This survey examines the age at onset of acute otitis media (AOM) in 591 unselected Greenlandic children aged 3, 4, 5 and 8 years from the two largest towns in Greenland. The attendance rate was 86%. Parental information about episodes of AOM was cross-checked in medical records, which were available for 95% of the children. AOM was defined as episodes with earache, otorrhoea or previous treatment for AOM, with written otoscopic evidence of AOM resulting in treatment with weak analgetics or antibiotics. Recurrent AOM (rAOM) was defined as > or = 5 AOM episodes since birth. In total, 66% of the children had experienced AOM at least once. Of all children, 40% had AOM during the first year of life. Median age of the first episode was 10 months (range: 1-84 months), and there was no sex difference. Children between 7 and 12 months of age were at highest risk of AOM. Children with rAOM had their first AOM episode at a significantly younger age than children with
OBJECTIVE: To describe the sociomedical risk factors associated with episodes of acute otitis media (AOM), recurrent AOM (rAOM), and chronic otitis media (COM) in Greenlandic children and especially to point out children at high risk of rAOM (defined as > 5 AOM episodes since birth) and COM which are prevalent among Inuit children all over the Arctic. METHODS: The study design was cross-sectional and included 740 unselected children, 3, 4, 5, and 8-years-old, living in two major Greenlandic towns, Nuuk and Sisimiut. All children were otologically examined and the parents answered a questionnaire containing sociomedical variables including ethnicity, family history of OM, housing, insulation, crowding, daycare, passive cigarette smoking, breast feeding, type of diet, allergy, and chronic diseases. Historical data were cross-checked in medical records which also formed the basis for the drop-out analyses. Statistical analyses included frequency tests, calculation of odds ratio (OR), and multiple logistic regression. RESULTS: The attendance rate was 86%. Former episode of AOM was reported by 2/3 of the children, rAOM by 20%, and COM by 9%. The following variables were found significantly more often in children with AOM by simple frequency testing: Parental (OR = 1.83), sibling (OR = 1.62), and parental plus sibling (OR = 2.56) history of OM, crowding (OR = 5.55), long period of exclusive breast feeding ( > 4 months) (OR = 2.47), and recent acute disease (P = 0.034). The following variables were found significantly more often in children with rAOM or COM by simple frequency testing: Parental history of OM (OR = 1.60; OR = 2.11, respectively) and no recall of breast feeding (P = 0.005; P = 0.003, respectively). Also, COM was found significantly more often in children with two Greenlandic parents (OR = 3.07). A multiple logistic regression test denoted only parental history of OM (OR = 1.82) and long period of exclusive breast feeding (OR = 1.14) as significant predictors of AOM. CONCLUSIONS: Many of the risk factors usually associated with AOM could not be confirmed as risk factors in this survey. Parental history of OM and long period of exclusive breast feeding were the strongest factors associated with AOM in Greenlandic children and ethnicity was associated with COM. However, the study confirms that AOM is a multifactorial disease determined by a number of genetic and environmental factors.
Chronic otitis media is frequent among the Inuit in Greenland, but reports of cholesteatomas are rare. To describe cholesteatoma in Greenland, we have performed a retrospective study and follow-up of Greenlandic Inuit treated at the ENT-department, Rigshospitalet, Denmark in the period 1976-91. We found 35 Greenlandic Inuit with cholesteatoma, the first in 1976. Median age was 19 years. The total incidence was calculated to 5 per 100.000 per year, or 2 new cases per year. The geographical distribution showed less cholesteatomas among the people with a traditional way of life in the Hunter region. The complication rate was 11%. The extension and pathology of the cholesteatomas indicated late and infrequent contact with an ENT specialist. The follow-up study revealed 53% dry ears with intact tympanic membrane, and 47% with intermittent ear discharge. Residual or recurrent cholesteatoma was found in 46% of the patients, less frequently when the primary operation included mastoidectomy with canal wall-down technique. We recommend this operation in most Greenlandic Inuit with cholesteatomas.
From 1950 to 1989 one hundred and forty-four cases of either undifferentiated nasopharyngeal carcinoma (NPC) or salivary gland carcinoma (SGC) were diagnosed in Greenlanders, all born in Greenland. The Greenland SGC is an anaplastic carcinoma with histopathology and electronmicroscopic cytopathological alterations as found in undifferentiated NPC. Both NPC and SGC from Greenland and Alaska are associated with Epstein-Barr virus infection. The incidence rate of NPC based on newly diagnosed cases during the last 15 years is 12.7 for men and 9.2 for women. The same figures for anaplastic SGC are 3.4 and 3.1. These are among the highest incidence rates of Epstein-Barr virus associated carcinomas on record. From 1950 to 1989 there has been an increase in the rate of NPC. From the cumulated rate, it can be predicted that the number of cases will continue to increase during the years to come. During the ten year period 1980 to 1989 patients were questioned about their childhood life style and the family history was taken. The Inuit lifestyle is quite different from that of Europeans and Chinese, but in common with Chinese from Guangzhou (formerly Canton) Greenlanders have a high consumption of fish, fresh as well as dried. Familial clustering has been rarely reported, but in the present investigation 27% of the patients diagnosed between 1980 and 1990 had a positive familial history with one or more confirmed cases among first degree relatives.(ABSTRACT TRUNCATED AT 250 WORDS)
We evaluated positron emission tomography (PET) with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) in the detection of recurrent head and neck cancer, and compared visual and quantitative interpretation of PET images for their accuracy in the identification of tumour recurrence. Sixty-two FDG PET studies were performed in 56 patients having a total of 81 lesions, which were clinically suspected for recurrent carcinoma of the head and neck. The PET images were interpreted visually, and tracer uptake was quantitated as the standardised uptake value adjusted to body weight (SUV). Sensitivity of visual interpretation of the PET images for the presence of malignancy ranged from 84 to 95%, and specificity from 84 to 93%, respectively, depending on the selected scheme for grading of the lesions. Malignant lesions accumulated significantly more FDG than the benign ones (the median SUVs were 6.8 and 3.3, respectively, P
BACKGROUND. Nasopharyngeal carcinoma (NPC) and anaplastic salivary gland carcinoma (SGC), both associated with Epstein-Barr virus (EBV), are common among Inuit from Greenland, Canada, and Alaska. Because immigrant studies have shown that factors acting early in life are important for the development of NPC, the authors interviewed new patients in Greenland with either NPC or SGC about their lifestyles during childhood and additional cases in their families. METHODS. On admission, new patients from Greenland with either NPC or SGC were interviewed about childhood life-style, family size, and other cases of NPC or SGC within the family. Additional cases were confirmed by review of the medical records concerning these patients. RESULTS. During the 11 years from 1980 through 1990, 17 of 63 (27%) cases in Greenland were found in familial clusters among first-degree relatives. There were no differences in the life-styles of multiple-case families and single-case families. CONCLUSIONS. The high rate of familial clusters among natives of Greenland is of interest because EBV is believed to play a role in the origin of these two diseases similar to that of Marek disease in neurolymphomatosis of chickens. Therefore, the familial clustering of NPC and SGC may indicate that an enhanced oncogenic potential of an EBV strain may occur more frequently in Greenland than in other parts of the world.
In an unselected survey in two Greenlandic towns, 591 children were examined to study the prevalence of otitis media (OM). The attendance rate in Nuuk was 80%, while 93% participated in Sisimiut. The children were three-, four-, five- and eight-years-old and represented 18% of children in these age groups in all Greenland. In total, 51.7% in Nuuk and 54.1% in Sisimiut presented pathologic middle ear affections ranging from slight to severe. The prevalence rates of chronic OM (COM) were 6.8% in Nuuk and 11.7% in Sisimiut (P = 0.055) but without significant age or sex difference. The acute OM point prevalence rate was between 1.5% and 0.4%. The prevalence rate of middle ear effusion (MEE) was between 23.0% and 28.2%. Secretory OM was significantly more prevalent in the younger age groups. The odds ratio of having COM was significantly higher in children with two Greenlandic born parents (3.07) than in children with only one Greenlandic born parent. A follow-up study after one year in Sisimiut revealed unchanged or aggravated middle ear disease in 56.8% of 82 children with middle ear pathology at the primary survey. Thus, OM persists as a major health problem among Greenlandic children, although the general socio-economic and medical conditions have improved during the last decades. Proposals are provided for increased otologic efforts.