RESUMO
OBJECTIVE: To document the prevalence of otitis media with effusion (OME) in 102 black children observed prospectively between 6 and 24 months of age. METHODS: Study children attended nine different center-based child care facilities. Middle ear status was assessed by pneumatic otoscopy and tympanometry every 2 weeks. RESULTS: All children, except one, had OME during the period of observation. The proportion of child-examinations revealing bilateral OME ranged from 76% between 6 and 12 months of age to 30% between 21 and 24 months of age. Effusions were considered purulent in only 13% of examinations revealing middle ear fluid. The mean incidence of purulent OME was 2.13 episodes per child per year. Sixty-six children had at least 4 months of continuous bilateral OME during the period of observation; 57 were followed without placement of tympanostomy tubes. Bilateral OME had resolved before the second birthday in 95% of these children, and within 3 months of achieving the 4-month criterion in 50% of subjects. CONCLUSIONS: Persistent bilateral OME occurs commonly between 6 and 18 months of age in infants who enter group child care during the first year of life. In this study, spontaneous resolution of bilateral effusion by 2 years of age was typical.
Assuntos
População Negra , Bem-Estar do Lactente , Otite Média com Derrame/diagnóstico , Testes de Impedância Acústica , Creches , Pré-Escolar , Estudos de Coortes , Orelha Média/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Profissionais de Enfermagem , Variações Dependentes do Observador , Otite Média com Derrame/fisiopatologia , Enfermagem Pediátrica , Estudos Prospectivos , Recursos HumanosRESUMO
The relation of otitis media with effusion (OME) and associated hearing loss to language and cognitive skills at 1 year of age was studied to determine whether OME-related hearing loss had a direct association with language and cognitive outcomes at 1 year of age or an indirect association with these outcomes, as mediated by the child-rearing environment. Subjects were 61 black infants attending community-based child care programs. The presence of OME was assessed biweekly from 6 to 12 months of age by otoscopy and tympanometry. Hearing was assessed with visual reinforcement audiometry when children were well and when ill with OME. Language and cognitive skills and the child-rearing environment at home and in child care were examined. The results indicated a modest correlation between hearing loss associated with OME and receptive language. However, the direct association between OME-related hearing loss and all the language and cognitive measures was negligible. Hearing loss had an indirect association with receptive and expressive language, cognitive development, and overall communication as mediated by child-rearing factors. That is, children with more frequent hearing loss tended to have less responsive mothers and home environments, and this association was linked to lower performance on the infant assessments.
Assuntos
Linguagem Infantil , Educação Infantil , Transtornos da Audição/etiologia , Relações Mãe-Filho , Otite Média com Derrame/complicações , Adulto , Creches , Feminino , Transtornos da Audição/diagnóstico , Humanos , Lactente , Estudos Longitudinais , Masculino , Poder FamiliarRESUMO
The incidence, clinical manifestations, and infectious etiology of respiratory illnesses observed in a prospective longitudinal study were correlated with serum IgE values, which were used as objective markers of atopy. The incidence of wheezing illnesses was greater in children with elevated IgE levels, confirming an association previously reported. In contrast, the incidence of upper respiratory illness or middle ear disease showed no correlation with IgE values. The number and types of viral infections distributed evenly throughout the population. The results suggest that children with recurrent URI or MED deserve evaluation for allergy only if there are other clinical findings suggestive of atopy.
Assuntos
Imunoglobulina E/análise , Infecções Respiratórias/imunologia , Viroses/imunologia , Espasmo Brônquico/epidemiologia , Espasmo Brônquico/imunologia , Pré-Escolar , Otopatias/epidemiologia , Otopatias/imunologia , Orelha Média , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , North Carolina , Sons Respiratórios , Infecções Respiratórias/epidemiologia , Viroses/epidemiologiaRESUMO
A prospective tympanometric and microbiologic study of 28 pre-schoolchildren was undertaken to better define the effect of acute URI on induction of eustachian tube dysfunction. Significant negative middle ear pressure was present in 12.7% of tympanograms from well children. However, abnormal tympanograms were detected during 74.7% of acute URIs. The abnormality was present on day 1 or 2 of illness in the majority of cases; 10.1% of illnesses were complicated by OME. Respiratory viruses or Sp were etiologically implicated in 40.5% of illnesses; isolation rates of Pn and HF from well and ill children were similar. Although colonization of the nasopharynx of well children with Pn or HF was associated with a higher incidence of abnormal middle ear pressure, colonization with Pn or HF during URI did not influence the frequency of tympanogram abnormality.
Assuntos
Testes de Impedância Acústica , Tuba Auditiva/fisiopatologia , Infecções Respiratórias/fisiopatologia , Infecções Bacterianas , Pré-Escolar , Feminino , Haemophilus influenzae/isolamento & purificação , Humanos , Masculino , Nasofaringe/microbiologia , Infecções Respiratórias/etiologia , Infecções Respiratórias/microbiologia , Streptococcus pneumoniae/isolamento & purificação , VirosesRESUMO
To develop a broad understanding of the causes and patterns of occurrence of wheezing associated respiratory infections, we analyzed data from an 11-year study of acute lower respiratory illness in a pediatric practice. Although half of the WARI occurred in children less than 2 years of age, wheezing continued to be observed in 19% of children greater than 9 years of age who had lower respiratory illness. Males experienced LRI 1.25 times more often than did females; the relative risk of males for WARI was 1.35. A nonbacterial pathogen was recovered from 21% of patients with WARI; respiratory syncytial virus, parainfluenza virus types 1 and 3, adenoviruses, and Mycoplasma pneumoniae accounted for 81% of the isolates. Patient age influenced the pattern of recovery of these agents. The most common cause of WARI in children under 5 years of age was RSV whereas Mycoplasma pneumoniae was the most frequent isolate from school age children with wheezing illness. The data expand our understanding of the causes of WARI and are useful to diagnosticians and to researchers interested in the control of lower respiratory disease.