John H. Ploussard

Bacterial etiology of otitis media during the first six weeks of life

Tympanocentesis was performed on 70 infants who had otitis media during the first six weeks of life. The bacteria isolated from their middle-ear effusions were Streptococcus pneumoniae (13 patients), Neisseria catarrhalis (11 patients), Hemophilus influenzae (ten patients), Enterobacteriaceae (four patients), Staphylococcus aureus (four patients), streptococci (groups A and B) (three patients), and Pseudomonas aeruginosa (two patients). Thirty patients (42.9%) had middle-ear effusions which did not contain pathogenic bacteria. Twenty-seven infants were followed for at least 12 months and 12 (44.4%) of these infants had six or more episodes of otitis media during the observation period. Further studies will be needed to establish the significance of middle-ear disease at this age and the role of therapy in improving its outcome.

Treatment of Serous Otitis Media with Ventilatory Tubes

The first five papers in this symposium were read at the first meeting of the Society for Ear, Nose and Throat Advances in Children, SENTAC. This was held at the Hospital for Sick Children in Toronto on October 9th and 10th, 1973. The meeting was the outcome of several years of effort in organizing a new Society devoted to the many aspects of Pediatric Otorhinolaryngology. Membership is open to professionals of all related disciplines -such as physiology, education, psychology, testing, evaluation and treatmentwhose sphere of interest includes the enhancement of the quality of life for children with ear, nose, and throat problems. Information regarding membership may be obtainted bywriting to LaTJ’anne Bergstrom, M.D., University Hospital, 4200 East 9th Avenue, Denver, Colorado 80220.

EXPLORATORY TYMPANOCENTESIS FOR THE DIAGNOSIS OF ACUTE OTITIS MEDIA WITH EFFUSION IN THE NEONATE: LIMITATIONS IN THE USE OF THE TYMPANOMETER UNDER SEVEN MONTHS OF AGE

Sixty-five patients presenting to a general pediatric practice for either well baby care or acute illness in the first seven months of life over a two year period with signs of acutely discovered otitis media with effusion (AOME) were subjected to tympanometry and subsequent tympanocentesis. The overall sensitivity in detecting AOME of the practitioners on the 129 ears studied varied from 92 to 100 percent using pneumatic otoscopy. The specificity of the practitioners varied from 40 to 67% but there was marked variation in the diagnosis under one month of age. Tympanometry was 44% sensitive and 77% specific in the same patients with some special considerations in the infants head position seeming to account for some of the lack of sensitivity. The presenting author feels that there is a distinct advantage in obtaining a definitive diagnosis by using the technique of exploratory tympanocentesis in suspected AOME under one month of age.

HUMORAL AND CELLULAR IMMUNE RESPONSES TO PRP

Immune responses to Hemophilus influenzae, type b, polyribophosphate (PRP) were studied in 4 infants vaccinated at 6 months with 3 injections of PRP spaced 2 to 3 weeks apart. The injections totaled 1.6ugm of PRP mixed with 0.2ugm of cellular protein. Antibody to PRP was assayed by the Farr technique. Cellular responses were evaluated by incubating peripheral blood lymphocytes with several dilutions of pure PRP or PRP with protein and assaying for either protein or DNA synthesis. Generally significant increases in antibody to PRP were not seen as a result of this vaccination. No pre or post-vaccination lymphocyte cultures displayed increased DNA synthesis to the various dilutions and preparations of PRP tested. On the other hand, post-vaccination lymphocyte cultures from 2 infants displayed increased protein synthesis to pure PRP and one of these infants reacted similarly to PRP-protein. A third infant had significant pre-vaccination stimulation of protein synthesis and remained so following vaccination. The significance of cellular immune responses to PRP is unknown, however since antibody to PRP is not normally generated in the young infant, evaluation of both humoral and cellular immune responses may reveal additional mechanisms of immunity to infection with H. influenzae.