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Medical management of chronic suppurative otitis media without cholesteatoma in children
International Elsevier
Journal of Pediatric
Otorhinolaryngology,
20 (1990) 185-192
185
Selected Abstracts and References generated from EMBASE Abstracts
Gain and feedback problems when fitting behind-the-ear hearing aids to profoundly hearing-impaired children Drylund O.;Lundb P. SCAND. AUDIOL. (1990) 19/2 (89-95) Previous laboratory studies with severely and profoundly hearing-impaired persons aided with behindthe-ear (BTE) hearing aids have resulted in prediction rules for insertion gain and maximum gain without occurrence of acoustic feedback. The practicability of these findings was investigated in the present field trial with 21 profoundly deaf children fitted with power BTE hearing aids. In dialogue situations without background noise, the gain control settings were in accordance with the insertion gain prediction rule, whereas preferred gain may be 10 dB lower in the presence of noise. Consistent with the prediction rule for maximum gain without feedback and the gain response of the present test hearing aid, we observed oscillation in the high-frequency range in which the children had no remaining hearing. When the high-frequency gain was reduced, sufficient low-frequency gain could be provided without feedback problems. Malignant nasopharyngeal tumors in children Fearon B.;Forte V.;Brama 1. LARYNGOSCOPE (1990) 100/5 (470-472) From 1964 to 1984, 25 children with malignant tumors of the nasopharynx were seen, and their progress was followed at The Hospital for Sick Children in Toronto. Two types of malignancies: rhabdomyosarcoma and lymphoepithelioma were most prevalent with eight cases apiece. The presenting signs and symptoms were related to local and/or regional manifestations of disease. No child presented with signs or symptoms related to distant metastatic disease. The diagnosis and treatment of this series of patients are described briefly. The advent of combined treatment modalities in the past decade has improved the prognosis for nasopharyngeal tumors, especially for the rhabdomyosarcomas; in general, however, survival rates are still poor; approximately 50%. Medical management of chronic suppurative otitis media without cbolesteatoma in children Fliss D.M.;Dagan R;Homi Z.;Leiberrnan A. J. PEDIATR. (1990) 116/6 (991-996) To determine whether systemic administration of antibiotics may eliminate or reduce the need for tympanomastoid surgery in chronic suppurative otitis media without cholesteatoma, we undertook a randomized, prospective study comparing three regimens: (1) daily suction and debridement, with intravenous administration of meliocillin until 3 days after the discharge stopped, (2) daily suction and debridement, with intravenous use of ceftazidime until 3 days after the discharge stopped, and (3) daily suction and debridement without antibiotics. No topical antimicrobial agents were used during the study. Fifty-one patients were included, and 48 children completed the study. The duration of discharge from the ear before treatment was 2 to 123 months (median 20 months). In 26 patients (51%), the disease was bilateral. Aerobic cultures, obtained with the Alden-Senturia middle ear aspirator, yielded Pseudomonas aeruginosa in 98%, enteric gram-negative bacilli in 33%. staphylococci in 258, and Haemophilus influenzae in 12%. The first 33 patients were randomly assigned to one of the three regimens. In the 21 patients treated with suction and antibiotics (either meliocillin or ceftazidime), the discharge stopped completely, versus in only 1 (8%) of 12 patients in the suction-only regimen (p < 0.01). Therefore the following 18 patients were randomly assigned to one of only two groups, which included the two
0165-5876/90/$03.50
0 1990 Elsevier Science
Publishers
B.V. (Biomedical
Division)
186 suction-and-antibiotic regimens. In all patients treated initially with antibiotics, discharge stopped after 4 to 18 days (mean 12.0 days), but 25% needed treatment for >14 days. Amoxicillin prophylaxis was administered to 27 (56%) of the patients after completion of therapy. All patients were followed for 6 months. Drainage recurrent in 12 (25%) patients during the first 3 months after the study. The recurrence rate was not affected by the antibiotic regimen, the patient’s age, the duration of drainage before initiation of antibiotic therapy, or prophylaxis. We conclude that intravenous wide-spectrum antibiotic therapy in conjunction with daily suction and debridement is efficacious for the treatment of chronic suppurative otitis media without cholesteatoma. Long-term impairments of brain and auditory functions of children recovered from purulent meningitis Jiang Z.D.;Liu X.Y.;Wu Y.Y.;Zheng M.S.;Liu H.C. DEV. MED. CHILD NEUROL. (1990) 32/6 (473-480) Sixty children who had recovered from purulent meningitis one to six years earlier were investigated for long-term impairment of brain and auditory function, using brainstem auditory evoked potentials (BAEP) and ‘developmental screening tests. Neurological and/or audiological BAEP abnormalities were found in 23 per cent of the children: 15 per cent had mild brainstem impairment and 12 per cent had hearing dysfunction. Developmental screening tests were administered to 46 children, of whom 61 per cent had normal, 22 per cent questionable and 17 per cent abnormal results. The results of the BAEP significantly correlated with those of the developmental screening tests, suggesting that the neuropsychological development of children with BAEP abnormalities was significantly delayed compared with that of children without BAEP abnormalities. The characteristic finding in a neurologically abnormal BAEP was slightly depressed amplitude of wave V, and the authors suggest that this is the most sensitive BAEP measure for the assessment of brainstem function in children recovered from meningitis. Imbalance and chronic secretory otitis media in children: Effect of myringotomy and insertion of ventilation tubes on body sway Jones N.S.;Prichard A.J.N.;Radomskij P.;SnashaU SE. ANN. OTOL. RHINOL LARYNGOL. (1990) 99/6 I (477-481) We studied balance in 34 children with chronic secretory otitis media and compared them with 34 ageand sex-matched control children between the ages of 3 and 5 years. In addition to history and examination, objective measurements were obtained by use of a fixed force plate body sway platform in both the control group and the group with chronic secretory otitis media. We took measurements in both groups at an interval of 4 months to ensure that any improvement in body sway could not be attributed to normal maturation. Eight parameters of body sway were compared, including three new parameters not described elsewhere (mean squared velocity, the number of intersections, and velocity moment). Our study showed that balance is significantly worse in children with chronic secretory otitis media compared to a control group. Furthermore, the increased body sway of children with chronic secretory otitis media was returned to the normal range by myringotomy and insertion of ventilation tubes. Residual hearing capacity of severely hearing-impaired subjects Lamore P.J.J.;Verweij C.;Brocaar M.P. ACTA OTO-LARYNGOL. SVPPL. (1990) -/469 (7-15) Speech reception functions (speech reception threshold and maximum discrimination score for phonemes) and auditory functions (hearing threshold, difference limens for intensity and frequency, temporal modulation threshold function, critical ratio and temporal integration) have been investigated in a group of severely hearing-impaired subjects (64 ears, median Fletcher Index of 80 dB). The results were separated into low-, middle- and high-frequency regions. The investigations were intended to describe and quantify the residual hearing capacities and the correlations between the different functions. It was found that the speech functions, the difference limen for frequency, the critical ratio and the time constant of temporal integration deteriorate gradually with increasing hearing loss. The functions show a relatively high mutual correlation in the low-frequency region and considerable scatter in the highfrequency part. The sensitivity for modulations and the difference limen for intensity were least affected. The results revealed that the residual capacity can be described by means of two independent factors:
Journal of Pediatric
Otorhinolaryngology,
20 (1990) 185-192
185
Selected Abstracts and References generated from EMBASE Abstracts
Gain and feedback problems when fitting behind-the-ear hearing aids to profoundly hearing-impaired children Drylund O.;Lundb P. SCAND. AUDIOL. (1990) 19/2 (89-95) Previous laboratory studies with severely and profoundly hearing-impaired persons aided with behindthe-ear (BTE) hearing aids have resulted in prediction rules for insertion gain and maximum gain without occurrence of acoustic feedback. The practicability of these findings was investigated in the present field trial with 21 profoundly deaf children fitted with power BTE hearing aids. In dialogue situations without background noise, the gain control settings were in accordance with the insertion gain prediction rule, whereas preferred gain may be 10 dB lower in the presence of noise. Consistent with the prediction rule for maximum gain without feedback and the gain response of the present test hearing aid, we observed oscillation in the high-frequency range in which the children had no remaining hearing. When the high-frequency gain was reduced, sufficient low-frequency gain could be provided without feedback problems. Malignant nasopharyngeal tumors in children Fearon B.;Forte V.;Brama 1. LARYNGOSCOPE (1990) 100/5 (470-472) From 1964 to 1984, 25 children with malignant tumors of the nasopharynx were seen, and their progress was followed at The Hospital for Sick Children in Toronto. Two types of malignancies: rhabdomyosarcoma and lymphoepithelioma were most prevalent with eight cases apiece. The presenting signs and symptoms were related to local and/or regional manifestations of disease. No child presented with signs or symptoms related to distant metastatic disease. The diagnosis and treatment of this series of patients are described briefly. The advent of combined treatment modalities in the past decade has improved the prognosis for nasopharyngeal tumors, especially for the rhabdomyosarcomas; in general, however, survival rates are still poor; approximately 50%. Medical management of chronic suppurative otitis media without cbolesteatoma in children Fliss D.M.;Dagan R;Homi Z.;Leiberrnan A. J. PEDIATR. (1990) 116/6 (991-996) To determine whether systemic administration of antibiotics may eliminate or reduce the need for tympanomastoid surgery in chronic suppurative otitis media without cholesteatoma, we undertook a randomized, prospective study comparing three regimens: (1) daily suction and debridement, with intravenous administration of meliocillin until 3 days after the discharge stopped, (2) daily suction and debridement, with intravenous use of ceftazidime until 3 days after the discharge stopped, and (3) daily suction and debridement without antibiotics. No topical antimicrobial agents were used during the study. Fifty-one patients were included, and 48 children completed the study. The duration of discharge from the ear before treatment was 2 to 123 months (median 20 months). In 26 patients (51%), the disease was bilateral. Aerobic cultures, obtained with the Alden-Senturia middle ear aspirator, yielded Pseudomonas aeruginosa in 98%, enteric gram-negative bacilli in 33%. staphylococci in 258, and Haemophilus influenzae in 12%. The first 33 patients were randomly assigned to one of the three regimens. In the 21 patients treated with suction and antibiotics (either meliocillin or ceftazidime), the discharge stopped completely, versus in only 1 (8%) of 12 patients in the suction-only regimen (p < 0.01). Therefore the following 18 patients were randomly assigned to one of only two groups, which included the two
0165-5876/90/$03.50
0 1990 Elsevier Science
Publishers
B.V. (Biomedical
Division)
186 suction-and-antibiotic regimens. In all patients treated initially with antibiotics, discharge stopped after 4 to 18 days (mean 12.0 days), but 25% needed treatment for >14 days. Amoxicillin prophylaxis was administered to 27 (56%) of the patients after completion of therapy. All patients were followed for 6 months. Drainage recurrent in 12 (25%) patients during the first 3 months after the study. The recurrence rate was not affected by the antibiotic regimen, the patient’s age, the duration of drainage before initiation of antibiotic therapy, or prophylaxis. We conclude that intravenous wide-spectrum antibiotic therapy in conjunction with daily suction and debridement is efficacious for the treatment of chronic suppurative otitis media without cholesteatoma. Long-term impairments of brain and auditory functions of children recovered from purulent meningitis Jiang Z.D.;Liu X.Y.;Wu Y.Y.;Zheng M.S.;Liu H.C. DEV. MED. CHILD NEUROL. (1990) 32/6 (473-480) Sixty children who had recovered from purulent meningitis one to six years earlier were investigated for long-term impairment of brain and auditory function, using brainstem auditory evoked potentials (BAEP) and ‘developmental screening tests. Neurological and/or audiological BAEP abnormalities were found in 23 per cent of the children: 15 per cent had mild brainstem impairment and 12 per cent had hearing dysfunction. Developmental screening tests were administered to 46 children, of whom 61 per cent had normal, 22 per cent questionable and 17 per cent abnormal results. The results of the BAEP significantly correlated with those of the developmental screening tests, suggesting that the neuropsychological development of children with BAEP abnormalities was significantly delayed compared with that of children without BAEP abnormalities. The characteristic finding in a neurologically abnormal BAEP was slightly depressed amplitude of wave V, and the authors suggest that this is the most sensitive BAEP measure for the assessment of brainstem function in children recovered from meningitis. Imbalance and chronic secretory otitis media in children: Effect of myringotomy and insertion of ventilation tubes on body sway Jones N.S.;Prichard A.J.N.;Radomskij P.;SnashaU SE. ANN. OTOL. RHINOL LARYNGOL. (1990) 99/6 I (477-481) We studied balance in 34 children with chronic secretory otitis media and compared them with 34 ageand sex-matched control children between the ages of 3 and 5 years. In addition to history and examination, objective measurements were obtained by use of a fixed force plate body sway platform in both the control group and the group with chronic secretory otitis media. We took measurements in both groups at an interval of 4 months to ensure that any improvement in body sway could not be attributed to normal maturation. Eight parameters of body sway were compared, including three new parameters not described elsewhere (mean squared velocity, the number of intersections, and velocity moment). Our study showed that balance is significantly worse in children with chronic secretory otitis media compared to a control group. Furthermore, the increased body sway of children with chronic secretory otitis media was returned to the normal range by myringotomy and insertion of ventilation tubes. Residual hearing capacity of severely hearing-impaired subjects Lamore P.J.J.;Verweij C.;Brocaar M.P. ACTA OTO-LARYNGOL. SVPPL. (1990) -/469 (7-15) Speech reception functions (speech reception threshold and maximum discrimination score for phonemes) and auditory functions (hearing threshold, difference limens for intensity and frequency, temporal modulation threshold function, critical ratio and temporal integration) have been investigated in a group of severely hearing-impaired subjects (64 ears, median Fletcher Index of 80 dB). The results were separated into low-, middle- and high-frequency regions. The investigations were intended to describe and quantify the residual hearing capacities and the correlations between the different functions. It was found that the speech functions, the difference limen for frequency, the critical ratio and the time constant of temporal integration deteriorate gradually with increasing hearing loss. The functions show a relatively high mutual correlation in the low-frequency region and considerable scatter in the highfrequency part. The sensitivity for modulations and the difference limen for intensity were least affected. The results revealed that the residual capacity can be described by means of two independent factors: