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PubMed1988

[Hearing impairment and earache as initial symptoms of Wegener's granulomatosis].

Wegener's Granulomatosis occurs rarely. It is an autoimmune disease and as such it is a special form of panarteriitis nodosa. Manifestations are seen in various organs. Granulomatous lesions in the nose, paranasal sinuses and pharynx are very characteristic and often mark the beginning of the disease. However, a painful otitis media with combined hearing loss may also be the first sign of this generalised rheumatic disease. By describing three cases we document clinical constellations of results and summarise them in tabular form. The knowledge of these constellations prevents confusing this disease with otitis media, tuberculosis and sudden deafness.

Adolescent↗
PubMed1971

[Chronic earache].

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Chronic Disease↗
PubMed1995

Signs and symptoms predicting acute otitis media.

OBJECTIVE: To determine whether acute otitis media can be distinguished from an uncomplicated upper respiratory tract infection by the symptoms of the children. DESIGN: Prospective cohort study. SETTING: Urban, pediatric primary care center in Turku, Finland. PATIENTS: Three hundred two children younger than 4 years (mean age, 2.1 years) attending day-care centers were followed up and examined during episodes of upper respiratory tract infection. The signs and symptoms of the children were recorded daily by the parents. MAIN RESULTS: 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. Thirty-one percent 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. CONCLUSIONS: 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.

Acute Disease↗
PubMed2000

Chronic pain among children and adolescents: physician consultation and medication use.

OBJECTIVE: The goal of this study was to assess physician consultation and use of medication in Dutch children and adolescents (0-18 years old) having chronic pain in relation to sociodemographic factors and pain characteristics. DESIGN: This was a population-based cross-sectional survey. A questionnaire was either mailed to the participants' parents or distributed at school, and it was filled out by the parents (for children aged 0-7 years) or by the participant (for children and adolescents aged 8-18 years). SETTING: The study was conducted in the Rotterdam area. PATIENTS: Participants included a random sample of 1,300 children aged 0 to 3 years taken from the register of population. In addition, 41 schools were selected to obtain a representative sample of 5,336 children and adolescents aged 4 to 18 years. OUTCOME MEASURES: Reported physician consultation and medication use were assessed. RESULTS: Of the 6,636 children and adolescents surveyed, 5,424 (82%) responded. A total of 1,358 respondents (25%) reported chronic pain. Of these, 57% had consulted a physician and 39% had used medication for the pain. Respondents with earache, more intense pain, and more frequent pain and those attending lower vocational training programs were more likely to consult a physician for the pain than the average respondent. Respondents with earache, sore throat, headache, more intense pain, and multiple pain; children aged 0 to 3 years; and girls were more likely to use medication for the pain. Logistic regression analyses showed that for physician consultation, the most significant predictive factors were the intensity of pain, age, and earache as well as the level of education for respondents aged 12 to 16 years. The use of medication was predicted by earache, headache, limb pain, intensity of pain, and age. CONCLUSIONS: Chronic pain is a common complaint in children and adolescents, frequently resulting in consultation of a physician and medication use. Regarding physician consultation, children and adolescents with a lower educational level seem to be a group at risk.

Adolescent↗
PubMed2006

Longer term outcomes from a randomised trial of prescribing strategies in otitis media.

BACKGROUND: There are limited data about the longer-term outcomes in acute otitis media (AOM) when comparing the realistic alternatives of immediate prescription of antibiotics and a 'wait and see' or delayed prescribing policy. AIM: The aim was to assess the medium and longer term outcomes of two prescribing strategies for otitis media. DESIGN OF STUDY: Follow-up of a randomised controlled trial cohort. SETTING: Primary care. METHOD: Three-hundred and fifteen children aged 6 months to 10 years presenting with AOM were randomised to immediate antibiotics, or antibiotics delayed at the parents discretion 72 hours if the child still had significant otalgia or fever, or was not improving. Episodes of earache since study entry were documented, and a poor score (of 9 or more--the top 20%) on a reliable six-item functional rating scale (Cronbach's alpha = 0.75). RESULTS: The delayed prescribing strategy did not significantly increase reported episodes of earache in the 3 months since randomisation (odds ratio [OR] = 0.89; 95% confidence interval [CI] = 0.48 to 1.65) or over 1 year (OR = 1.03; 95% CI = 0.60 to 1.78) nor of poor scores on the function scale at 3 months (OR = 1.16; 95% CI = 0.61 to 2.22) or 1 year (OR = 1.12; 95% CI = 0.57 to 2.19), and controlling for subsequent antibiotic use after the randomised episode did not alter these estimates. The number of prior episodes of AOM documented in the doctor's notes predicted episodes of earache reported (0, 1, > or = 2 episodes, respectively; OR = 1, 2.42, 2.61; chi2 for trend 8.04; P<0.01). There was weaker evidence that prior episodes also predicted poor function at 1 year (OR = 1, 1.86, 2.28; chi2 for trend 5.49; P = 0.019). For children with recurrent AOM (two or more previous episodes documented in the doctor's notes, n = 43) there was possible evidence of fewer episodes of earache in the 3 months since study entry in the immediate antibiotic group (10% compared to 39% in the delayed group, chi2 4.8, P = 0.029), but no effect from randomisation to 1 year. CONCLUSIONS: For most children, delayed prescribing is not likely to have adverse longer-term consequences. Children with recurrent AOM are more likely to have poorer outcomes. Secondary analysis should be treated with caution and requires confirmation, but suggests that treating such children with antibiotics immediately may not alter longer-term outcomes.

Amoxicillin↗
PubMed2006

Auditory symptoms in whiplash patients - could earwax occlusion be a benign cause?

BACKGROUND: Excess cerumen (earwax) in the external auditory canal is associated with symptoms of earache, fullness in the ears, and diminished hearing. These symptoms, and tinnitus, are commonly associated with whiplash injury. METHODS: Eighty-six whiplash patients were examined to determine if there was a correlation between symptoms of earache, fullness in the ear, diminished hearing, and tinnitus, and the degree of cerumen occlusion. Cerumen occlusion was measured by visualisation of the tympanic membrane and graded according to a 4 point scale. RESULTS: Of 71 subjects reporting no acute onset (within 7 days of the collision that caused their whiplash) earache, fullness in the ears, hearing loss, or tinnitus, 62 had little or no cerenum occlusion. Of seven subjects reporting tinnitus but no other auditory symptoms, none had greater than moderate cerenum occlusion. Of eight subjects reporting one or more of acute onset earache, fullness in the ears, diminished hearing, and tinnitus, seven had complete cerenum occlusion in the affected ear. DISCUSSION: The findings suggest high grade cerumen occlusion frequently occurs in the ear affected by acute auditory symptoms. However, tinnitus alone has no apparent association with cerumen occlusion. It is possible that a significant number of acute onset auditory symptoms reported in whiplash patients have a benign cause.

Adolescent↗
PubMed1994

Health insurance status and ambulatory care for children.

BACKGROUND: Many children in the United States lack health insurance. We tested the hypothesis that these children are less likely than children with insurance to visit a physician when they have specific conditions for which care is considered to be indicated. METHODS: We examined the association between whether children were covered by health insurance and whether they received medical attention from a physician for pharyngitis, acute earache, recurrent ear infections, or asthma. Data were obtained on the subsample of 7578 children and adolescents 1 through 17 years of age who were included in the 1987 National Medical Expenditures Survey, a national probability sample of the civilian, noninstitutionalized population. RESULTS: Uninsured children were more likely than children with health insurance to receive no care from a physician for all four conditions (unadjusted odds ratios, 2.38 for pharyngitis; 2.04 for acute earache; 2.84 for recurrent ear infections; and 1.87 for asthma). Multiple logistic-regression analysis was subsequently used to control for age, sex, family size, race or ethnic group, region of the country, place of residence (rural vs. urban), and household income. After adjustment for these factors, uninsured children remained significantly more likely than insured children to go without a visit to a physician for pharyngitis (adjusted odds ratio, 1.72; 95 percent confidence interval, 1.11 to 2.68), acute earache (1.85; 95 percent confidence interval, 1.15 to 2.99), recurrent ear infections (2.12; 95 percent confidence interval, 1.28 to 3.51), and asthma (1.72; 95 percent confidence interval, 1.05 to 2.83). CONCLUSIONS: As compared with children with health insurance, children who lack health insurance are less likely to receive medical care from a physician when it seems reasonably indicated and are therefore at risk for substantial avoidable morbidity.

Adolescent↗
PubMed2005

Recurrent tinnitus and associated ear symptoms in adults.

This study aimed to reveal in general population the prevalence, associations, and statistical model of recurrent tinnitus by means of a mailed questionnaire. The study sample consisted of 1720 randomly selected adults who were classified into three subgroups: recurrent (once a month or more often), occasional (less often than once a month), and no tinnitus. According to age and gender standardized prevalence, recurrent tinnitus was reported in 15% of the sample. It was statistically highly significantly associated with earache, fullness of ears shoulder pain, the 25-years age group, and visits to a physician. The strongest predictor of recurrent tinnitus was fullness of ears followed by earache, shoulder ache, and temporomandibular disorder pain. We conclude that recurrent tinnitus seems to be quite common in adults and associated with earache and fullness of ears In patients with tinnitus without clinical findings, the examination of the stomatognathic system and cervical spine is recommended.

Adult↗
PubMed2003

The symptoms and clinical course of acute bullous myringitis in children less than two years of age.

OBJECTIVE: the most characteristic symptom of acute bullous myringitis (inflammation of the tympanic membrane) is a sudden onset of severe ear pain. However, in infants and young children a precise symptom history is more difficult to obtain and the symptoms may be less specific. Our objective was to determine the occurrence of different symptoms, signs and the recovery of symptoms during the course of acute bullous myringitis in children less than 2 years. We also evaluated whether there were any specific features in bullous myringitis in comparison with acute otitis media (AOM). METHODS: 2028 children (aged 7-24 months) at primary care level in a prospective longitudinal cohort study in the Finnish Otitis Media Vaccine Trial. RESULTS: during the follow-up there were 86 office visits with bullous myringitis in 92 ears and 1876 office visits with acute otitis media in 2683 ears. Middle ear fluid developed in 97% of cases of bullous myringitis during the course of disease. Earache was present in 58% and fever (>or=38 degrees C) in 62% of cases of bullous myringitis. The symptoms of upper respiratory tract infection (rhinitis in 93% and cough in 73% of events) were present in a majority of cases. Earache, fever, rubbing of the ear, restless sleeping, excessive crying and poor appetite were present more often in bullous myringitis than in acute otitis media. The symptoms were relieved in 1-2 days in a majority of cases. There were no recognized cases of bullous myringitis in ears with patent tympanostomy tubes. CONCLUSIONS: acute bullous myringitis in children represents a special form of AOM with more severe symptoms. Earache and fever were more common in bullous myringitis than in AOM. However, the condition resolved rapidly and the short-term outcome was good.

Acute Disease↗
PubMed1994

Lack of specific symptomatology in children with acute otitis media.

Although the symptoms of the acutely ill child are important both in the diagnosis and follow-up of acute otitis media (AOM), data about them are quite limited. We carried out a prospective survey by collecting information on 354 consecutive children visiting a pediatrician, otolaryngologist or general practitioner because of any kind of acute symptoms to compare symptoms of children with acute otitis media with those of children with other acute infectious diseases. The symptoms and signs observed at home were recorded by the parents before the visit and the findings in the physical examination were recorded later by the physician. AOM was diagnosed in 191 patients (54.0%). The most important symptoms increasing the likelihood of AOM significantly were ear-related symptoms, such as earache (relative risk (RR) 5.4; P < 0.001), rubbing of the ear (RR 5.0; P < 0.001) and feeling of blocked ear (RR 4.5; P < 0.05). However, only 67.7% of children younger than 2 years of age with AOM had any ear-related symptoms. The children with tympanostomy tubes had earache (47.8%) and rubbing of the ear (58.8%) of the same magnitude as did children without tubes. Rhinitis increased the likelihood of AOM (RR 2.3; P < 0.001) as did excessive crying in children older than 2 years of age (RR 3.0; P < 0.001). Fever, earache or excessive crying was present in 90.1% of patients with AOM but also in 72.4% of patients without AOM.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2000

Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

AIMS: To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. STUDY DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. SUBJECTS AND METHODS: The mothers of 10006 infants gave information on their child's use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. RESULTS: 36.3% of infants sucked a pacifier, 21. 3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. CONCLUSIONS: Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.

Adult↗
PubMed1996

Incidents of symptomatic temporomandibular (TM) joint disorders in female population with missing permanent first molar(s).

In the literatures, the relationship between missing teeth or malocclusion and the symptoms of temporomandibular joint disorder such as frequent headaches, earaches, sinus pain, and jaw pain, has been documented. However, there were no specific details as to which teeth were missing to cause these symptoms. In this project the relationship between missing first molars in adult female subjects to the previously mentioned symptoms was studied using one group of 65 subjects with missing one, two, three, or four first molars and a control group of 67 subjects with no missing first molars. The study revealed a significant relationship of missing first molar(s) and the occurrence of headaches, earaches, sinus pain, and jaw pain.

Adult↗
PubMed1998

Symptoms of acute otitis media.

BACKGROUND: The decision to seek medical advise for children during upper respiratory infections is largely based on the parental assumption that the child's symptoms are related to acute otitis media. The symptoms related to acute otitis media, however, are considered nonspecific. METHODS: Altogether 857 healthy day-care children (mean age, 3.7 years) were followed up for 3 months, and the symptoms of each child were compared during upper respiratory infections with and without acute otitis media. RESULTS: A total of 138 children had upper respiratory infections with and without acute otitis media. The symptom with the strongest association with acute otitis media was earache [relative risk (RR), 21.3; 95% confidence intervals (CI), 7.0 to 106, P < 0.0001] but sore throat (RR = 3.2; CI = 1.1 to 11; P = 0.027), night restlessness (RR = 2.6; CI = 1.1 to 6.9; P = 0.024) and fever (RR = 1.8; CI = 1.1 to 3.2; P = 0.025) also had significant associations. Logistic regression analysis showed 71% of the cases to be correctly diagnosed on the basis of the symptoms of earache and night restlessness. The parents were able to predict the presence of acute otitis media with a sensitivity and specificity of 71 and 80%, respectively (positive predictive value, 51%; negative predictive value, 90%). CONCLUSIONS: Despite the limited value of symptoms in differentiating acute otitis media from upper respiratory infection, the parents are able to predict acute otitis media somewhat reliably. More symptoms than have been reported earlier appeared to be associated with acute otitis media.

Acute Disease↗