Oral decongestant in acute otitis media. Results of a double-blind trial.

In order to investigate the influence of an orally administered decongestant, norephedrine, upon the clinical course of acute otitis media and tubal function, a double-blind trial was performed in Copenhagen in December, 1976-February, 1977, in which 93 patients, aged 6 months to 10 years, with 135 ears with acute otitis media, were treated either with norephedrine or placebo in a randomized order. Most other treatment was avoided except for pain-relieving baby aspirins. The effect of norephedrine seemed to be no other than that of placebo. Because of this inefficacy of norephedrine the authors have, therefore, a material of patients with acute otitis media where the main treatment was pain-relieving aspirin. The use and abuse of antibiotics in the treatment of this disease are discussed, and the authors stress the necessity of performing controlled studies of the efficacy of antibiotics in acute otitis media, since such studies do not exist.

Normal values in a routine ENG test.

A total of 50 normal subjects were examined by electronystagmography for spontaneous and positional nystagmus. In this way the normal limit of the speed of the slow phase was determined to be 6.5 degrees/sec. By examining 15 of the subjects twice, the normal limit of the mean value of the two results was determined to be 4.5 degrees/sec. Forty-nine of the subjects were calorically tested, using 30 degrees and 44 degrees C stimulation. The results were calculated as indices expressing the degree of unilateral hypofunction and directional preponderance relative to the total caloric excitability. The results were evaluated for the duration of and for the maximum eye speed of the slow phase. The normal limits were determined as the mean value +/- twice the standard deviation. Our results indicate that a left-side hypofunction is a normal phenomenon and that duration and maximum eye speed of the slow phase reflect different aspects of the vestibular function.

Oral norephedrine in the treatment of acute otitis media. Results of a double-blind, placebo-controlled trial.

One hundred patients with acute otitis media were treated with oral norephedrine or with placebo for one to two weeks. Symptom cards, otoscopy and tympanometry were used for evaluation of the results. There were no differences between the two groups with regard to acute symptoms or healing of the disease. It is concluded that oral decongestants are of no value in the management of acute otitis media.

Aerosol distribution in the nose.

Using a cast of the human nose the intranasal distribution of drugs, delivered from pressurized aerosols and nebulizers was studied. The results indicate that a pressurized aerosol should be used twice in each nostril to give an acceptable drug distribution, and also that an automized pump is preferable for a plastic-bottle nebulizer with regard to drug distribution.

A new and simple calibration of the electro-ocular signals for vestibulo-ocular measurements.

Reliable calculation of the gain of the vestibulo-ocular reflex depends on a reliable way of calibrating the eye movements. During the new calibration manoeuvre, the subject fixes the eyes at a point about 1 m away and moves the head either in pitch or yaw approximately +/- 30 degrees. The head movements are recorded by means of an angular rate sensor. The eye movements are recorded with standard surface electrodes. By integrating the angular rate signal the precise head position angle is calculated. The fixating eyes will compensate for this angle and, thus, the signal level of the eye movements is defined. A systematic error is introduced in this procedure. Because the distance to the fixating point is finite, the eyes must deviate more than the head movement. The extra angle is dependent on the distance to the target. In yaw, the angle is independent of the direction of the head movement. In pitch, the angle is both dependent on the distance to the target and on the direction of the head movement. Correction for the error must, in most cases, be performed directly on the eye recordings before calculating the VOR gain.

Heart rate responses to moderate linear body accelerations: clinical implications in aeromedical evacuation.

Linear accelerations during take-off and landing were measured in both civilian and military aircraft usually involved in aeromedical evacuations in Denmark. Accelerations of similar durations and magnitudes were induced in six healthy subjects transported in an ambulance in different supine positions. Heart rate responses recorded depended significantly on the position of the subject. It was concluded that seriously ill patients must be positioned transversely to the axis of acceleration during aeromedical evacuation.

Vestibular autorotation test in primary selection of military student pilots using neural networks.

BACKGROUND: Selection of student pilots to the Royal Danish Air Force involves a physical examination including a vestibular test. Usually tests for selection proposes are not well documented. HYPOTHESIS: The result of the vestibular autorotation test (VAT) is correlated to the ability to learn to fly in a military context. METHODS: A Multi Layer Perception neural network with three layers configured as a Back Propagation Network was tested using data originating from horizontal VAT of 59 student pilot candidates, given the outcome of the pre-jet basic flight check. In the analysis the leave-one-out method was used. RESULTS: Based on horizontal data only the network correctly classified the student pilot candidates as having been passed or rejected within a verification error margin < 0.1. CONCLUSION: The result indicates that VAT performed at the initial physical examination is a powerful tool for the elimination of unfit student pilot candidates when data are analyzed in neural networks.

[Bone-anchored auricular prosthesis]. / Knogleforankret aurikelprotese.

During the period February 1989-September 1991, 15 patients with absent or defective pinna were treated with a bone-anchored auricular prosthesis at the ENT-department, Rigshospitalet, Copenhagen. These patients were followed up from the hospital records and by means of a questionnaire. Altogether 40 titanium implants have been inserted, of which one implant was found not to be integrated at the time of the second-stage surgery. Five patients underwent additional surgery, one patient because of non-integration of a screw, and four patients on account of soft-tissue reactions. From the questionnaire replies it appears that all patients found the cosmetic result and the technique concerning mounting of the prosthesis very satisfactory. Nearly half the patients found that the care of the skin around the abutments caused considerable problems. Three patients had experienced unintended losses of the prosthesis. In conclusion, treatment with a bone anchored auricular prosthesis has considerable advantages compared to treatment with a prosthesis attached by adhesive. Furthermore the use of a bone-anchored prosthesis should be considered a viable alternative to surgical reconstruction because of the outstanding aesthetic result and because the surgical procedure puts less strain on the patient. The disadvantage of the method is the lifelong daily care of the skin and the dependence on the health services.

An elevated pro-inflammatory cytokine profile in multiple chemical sensitivity.

BACKGROUND: Multiple chemical sensitivity (MCS) is a medically unexplained condition characterized by reports of recurrent unspecific symptoms attributed to exposure to low levels of common volatile chemicals. The etiology of MCS is poorly understood, but dysregulation of the immune system has been proposed as part of the pathophysiology. OBJECTIVE: To compare plasma levels of cytokines in Danish MCS individuals with a healthy, sex- and age-matched control group. METHOD: Blood samples were obtained from 150 un-exposed MCS individuals and from 148 age- and sex-matched healthy controls. Plasma concentrations of 14 cytokines, chemokines and growth and allergen-specific IgE were measured. All participants completed a questionnaire including questions on MCS, psychological distress, morbidities and medication use at the time of the study. RESULTS: Plasma levels of interleukin-1ß, -2, -4, and -6 were significantly (P<0.001) increased in the MCS group compared with controls, tumor necrosis factor-α was borderline significantly (P=0.05) increased and interleukin-13 was significantly decreased (P<0.001). CONCLUSION: MCS individuals displayed a distinct systemic immune mediator profile with increased levels of pro-inflammatory cytokines and interleukin-2 and inverse regulation of Th2 associated cytokines interleukin-4 and interleukin-13 suggestive of low-grade systemic inflammation, along with a deviating Th2-associated cytokine response not involving IgE-mediated mechanisms.

The capsaicin cough reflex in patients with symptoms elicited by odorous chemicals.

Patients with multiple chemical sensitivity and eczema patients with airway symptoms elicited by odorous chemicals have enhanced cough reflex to capsaicin when applying the tidal breathing method. The aims of the present study were to test whether the capsaicin induced cough reflex was enhanced when applying the single breath inhalation method in similar groups of patients with symptoms related to odorous chemicals e.g. other persons wearing of perfume; and to investigate to what extent the reporting of lower airway symptoms influenced the cough reflex. Sixteen patients fulfilling Cullen's criteria for multiple chemical sensitivity and 15 eczema patients with airway symptoms elicited by odorous chemicals were compared with 29 age-matched, healthy controls. We measured C5--the capsaicin concentration causing five coughs or more--using the single breath inhalation test. No difference was found between groups in age, body mass index or pulmonary function. The median C5 were 129 micromol/L (control group), 48 micromol/L (multiple chemical sensitivity patients), 32 micromol/L (eczema patients). The reporting of lower airway symptoms from odorous chemicals was significantly (p<0.05) correlated to increased cough reflex sensitivity to capsaicin, independent of patient group or co-existence of asthma. The results suggest that the C5 is not reliable for diagnosing MCS but C5 can be used to verify presence of lower airway symptoms related to odorous chemicals.