently relapsed. Two patients with acute febrile illness, in whom the etiologic agent was unidentified, recovered. Serial audiograms revealed no change in 26 of 27 patients; one had a significant deterioration in hearing. A transient rise in the level of serum creatinine was noted in three patients. Serial tests of liver function revealed no abnormalities.

Tracheal stenosis.

Tracheal stenosis following assisted ventilation is becoming recognized as a major complication of tracheostomy, and the use of cuffed tracheostomy tubes. The possible causes and surgical management of this condition are discussed together with recommendations to minimize the possibility of post-tracheostomy tracheal stenosis.