Jan J. Grote

Treatment of chronic maxillary sinusitis in children.

In the present study 141 children aged between 3 and 10 years and suffering from chronic maxillary sinusitis were treated non-selectively in one of 4 ways: amoxicillin combined with decongestive nose drops, drainage of the maxillary sinus, a combination of the two, or a placebo. The duration of the follow-up period was 6 months. The therapeutic effects of the 4 forms of treatment did not differ significantly. Haemophilus influenzae and streptococcus pneumoniae were the micro-organisms encountered most often in these children. The results are discussed.

Breast-feeding and acute otitis media

INTRODUCTIONnThe risk of acute otitis media (AOM) is estimated as a function of a number of covariates, with special emphasis on changes to this risk after breast-feeding is discontinued.nnnMATERIALS AND METHODSnTwo hundred eighty-nine children born between July 1987, and October 1988, were studied up to the age of 24 months. The enrollment of the children took place during their regular check-up visits at three different child health care centers.nnnRESULTSnThe risk of AOM was significantly decreased until 4 months after breast-feeding was discontinued; then, without the protective effect of breast-feeding, and with increasing months, the children approached the risk level estimated in the group of children who were never breast-fed. Approximately 12 months after breast-feeding was discontinued, the risk was virtually the same as if the child had never been breast-fed. The risk of AOM was also significantly dependent on the infants number of siblings and socioeconomic status.nnnCONCLUSIONnThe risk of AOM depends on the number of months an infant is breast-fed and the number of months that pass after breast-feeding is discontinued.

Otitis media with effusion and chronic upper respiratory tract infection in children: A randomized, placebo-controlled clinical study

This study was performed to investigate the course of spontaneous recovery from otitis media with effusion in children with chronic rhinosinusitis treated in various ways. One hundred forty‐one children between 3 and 10 years of age were selected for the presence of chronic rhino‐sinusitis and unilateral or bilateral otitis media with effusion.

The diagnostic value of transillumination for maxillary sinusitis in children

In 52 children between 3 and 9 years of age drainage of the maxillary sinus was performed because of chronic purulent rhinitis and opacity of the maxillary sinuses on the radiographs. The results of preoperative transillumination were compared with the drainage findings. In this selected group of children the sensitivity of transillumination for the demonstration of congestion in the maxillary sinuses was found to be limited. The authors consider transillumination to be an obsolete method for this purpose in children.

Risk factors for otitis media with effusion in children 0 to 2 years of age

PURPOSEnTo determine the possible risk factors associated with the occurrence of otitis media with effusion.nnnPATIENTS AND METHODSnTwo hundred eighty-nine children born between July 1987 and October 1988 were studied up to the age of 24 months. The enrollment of the children took place during their regular check-up visits at three different health-care centers.nnnRESULTSnHaving older sibling was the most important risk factor, for both the time elapsed until the first occurrence and for the probability of otitis media with effusion at each visit. Other significant risk factors for the probability at each visit were: having had acute otitis media before the visit or before the previous visit, age, a positive family history of otitis media, and upper respiratory tract infections (URTI).nnnCONCLUSIONnHaving older siblings is the most important risk factor for otitis media with effusion in this age group.

The Prognostic Value of Electrocochleography in Severely Hearing-impaired Infants

This paper presents a longitudinal evaluation of electrocochleographic assessment in severely hearing-impaired infants. Electrophysiological data were obtained by transtympanic electrocochleography to tone-burst stimuli at octave frequencies of 500 to 8000 Hz at the age of 0-6 years in a group of 126 subjects. The results are compared with auditory thresholds determined at school age in the same children by means of pure-tone audiometry. Cochlear microphonics could be recorded in virtually all ears, although the majority of subjects had hearing losses of 90 dB and more. Compound action potentials (CAPs) showed waveforms varying from normal to a wide range of abnormalities. Audiometric thresholds correlated generally well with the compound action potential (CAP) thresholds obtained in infancy. The error in the predicted audiometric thresholds is between 15 and 20 dB, as compared with 11 dB reported for more moderate hearing losses. It is shown that, in spite of the high stimulus levels used, substantial frequency-specific threshold information is retained. Occasional large discrepancies in thresholds were often associated with markedly abnormal response waveforms. Among the many cases in which no ABR could be elicited, 68 per cent produced detectable electrocochleographic responses in the 1000-4000 Hz range. It is concluded that electrocochleography is a valuable method for the assessment of residual hearing in infants suspected of having a severe hearing impairment.

Long-term follow-up of chronic maxillary sinusitis in children

In 26 children, aged between 3 and 7 years, the course of therapy-resistant chronic maxillary sinusitis over a mean period of 6 years and 3 months, was analysed. The results showed that spontaneous cure had occurred in 24 of the 26 children, on average after they reached the age of 7 years. The chronic character of upper respiratory tract infections in young children is difficult to explain.

Long-Term Audiometric Follow-up of Click-Evoked Auditory Brainstem Response in Hearing-Impaired Infants: Seguimiento audiométrico a largo plazo de los potenciales evocados auditivos del tallo cerebral (PEA) en niños hipoacüAsicos

Conventional pure-tone thresholds were collected as determined at ages between 4 and 8 years from a group of 163 infants, tested by auditory brainstem response (ABR) in the age range between 1 and 3 years old for objective hearing assessment. The subjects suffered from a variety of degrees and types of sensorineural hearing impairment. The prognostic value of the ABR peak V thresholds in response to 0.1 ms clicks with respect to the behavioural thresholds at octave frequencies from 125 to 8,000 Hz obtained later is evaluated. Correlation between ABR and behavioural thresholds is largest in the 1,000- to 8,000-Hz frequency range. Predicted pure-tone audiograms (mean and SD) were determined for each 10-dB class of ABR thresholds. SDs are in the order of 15 to 18 dB in the 500- to 4,000-Hz range and slightly higher at adjacent frequencies (i.e., somewhat larger than in comparable adult studies). Mean pure-tone thresholds in the 1,000- to 8,000-Hz frequency range are up to 20 dB worse than ABR thresholds, which is opposite to findings in normally-hearing subjects. Thus, with an increasing degree of sensorineural hearing impairment, pure-tone thresholds increase at a significantly higher rate than ABR thresholds. The observation is explained in terms of reduced temporal integration in cochlear hearing loss. ABR thresholds worse than 80 dB nHL are demonstrated to have very limited predictive value with respect to the amount of residual hearing, not only in the low- but also in the high-frequency range. The presence of otitis media during ABR testing is shown to make estimation errors increase to more than 25 dB (SD).