The high incidence of chronic ear disease among the three ethnic groups, Eskimo, Algonkian Indians, and Caucasians living under the same environmental conditions is studied. The role of socio-economic factors in the incidence and sequelae of ear disease in this population was similar to other studies among the native peoples of Alaska, Canada, and Greenland. The variation in the disease pattern in the different ethnic groups was shown to be related to the aeration of the middle ear cleft. The air cell system of the mastoid is determined by x-rays and/or surgical exploration, but the patency of the Eustachian tube and its size is determined by impedance audiometry and use of ureteric catheters. The clinical and surgical findings of the behavior of chronic ear disease in the different ethnic groups is correlated to tissue culture experiments. The role of lowered oxygen tension in the formation and behavior of cholesteatoma is illustrated well among the Caucasians with poor aeration of the middle ear cleft who show a high incidence of cholesteatoma, unlike the Eskimos with good aeration who show a complete absence of cholesteatoma.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2445.
Middle ear pathology in Alaska is a problem of considerable magnitude. Various studies reported hearing loss in 14% of Caucasians and 34% of Eskimos and evidence of chronic otitis media in about one third of Alaskan Natives. An infant morbidity and mortality study conducted by the Arctic Health Research Center in Eskimo villages revealed that of 323 infants, 38% had at least one episode of draining ears during their first year of life. To combat acute and chronic otitis media, routine medical and surgical treatment is dispensed within the limits of available personnel, and an aggressive tonsillectomy and adenoidectomy campaign is in progress. The present study was undertaken to investigate the natural history and epidemiology of ear disease and also the relationship between hearing loss and otitis media.
From: Fortuine, Robert et al. 1993. The Health of the Inuit of North America: A Bibliography from the Earliest Times through 1990. University of Alaska Anchorage. Citation number 2410.
Cited in: Fortuine, Robert. 1968. The Health of the Eskimos: a bibliography 1857-1967. Dartmouth College Libraries. Citation number 697.
Data on liquorrhoea in cases collected in 1947-1977 at the Department of Neurosurgery, University Hospital of Lund, Sweden, are analysed with reference to: 1. Time of onset. 2. Symptoms and signs. 3. Diagnostic methods. 4. Treatment-conservative and surgical. 5. Antibiotic prophylaxis. In more than half of the 66 patients the onset of liquorrhoea was delayed more than one month after the head trauma. Antibiotic prophylaxis to all skull base fractures therefore is questioned. False positive reaction with locally applied test strips is noted. Gammacisternography for localization of the leaking area is recommended. If surgery is performed, a high rate of recurrence can be expected if the supposed leaking area is blindly covered.
The management of skull base fractures in the pediatric age group continues to be a major challenge even for experienced multidisciplinary teams. This retrospective study was undertaken at a tertiary care academic hospital to evaluate the management and outcome of pediatric skull base fractures.
Retrospective analysis covering a period of 13.5 years (from 1996 to 2009) and 63 patients (mean age 10.7 years; range 1-18 years) was performed.
A road traffic accident was the most frequent etiological factor (38%). The most common skull base fracture type was temporal bone fracture (64%). Longitudinal temporal fractures were observed in 45% and transversal in 23% of these patients; in 10 cases (25%) the fracture was comminuted or mixed type. A fracture involving the spheno-ethmoidal complex was the second most common type of basilar skull fracture (41%) followed by fracture through the orbital bone (35%). Forty-three percent of the patients had a concomitant intracranial injury. Early neurological deficits were diagnosed in 21 patients (33%) and 10 patients (16%) had permanent neurological deficits. One patient died after 1 week of intensive care treatment. Fifty-four patients (86%) were discharged home and 8 patients (13%) were discharged for further rehabilitation. Glasgow Coma Scale score of 8 or lower correlated with moderate to poor outcome.
We conclude that skull base fracture is a rare injury in childhood. Mortality is uncommon, but this trauma is commonly associated with intracranial injury. Early neurological deficits are caused by traumatic brain injury and were observed in one-third of the patients. However, only less than one-sixth suffered from permanent neurological or neuropsychiatric disorders.