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Biomedical subjects

P Karma

Publications and source records attributed to P Karma.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Vaccination and otitis media.

Acute otitis media (AOM) caused by Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis may induce specific systemic and/or local immune responses, which may protect from otitis media caused by the same bacteria. However, earlier clinical trials with pneumococcal capsular polysaccharide vaccines have not been successful in preventing AOM. Recently developed pneumococcal polysaccharide-protein conjugates proved immunogenic even in infants, and a heptavalent pneumococcal CRM 197 conjugate vaccine gave a 57% reduction in the number of pneumococcal AOM episodes caused by the vaccine serotypes in infants in Finland. H. influenzae causing AOM is noncapsulated, and like M. catarrhalis, calls for another kind of vaccine development. Suitable vaccine candidates are not yet available but are under development and being tested for immunogenicity and safety. In some trials influenza vaccines have shown protection from AOM during respective viral epidemics. Passive immunoprophylaxis might be an important alternative for immunocompromised children, although this approach has not been successful so far. Mucosal immunization and the advent of DNA and gene technology will open new interesting prospects in the future.

Acute Disease↗
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Protein and cellular pattern of glue ear secretions.

Analysis of glue ear secretions showed that the total protein content was slightly higher than in serum and that in the effusion proteins appeared that were specific to the mucosal secretion. The cellular analysis of samples from 137 ears showed that lymphocytes and neutrophils predominated, and that monocytes and phagocytes appeared in most specimens. Eosinophils and mast cells were rare. Staining of bacteria in the smear was seen in one-third of the slides and the mucus strands were numerous. The cellular picture is in line with an infective etiology.

Exudates and Transudates↗
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Efficacy of pneumococcal vaccination against recurrent otitis media. Preliminary results of a field trial in Finland.

For this study, 781 children, and 3 to 83 months, after presenting with acute otitis media, were immunized with either 14-valent pneumococcal or Haemophilus influenzae type b capsular polysaccharide vaccine. The vaccines were tolerated well. Antibody responses to the 14 pneumococcal polysaccharide types, measured by radioimmunoassay, were fair to good and increased with age, with the exception of types 1, 6 and 12 to which the responses were generally poor. During the follow-up of 1-17 months, average 13 months, 45 vaccine type (except type 6) pneumococcal recurrences were met among 456 pneumococcal-vaccinated and 45 among 288 H. influenzae-vaccinated children, at least six months old (P < .05). The corresponding protective efficacy by the pneumococcal vaccine was 37%, for the first six months, 51% (P < .01). No protection by the pneumococcal vaccine was seen against group 6 pneumococci, nor among 19 infants under six months of age. Nonvaccine type pneumococcal ad H. influenzae recurrences did not significantly concentrate in either of the vaccination groups. Thus, it seems that parenteral immunization of children can reduce the recurrence rate of otitis media caused by pneumococci of types (except type 6) present in the vaccine.

Antibody Formation↗
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Prevalence of handicapping hearing loss in an aging population.

The mean hearing thresholds of 369 Finnish inhabitants, 65 years, and born in 3 consecutive years on two elected days each year, were studied in high standard measurement conditions. Eighty-nine of these subjects were reexamined 3 years later. They represented a typical partly industrialized white population with a high standard of living. With the criteria for hearing rehabilitation for presbycusis set at a mean hearing threshold of 30 dB or worse at 500 to 1,000 to 2,000 Hz, and/or 50-dB hearing loss at 2,000 Hz, the prevalence of rehabilitation need was 3.2%. Conductive hearing losses were found in 6% of the subjects.

Age Factors↗
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Finnish approach to the treatment of acute otitis media. Report of the Finnish Consensus Conference.

The theme of the first consensus conference to be held in Finland was the treatment of acute otitis media. The statements and recommendations accepted by the conference, which was organized according to the National Institutes of Health model, are presented in this report. On the basis of scientific knowledge, clinical experience, and conditions in Finland, the conference delegates concluded that penicillin V, in large doses, is still the drug of first choice in this disease. The importance of surgical drainage of the middle ear was stressed, as was the necessity of careful follow-up of the patient until the condition is completely healed. Decongestants were considered rather useless. In the prevention of recurrent attacks, adenoidectomy but not tonsillectomy was regarded as being of help, tympanostomy of probable benefit, antimicrobial (sulfonamide) prophylaxis worth considering in selected cases, but the effect of pneumococcal vaccination poor. The conference delegates agreed that uncomplicated acute otitis media should, as before, usually be treated by physicians taking care of children at the primary health care level.

Acute Disease↗
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Immunological defects in children with chronic otitis media.

A total of 59 children with chronic otitis media were examined for possible immunological defects by determination of serum gammaglobulin and immunoglobulins IgG, IgA and IgM, and by a tuberculin test, and additionally by noting any lymphopenia. Some divergence from normal values was found in 38 patients (64%). 14 children (24%) showed pathologically low immunoglobulin levels and 7 (12%) even a subtotal absence of one of the immunoglobulin fractions. 8 of the cases (14%) also showed a reduction of gammaglobulin level. In 20 children (34%), the level of one or more of the three major Ig classes was elevated. All except one became clinically normal within a few years, showing normal gamma or immunoglobulin levels when tested. The tuberculin test was positive in all patients. The length and course of the disease in these cases was similar to that in patients with normal test values. Gammaglobulin therapy did not have any beneficail effect. Consequently, it is concluded that although humoral immunological defects may be one aetiological factor, they do not play any major role in the course of chronic otitis media in children.

Adolescent↗
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Bacteriology of the chronically discharging middle ear.

Suitable bacteriological techniques revealed anaerobic bacteria in 38 (33%) of 114 chronically discharging middle ears. The genus Bacteroides was cultured from 25 ears. Aerobic bacteriology showed the predominance of staphylococci, facultative enteric gramnegative rods, diphtheroid bacilli and Pseudomonas species. Anaerobic bacterial cultures were always mixed with aerobic bacteria. 12 ears were culture-negative, and 9 of the 108 Gram-stained smers revealed no bacteria. No significant difference in bacteriology was noted between ears with or without local antimicrobial treatment, or between profusely draining or only moist ears. The ears with postoperative recurrent infection or with clinical suspicion of cholesteatoma grew anaerobes significantly more often, and were seldom sterile. Because anaerobic bacteria are frequently associated with chronic otitis media, their characteristics with regard to susceptibility to antimicrobials and to air must be remembered in the choice of therapy.

Bacteria↗
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Fluid pathways in temporal bones.

Five temporal bones were serially sectioned and studied concerning spread of erythrocytes and blood-derived precipitate in patients who died from subarachnoid hemorrhage. Erythrocytes followed the natural pathways--the cochlear aqueduct, the cochlear, vestibular, facial and glossopharyngeal nerves, and were demonstrable in the inner ear fluid spaces. The temporal bone marrow spaces were also filled with erythrocytes, particularly in the hypotympanal area. In the microimmunoelectrophoresis, no specific precipitation lines formed between the anti-CSF serum from rabbits and middle ear exudate from human ears with acute otitis media. Although, in animals, middle ear spaces have been shown to be connected to the middle ear space this does not seem to apply to human ears, and CSF fluid components are not involved in the formation of middle ear exudate.

Adult↗
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Ultrastructural morphology of mucoid effusion in secretory otitis media.

The ultrastructural morphology of 19 mucoid middle ear effusions in 14 children with secretory otitis media was studied. Phagocytosing neutrophil granulocytes were the most common inflammatory cells, and ingested bacteria were present in some of them. The next in frequency were macrophages and lymphocytes. Monocytes and polyblasts were also present in most specimens. No plasma cells, eosinophil granulocytes or mast cells were seen. Epithelial cells were common, and great numbers of free and phagocytosed mucus granules were found. Considerable numbers of all the celltypes were in various stages of disintegration. Thus, it seems that the effusion in secretory otitis media is primarily of inflammatory origin, and the dissolution of the cells with liberated cellular contents, together with the secretion of the mucosa, contributes to the formation of the effusion.

Cell Nucleus↗
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Bacteria in the middle ear and ear canal of patients with secretory otitis media and with non-inflamed ears.

Aerobic and anaerobic semiquantitative bacteriological cultures were taken from 110 mucoid middle ear effusions and the respective ear canals of 74 patients with secretory otitis media (SOM). Additionally, mucosal pieces from 20 non-inflamed middle ears and swabs from the ear canals were cultured similarly. Bacteria were found in 35 effusions and 65 ear canals with SOM; in both sites the most frequent species were S. epidermidis and S. aureus, and the species distributions were not significantly different in the sites. Ten effusions grew bacteria not culturable in the respective ear canal samples. Anaerobes were found in one effusion only. Nine non-inflamed middle ears revealed bacteria; the species distribution was no different from SOM, and four of the bacteria were not found in the ear canal of the same ear. In conclusion, there may be bacteria in the middle ear in the absence of inflammation and in SOM, but the role of viable bacteria seems to be nil in an established secretory otitis media.

Adolescent↗
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Inflammatory cells in mucoid effusion of secretory otitis media.

Inflammatory cells were studied in 269 mucoid middle ear effusions of 202 patients with secretory otitis media (SOM). Although the effusions contained inflammatory cells in all cases, the number of cells, the proportion of viable cells and the proportions of different cell types showed marked heterogeneity. However, the effusions formed a sliding scale with regard to the above cellular parameters. We suggest that these differences in the cellular picture might reflect differences in immune mechanisms and responses in the different effusions, possibly representing different phases of the course of an established SOM. In the subgroups of patients with cleft palate (22) or atopy (16) the cellular picture resembled that seen in the other patients (164), with the exception that the effusions of the cleft palate patients were somewhat more lymphocytic. Thus, from the immunological point of view, the effusions in established SOM seem to behave similarly, irrespective of the differences in the etiological background of SOM.

Cell Count↗
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Occurrence and recurrence of acute otitis media among children.

The occurrence and recurrence of acute otitis media among 37 570 Finnish children at risk who were under 15 years of age were studied. During a one-year period, 4 337 of the children experienced a total of 6 249 attacks of acute otitis media, giving an annual incidence rate of 16.6%. The highest incidence, 75.5%, was found among infants 6--11 months old. 50% of Finnish children had experienced at least one ear infection before their third birthday and 75% before the age of 10, and among this latter group the total number of otitis attacks per child-year during a lifetime was 0.71. Among children under 10, half of the index attacks were recurrences, and among children under 16, 28% of the index attacks were followed by recurrences during the study year. The highest relative recurrence rate was found during the second year of life. Before the second birthday both incidence and recurrence rates were significantly (p less than 0.001) higher among boys. Acute otitis media was most common in the higher social class families and the lowest incidence and recurrence rates were found among children of farmers.

Acute Disease↗
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Role of atopic allergy in chronic otitis media. Evaluation based on serum IgE and nasal/aural cytologic findings in patients with operated chronic ears.

Serum IgE levels and nasal/aural secretion eosinophils and basophils cells were studied in 84 patients with ear discharge despite previous radical operation, in 83 patients with postoperatively dry ears, and in 30 normal persons. Serum IgE values suggesting atopy (greater than 100 U/ml, PRIST) were more frequent (p less than 0.05) among patients with draining ears than among persons with healthy ears. Normal IgE concentrations showed reversed frequency distribution. Nasal secretion eosinophils and/or basophilic cells were also found more frequently (p less than 0.05) among patients with discharging ears than in other groups. Analogously, those with both serum IgE of greater than 100 U/ml and 'positive' nasal cytology more often had infected than dry (p less than 0.01) or normal (p less than 0.05) ears. Aural secretions showed eosinophils and/or basophilic cells in 14 (17%) patients; 11 of them had such cells in their nasal secretions too. It would seem that atopy is probably one cause of persistent therapy-resistant otitis media and it must be taken into account when considering the treatment of a chronic ear.

Basophils↗
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Incidence of acute otitis media.

The occurrence of acute otitis media was studied over a one-year period in a total population of 146822 persons living in different parts of Finland. Of these 146822 persons, 4583 experienced a total of 6518 otitis attacks giving an annual incidence rate of 4.44% (4.48% in males and 4.07% in females, P less than 0.001). Acute otitis media was strikingly concentrated in the youngest age groups, with the highest annual incidence rates, in the order of 50%, found in infants younger than 2 years. Half of all the episodes occurred before the age of 33 months. The relative risk of getting acute otitis media was about 200 times higher during the first 2 years of life than as an adult. The occurrence of otitic episodes followed seasonal variations, and in urban areas the incidence was significantly (P less than 0.001) higher than in the countryside.

Acute Disease↗
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Haemophilus influenzae in acute otitis media.

We studied the occurrence of Haemophilus influenzae (Hi) in 2625 middle ear fluid (MEF) specimens obtained from 523 children with otitis media, aged 3 months to 6 years, between October 1977 and May 1979. In clinically acute cases 12.3% of the MEFs grew Hi; 6.3% (13/206) of the strains were of type b and 4.9% (10/206) were beta-lactamase producing. In the very first acute case of a child 8.0% (21/263) of the MEFs grew Hi, but in acute recurrences it was cultured in 17.0% (184/1082) (p less than 0.001). In non-acute persistent MEFs obtained during control visits Hi was found in no less than 21.7% (198/913); as many as 12.6% (25/198) of them were beta-lactamase producing. Both of these figures, but not the proportion of type b strains (8.6%), were significantly (p less than 0.001 and p less than 0.01, respectively) greater than in clinically acute MEFs. Hi was grown in 13.1% of the acute MEFs taken from children less than 4 years old, but in only 8.6% of the older children (p less than 0.05). The annual survey of all the 1816 Hi strains isolated from the MEFs of acute or subacute cases of otitis media in one laboratory in 1976-81 showed the proportion of beta-lactamase producing strains of all Hi strains to be gradually increasing from 8.0% (17/212) in 1976 to 15.2% (16/105) in 1981 (p less than 0.05).

Acute Disease↗
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Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children.

The factors affecting the occurrence and recurrence of acute otitis media (AOM) were studied among 471 2-3-year-old children in two cities in Finland. Of these children, 188 had experienced greater than or equal to 3 attacks of AOM, 76 had had 1-2 attacks and 207 no otitis attacks (= control group). The study showed that the risk of recurrent AOM was increased among those children attending day-care nurseries as well as among those who had several siblings. Proneness to rhinorrhea and exposure to passive smoking at home was associated with an increased risk of AOM, while prolonged breast-feeding (greater than 6 months) seemed to reduce it. No correlation was found between the risk of recurrent AOM and the place of residence or type of housing, the parental otitis history, or atopic diathesis of a child. Thus the study suggested that to protect a young child from AOM we should promote breast-feeding and home-care for babies as well as avoid smoking in the home.

Acute Disease↗
PubMedDate not supplied

Branhamella catarrhalis in acute otitis media.

A total of 5217 middle ear fluid (MEF) samples obtained from 1203 children with otitis media, aged 3 months to 6 years, were studied for the presence of Branhamella catarrhalis (Br) between Oct. 1977 and Sept. 1981. Br grew in 10.2% of 3497 MEFs of acute otitis media (AOM), with almost the same frequency in the very first and subsequent attacks. During the first 4 years of life the percentage did not vary much; among older children it seemed to decrease. The overall prevalence of Br in AOM did not change during the study period. Br alone grew in 72.4% of acute MEFs with Br; with other bacteria the respective figure was 82.9% (p less than 0.001). Acute attacks with bilateral Br were found in 22.8% of attacks with Br. In 1720 non-acute MEFs obtained at postacute control visits, Br was isolated in only 7.0%. The proportion of beta-lactamase-producing strains among the 2419 otitis-Br strains tested in two laboratories of the two study regions showed an increase from 27.1% and 21.1% in 1980 to 57.6% and 38.6% in 1983, respectively (p less than 0.001).

Acute Disease↗