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Abstracts

Abstracts

Chiropractic Care

Chiropractic Care

To determine:
(a) if the patients improved while under chiropractic care;
(b) how many treatments were needed to reach improvement; and
(c) which factors were associated with early improvement.

Children aged 5 yr and under (# 46).

All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor's own modified applied kinesiology were also used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement.

93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history of antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments.

The addition of chiropractic care may decrease the symptoms of ear infection in young children.

Froehle RM: Ear infection: a retrospective study examining improvement from
chiropractic care and analyzing for influencing factors. J Manipulative Physiol Ther, 19:169-77, 1996 Mar-Apr.

Olive Oil

Olive Oil

A clinician recommends for softening of hardened earwax a few drops of "olive oil" in the "ear" canal at night held in place with a "cotton" stopper and removed the next morning without irrigation. In some patients this is painful.

"Olive Oil For Ear Irrigation", Sandidge, Ernie, MD, Cortlandt Forum, March 1990;25-14.

Otitis Media (1)

Otitis Media (1)

Determined whether acute otitis media can be distinguished from an uncomplicated upper respiratory tract infection by the symptoms of the children.

The specificity and positive predictive value of earache for acute otitis media were 92% and 83%, respectively. However, 40% of the children with acute otitis media had no apparent earache.

Restless sleeping had a specificity of 51% and a positive predictive value of 46% for acute otitis media.

Almost a third (31%) of the children with acute otitis media had no fever. Continuation of respiratory symptoms for several days after the first examination was significantly related with later development of acute otitis media.

Earache in children with upper respiratory tract infection is indicative of acute otitis media, but the absence of earache does not preclude acute otitis media. Therefore, even in the absence of any signs and symptoms localized to the ear, all children at risk for acute otitis media should be examined during upper respiratory tract infection, and if respiratory symptoms persist for several days after the initial visit, a reexamination should be performed.

Restless sleeping and fever are of no value in distinguishing acute otitis media from an uncomplicated upper respiratory tract infection.

Heikkinen T & Ruuskanen O: Signs and symptoms predicting acute otitis media. [see comments]. Arch Pediatr Adolesc Med, 149:26-9, 1995 Jan.

Otitis Media (2)

Otitis Media (2)

Predictability of the coexistence of acute otitis media on the basis of symptoms and signs of infection.

Of the 658 patients admitted to hospital during the period concerned, 197 (29.9%) had otitis media. For each child with otitis, the next patient of the same age was chosen as a control. The risk of having otitis media was increased among patients with cough, rhinitis and earache.

All three variables together correctly classified 67% of those not having otitis media and 63% of those with acute otitis, compared with the 50% which would theoretically be achieved by chance alone.

Prediction was worst (55%) among patients younger than 2 years of age not having otitis media and best among older patients who had otitis media, i.e. 78%. Prediction on these grounds would have caused significant over-treatment, and one-third of the otitis cases among the youngest group would have been missed.

It is important to always examine the ears of a child with an infection in order to reliably exclude the possibility of acute otitis media.

Uhari M et al., Prediction of acute otitis media with symptoms and signs. Acta Paediatr, 84:90-2, 1995 Jan.

Otitis Media (3)

Otitis Media (3)

The diagnosis of acute suppurative otitis media is not as easy and straightforward as it may seem. Many of the signs and symptoms in children with acute otitis media are also observed in children without it. Furthermore, several of the "classic" findings of acute otitis media, such as fever and earache, are often absent, even in cases confirmed by myringotomy.

An otoscope with a fresh bulb and a good power source, as well as a view of the tympanic membrane that is not obstructed by cerumen, are essential to making the diagnosis of acute otitis media. A bulging, cloudy, immobile tympanic membrane is highly associated with otitis media.

Erythema of the eardrum alone, however, is often the result of viral infection, crying or attempts to remove cerumen and should not be the sole basis for the diagnosis of acute otitis media.

To avoid the common problem of overdiagnosing acute otitis media, the clinician should consider the predictive values of the various symptoms and physical examination findings associated with ear infections.

Weiss JC et al., Acute otitis media: making an accurate diagnosis. Am Fam Physician, 53:1200-6, 1996 Mar.

Otitis Media (4)

Otitis Media (4)

The purpose of the present study is to assess the relationship between early acute otitis media (AOM) and exposure to respiratory pathogens mediated by siblings and day-care.

A prospective cohort of 3,754 Norwegian children born in 1992-93 was followed from birth through 12 months.

One or more episodes of AOM had been experienced by 25% of the children before age one.

Analysis showed that siblings attending day-care is the most important risk factor for early AOM. The total number of children in the day-care setting is another determinant for early AOM.

Siblings who attend day-care and the number of children in the child's own day-care setting are the most important determinants for AOM the first year of life.

Kvaerner KJ et al., Early acute otitis media: determined by exposure to respiratory pathogens. Acta Otolaryngol Suppl (Stockh), 1997, 529:, 14-8.

Passive Smoking

Passive Smoking

Studied the effects of passive smoking on health in adolescent schoolchildren by questionnaire, spirometry and laboratory investigations.

The prevalence of respiratory illness before and after 2 years, respiratory symptoms, earache over the past year, low birth weight and learning difficulties were found to be significantly increased in the children exposed to parenteral smoke in the home, especially those exposed to maternal smoking.

Spirometric and laboratory parameters, however, were not affected by passive smoking.

Richards GA et al., Health effects of passive smoking in adolescent children. S Afr Med J, 86:143-7, 1996 Feb.

Supertasting

Supertasting

Family studies using thresholds showed that PROP (6-n-propylthiouracil) tasting is produced by a dominant allele, T. Nontasters have two recessive alleles and tasters have one or two dominant alleles. The bitterness of suprathreshold PROP and anatomical criteria subdivide tasters into medium and supertasters. Supertasters may be TT tasters, but this has yet to be demonstrated. Supertasters preceive the greatest bitterness and sweetness from many stimuli as well as the greatest oral burn from alcohol and capsaicin.

Women are more likely than men to be supertasters.

Otitis media and head trauma can alter taste and thus PROP classifications, complicating studies on PROP genetics. Some subjects with a history of otitis media show taste reductions, but others show enhanced tastes and appear to have more taste buds per fungiform papilla.

Subjects with head trauma show reduced tastes on some oral loci, but there is evidence that severe reductions on the front of the tongue ameliorate reductions at the circumvallate papillae on the back of the tongue by a release of inhibition mechanism.

Bartoshuk LM et al., Supertasting, earaches and head injury: genetics and pathology alter our taste worlds. Neurosci Biobehav Rev, 20:79-87, 1996.

Xylitol

Xylitol

Researchers in Finland selected children (average age of 5 ) with a history of middle ear infections to begin chewing xylitol gum.

After 2 months the xylitol chewing group reported a 40% reduction in the incidenc eof infections.

Chewing xylitol gum appears to be a simple way to treat or prevent recurrent ear, sinus and throat infections which have become the most common medical complaint in children.

Anonymous: BMJ 1996, 93(13):1180 - 1184.

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