In a still ongoing prospective longitudinal study, more than 500 children--a total birth-cohort in a Danish municipality--were followed from their 3rd to their 9th year of life by multiple impedance tests in order to investigate a number of factors concerning epidemiology and long-term impacts of otitis media with effusion. This is a report on the influence of otitis media with effusion early in life on reading achievement. The study revealed no difference in school-class level between the 9% of the children (n = 46) who constantly had abnormal tympanometry during a 6-month period at the age of 3, and the other pupils in the municipality. At the Silent Reading Test (OS-400), done on 40 of the 46 case-pupils the results did not differ from (1) the other pupils in the municipality, (2) from other pupils of the same sex in the same classroom, or (3) from individual control-pupils matched by sex, social group and classroom.
The Inuit population of Nunavik (Canada) is exposed to immunotoxic organochlorines (OCs) mainly through the consumption of fish and marine mammal fat. We investigated the effect of perinatal exposure to polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) on the incidence of acute infections in Inuit infants. We reviewed the medical charts of a cohort of 199 Inuit infants during the first 12 months of life and evaluated the incidence rates of upper and lower respiratory tract infections (URTI and LRTIs, respectively), otitis media, and gastrointestinal (GI) infections. Maternal plasma during delivery and infant plasma at 7 months of age were sampled and assayed for PCBs and DDE. Compared to rates for infants in the first quartile of exposure to PCBs (least exposed), adjusted rate ratios for infants in higher quartiles ranged between 1.09 and 1.32 for URTIs, 0.99 and 1.39 for otitis, 1.52 and 1.89 for GI infections, and 1.16 and 1.68 for LRTIs during the first 6 months of follow-up. For all infections combined, the rate ratios ranged from 1.17 to 1.27. The effect size was similar for DDE exposure but was lower for the full 12-month follow-up. Globally, most rate ratios were > 1.0, but few were statistically significant (p
To compare the characteristics of acute mastoiditis in children in different age groups in order to identify risk groups and risk factors for acute mastoiditis.
Records for all children aged 0-16 years treated for acute mastoiditis during 1993-2007 at 33 Ear, Nose and Throat departments in Sweden were reviewed retrospectively according to defined criteria for acute mastoiditis.
A total of 678 cases fulfilled the inclusion criteria. Acute mastoiditis was most common in children younger than two years of age and this group was characterized by less prior history of other diseases and ear diseases, fewer visits to health care centers and less antibiotic treatment before admission, shorter duration of symptoms before admission, hospitalization for fewer days and lower frequency of complications and mastoidectomies. These children also showed a higher incidence of clinical findings, increased inflammatory markers such as fever and heightened counts of C-reactive protein and white blood cells compared with older children. They also tested positive for significantly more samples of Streptococcus pneumoniae while the older children more often exhibited growth of Streptococcus pyogenes or Pseudomonas aeruginosa or no microbial growth.
The characteristics of pediatric acute mastoiditis differed significantly between age groups. Acute mastoiditis was most common in children younger than two years of age. They showed more rapid progress of symptoms and more distinct signs of acute mastoiditis. This is probably the reason why parents rapidly seek medical care for small children and hospital treatment thus starts earlier in the youngest children, which may in turn explain the excellent outcome. This study showed that younger children have neither more severe acute mastoiditis nor more complications than older ones. The differences between age groups suggest that there are distinctions in the pathophysiology behind the onset and course of acute mastoiditis in younger and older children.
To study whether the incidence and characteristics of acute mastoiditis in children changed in Sweden following the introduction of new guidelines for diagnosis and treatment of acute otitis media advocating "watchful waiting" as an option in children 2-16 years of age with uncomplicated acute otitis media.
The records for all patients treated for mastoiditis during 1993-2007 at all Ear, Nose and Throat departments in Sweden were reviewed retrospectively according to defined criteria for acute mastoiditis. In this study the data from children aged 0-16 years were analyzed and compared 71/2 years before and 71/2 years after the introduction of the new guidelines in 2000.
A total of 577 cases aged 0-16 years fulfilled the inclusion criteria during the whole study period. Cases involving cholesteatoma were excluded. The number of children affected by acute mastoiditis did not increase after the introduction of new guidelines. Acute mastoiditis was most common in children younger than two years of age. The proportion of acute mastoiditis increased after 2000 in the group aged 2-23 months although they were not affected concerning treatment by the new guidelines. No decrease was found in the frequency of prehospital antibiotic treatment among the children admitted with acute mastoiditis, and no increase was seen in the duration of ear symptoms before hospital admission, duration of hospital stay, or in the frequency of complications or mastoidectomies, after the introduction of the new guidelines in either group of children.
The incidence of acute mastoiditis in children in Sweden did not increase following the introduction of new guidelines in 2000 for the diagnosis and treatment of acute otitis media. This is despite the fact that a significant decrease in antibiotic prescriptions for otitis media has been reported during the same time period. The characteristics of acute mastoiditis reflecting severity of illness did not change over time. Acute mastoiditis was most common and increased after 2000 only in children younger than two years of age in which antibiotics were still recommended in all cases of acute otitis media.
The study is based on a sample of 965 children living in Oulu region (Finland), who were monitored for acute middle ear infections from birth to the age of two years. We introduce a nonparametrically defined intensity model for ear infections, which involves both fixed and time dependent covariates, such as calendar time, current age, length of breast-feeding time until present, or current type of day care. Unmeasured heterogeneity, which manifests itself in frequent infections in some children and rare in others and which cannot be explained in terms of the known covariates, is modelled by using individual frailty parameters. A Bayesian approach is proposed to solve the inferential problem. The numerical work is carried out by Monte Carlo integration (Metropolis-Hastings algorithm).
The occurrence of acute otitis media (AOM) and factors predisposing to the disease among children were studied in a small rural community in Finland. The annual incidence of AOM was 13.5% among children under 16 years of age and 28.7% under the age of 5. The highest incidences were found during the second and third years of life, with a subsequent decrease in incidences, but with the exception of peaks at the ages of 4 and 7 years. The following factors were found to predispose a child to AOM: atopic diathesis, attending a day-care center, a lack or short duration of breast-feeding, frequent respiratory infections, and housing in the center of a community, especially in an apartment. The smoking habits and otitis history of the parents did not significantly affect the occurrence of AOM in children.
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
Acute otitis media (AOM) is one of the most common bacterial infectious diseases among children and is a leading cause of child healthcare visits and antibiotic prescriptions. Few vaccines have the potential to prevent AOM. The newer pneumococcal conjugate vaccines (PCV) offer a larger spectrum of protection against AOM, as well as preventing severe diseases. The main aim of this study was to assess pediatricians' opinions regarding AOM and its prevention by immunization.
Response rate was 50%. Around 60% of respondents estimated that more than 50% of their patients under the age of 3 years would suffer from at least one episode of AOM in the following year. Most respondents (79%) rated consequences of AOM as moderate. Almost all physicians (99%) considered the newer PCV as safe and effective. Most respondents considered their knowledge of the new vaccines was sufficient. More than 90% had a firm intention to recommend newer PCV to their patients. Perceived benefits of AOM prevention by immunization were: reduction of antibiotic administration and reduction of post-AOM complications. More than half of respondents (53%) considered the risk of adverse events as a barrier to AOM prevention by immunization. In multivariate analysis, the main determinant of pediatricians' intention to recommend newer PCV was perceived safety and efficacy of the vaccines (partial R2 = 0.40, p
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.
We reanalyzed the 7-valent pneumococcal conjugate vaccine trial FinOM for prevention of acute otitis media (AOM), with a focus on disease replacement due to other pathogens and AOM recurrence. We found evidence of replacement disease occurring early during the trial follow-up and little vaccine impact on recurrent overall AOM episodes.