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Prevalence, intensity, and correlation of different TMJ symptoms in Lebanese and Italian subpopulations.

AIM: The aim of this study was to compare self reported joint related temporomandibular disorder (TMD) symptoms in Lebanese and Italian dental and non-dental students and to detect any correlation between different symptoms. METHODS AND MATERIALS: A questionnaire was distributed in Sardinia (Italy) to dental and psychology students and in Lebanon to dental, physical therapy, and biology students to investigate the prevalence, intensity, and correlation of four temporomandibular joint (TMJ) symptoms. RESULTS: Prevalence of earache varied among the groups from 10.1% to 29.2%, ear stuffiness from 22.5% to 30.8%, TMJ pain from 13.2% to 21.2%, and TMJ sounds from 18.4% to 46.2%. DISCUSSION: Different prevalence and intensity of earache and TMJ sounds were found in the examined sub-populations diverse in cultural background and education. However, prevalence and intensity of ear stuffiness and TMJ pain were similar. Association between TMJ sounds and TMJ pain was detected in selected sub-populations, and correlation between one symptom on one side of the head with the same symptom on the contralateral side were noted suggesting most of these symptoms are bilateral. CONCLUSION: The results of the study might be useful to anticipate the possible occurrence of associated symptoms or the same symptom on both sides of the head. Correlations with cultural background and education are difficult to establish.

Adult↗

Effects of swimming on health.

An epidemiological study involving 893 people was undertaken during the 1980/81 summer period in the Richmond and Windsor region of New South Wales to determine the incidence of swimmers and non-swimmers reporting ear, eye, skin, throat and gastrointestinal complaints. Swimmers were found to report a greater incidence of ear and eye complaints than non-swimmers. Swimmers who swam in community pools were found to have a significantly higher incidence of earache compared to other swimmers. The findings of the study supported overseas work which suggests that the incidence of earache among swimmers may be a useful health indicator in the evaluation of waters for recreational use.

Adolescent↗

Clinical comparison of magnetic resonance imaging and nuclear emission imaging in cervical-facial trauma patients.

This retrospective study examined 20 consecutively treated trauma patients who reported a chief complaint of earache or trauma preauricular pain. These individuals were examined with magnetic resonance imaging (MRI), emission study using single photon emission, computerized tomography, and joints auscultation using Doppler sound magnification. There are no statistically significant correlations between clinical findings and imaging studies in trauma patients with complaints of earaches and preauricular pain.

Adolescent↗

TMJ symptoms and referred pain patterns.

The purpose of this study was to determine the relationship between TMJ symptoms, (muscle tenderness, joint noise, deviant jaw opening and closing patterns, and limited jaw opening), and a history of referred pain patterns (earaches, headaches, neck pain, and sinus problems). A questionnaire was completed by 100 subjects regarding histories of the previously mentioned problems. The researcher then examined the subject's TMJs, and their symptoms were recorded as being present or absent. The following relationships were found to be significant: Headaches and lateral pterygoid muscle tenderness, Earache and medial pterygoid muscle tenderness, Neck pain and one or more tender muscles, Sinus problems and one or more tender muscles, Sinus problems and temporal muscle tenderness, Sinus problems and medial pterygoid muscle tenderness. However, r values for the above relationships were between 0.22 and 0.3 indicating that the relationships were not strong. It appears that some normal patients already have patterns of masticatory muscle tenderness and associated referred pain patterns prior to seeking treatment for acute TMJ symptoms.

Adult↗

Use of visual analogue scale measurements (VAS) to asses the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study.

The objective of our study was to measure the effectiveness of Andrographis paniculata SHA-10 extract in reducing the prevalence and intensity of symptoms and signs of common cold as compared with a placebo. A group of 158 adult patients of both sexes completed the randomized double blind study in Valdivia, Chile. The patients were divided in two equal size groups, one of which received Andrographis paniculata dried extract (1200 mg/day) and the other a placebo during a period of 5 days. Evaluations for efficacy were performed by the patient at day 0, 2, and 4 of the treatment; each completed a self-evaluation (VAS) sheet with the following parameters: headache, tiredness, earache, sleeplessness, sore throat, nasal secretion, phlegm, frequency and intensity of cough. In order to quantify the magnitude of the reduction in the prevalence and intensity of the signs and symptoms of common cold, the risk (Odds Ratio = OR) was calculated using a logistic regression model. At day 2 of treatment a significant decrease in the intensity of the symptoms of tiredness (OR = 1.28; 95% CI 1.07-1.53), sleeplessness (OR = 1.71; 95% CI 1.38-2.11), sore throat (OR = 2.3; 95% CI 1.69-3.14) and nasal secretion (OR = 2.51; 95% CI 1.82-3.46) was observed in the Andrographis SHA-10 group as compared with the placebo group. At day 4, a significant decrease in the intensity of all symptoms was observed for the Andrographis paniculata group. The higher OR values were for the following parameters: sore throat (OR = 3.59; 95% CI 2.04-5.35), nasal secretion (OR = 3.27; 95% CI 2.31-4.62) and earache (OR = 3.11; 95% CI 2.01-4.80) for Andrographis paniculata treatment over placebo, respectively. It is concluded that Andrographis paniculata had a high degree of effectiveness in reducing the prevalence and intensity of the symptoms in uncomplicated common cold beginning at day two of treatment. No adverse effects were observed or reported.

Adult↗

The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study.

BACKGROUND: Pre-school children are frequent users of health services, but little contemporary data are available describing their symptoms or why they consult. OBJECTIVE: To describe symptom and consultation prevalence in pre-school children and to identify the socio-demographic factor or factors associated with consultations for those symptoms. METHODS: Prospective cohort study of 13,617 pre-school children living in south-west England. Parents completed questionnaires asking about symptoms and consultations for those symptoms at six, 18, 30, 42 and 57 months. RESULTS: During the pre-school years, all children experienced one or more symptoms, most commonly cold, cough, high temperature, vomiting or diarrhoea. Ninety seven percent consulted a doctor at least once, most commonly for cough, high fever and/or earache. Lower parity was most strongly and consistently associated with higher consultation rates. CONCLUSIONS: Fever, respiratory and gastro-intestinal symptoms are a normal part of pre-school life. Research of acute conditions in young children could focus on the most common symptoms leading to consultation, namely cough, fever and earache. Efforts to support parents' help seeking decision making might usefully be targeted at first time parents.

Child, Preschool↗

Penicillin in acute otitis media: a double-blind placebo-controlled trial.

The effect of peroral penicillin-V (55 mg/kg/day in 7 days) on acute otitis media was studied in 149 children between the ages of 1 and 10 years in a double-blind, placebo-controlled investigation. The parameters of the disease employed were symptom scores for earache, fever and common cold, the use of analgetics, otoscopy, as well as tympanometry. The children were followed-up for 3 months. Penicillin had no effect on fever and common cold, but earache was significantly reduced on the 2nd day of treatment. The acute course of the disease was satisfactory in 69% of the children in the placebo group and in 86% in the penicillin group. In patients with pneumococci or haemolytic streptococci in the nasopharynx, the pain disappeared after 1-2 doses of penicillin, whereas the treatment had no effect in children with Haemophilus influenzae. There was no difference between the penicillin and the placebo groups with regard to the results of otoscopy and tympanometry after 1 week, 1 month and 3 months. No serious complications were observed. It is concluded that an attitude of "masterly inactivity" with regard to the treatment of acute otitis media is justifiable, provided sufficient analgesic treatment is given and also that the patient can be closely followed. As there are still many unanswered questions more controlled investigations are warranted.

Acoustic Impedance Tests↗

[A neutropenic acute myeloid leukemia patient complicated with chronic otitis media due to Aspergillus niger and yeast-like fungi caused by superinfection].

There have been few reports describing otomycosis in association with compromised hosts. So we report a neutropenic acute myeloid leukemia (AML) patient complicated with otomycosis caused by superinfection. A 51-year-old male was admitted because a third relapse of AML in March 1998. Two years ago, he was diagnosed as having chronic otitis media involving the VII cranial nerve due to Pseudomonas aeruginosa coinciding with AML. Then, he had suffered from a right-sided earache and otic discharge in accord with every myelosuppression, which improved on treatment with otic administration of ofloxacin. After 1 course of induction chemotherapy, he developed a spiking fever with severe earache and otic discharge at a nadir period of WBC. Ear swab cultures yielded Aspergillus niger and yeast-like fungi. So, he was treated with intravenous administration of amphotericin B (AMPH-B): initial dose was 5 mg/day and was gradually increased to 30 mg/day. Thereafter, the otic symptoms subsided and never recurred. Subsequently, he was given another antifungal agent, itraconazole. Although induction chemotherapies resulted in failure, he did not suffer otic symptoms until his death due to cerebral bleeding in January 1999. For neutropenic patients without rapid hematological improvement, we recommend intensive antifungal therapy as the first-line of therapy for otomycosis rather than local therapy.

Acute Disease↗

An open comparative study of the efficacy and safety of sultamicillin versus cefaclor in the treatment of acute otitis media in children.

In an open study, children (age range 6 months-12 years) with otitis media due to a bacterial infection were treated orally with 50 mg/kg sultamicillin (n = 30) in two equal doses each day for a mean of 10 days, or 40 mg/kg cefaclor (n = 30) in three equal doses each day for a mean of 11 days. Earache was rapidly improved by either treatment; none of the 27 evaluable sultamicillin-treated or the 29 evaluable cefaclor-treated patients had earache after 8-10 days. Other signs and symptoms (reddened eardrums, perforated eardrums, middle ear fluid, hearing loss) gradually improved during treatment. All the pathogens isolated from patients in the sultamicillin treatment group were eradicated, as were all but one of the pathogens isolated from patients in the cefaclor treatment group. In the sultamicillin treatment group 65.4% of patients were cured and 34.6% were improved, and in the cefaclor group 65.5% were cured and 31.0% improved, but there was one treatment failure. Study drug-related adverse events were experienced by 33.3% of sultamicillin- and 40.0% of cefaclor-treated patients, all but one (urticaria in a cefaclor-treated patient) were gastro-intestinal. The dose administered was reduced by approximately 50% in patients experiencing adverse effects. This did not lead to any reduction in efficacy and no patient was withdrawn due to adverse events.

Acute Disease↗

Ventilation tubes in infants increase the risk of otorrhoea and antibiotic usage.

1) PROBLEM/OBJECTIVE: The effect of ventilation tubes on acute otitis related symptoms (otorrhoea, earache, and fever) and on antibiotic usage was investigated in children with persistent otitis media with effusion, as part of a multicenter, randomised, controlled clinical trial. 2) METHODOLOGY: One hundred-eighty-seven children were randomly placed into either a watchful waiting group (WW group) (n = 94) or a group treated with ventilation tubes (VT group) (n = 93). Both groups were followed for 12 months. Data were collected from parental reports and from medical files kept by the attending ENT-surgeons. 3) RESULTS: There were significant differences in the reported frequency of otorrhoea (but not of earache or fever) between both groups during follow-up, i.e. children in the VT group had more episodes of otorrhoea than the children in the WW group (p < 0.003). As a consequence, children in the VT group had been prescribed antibiotics more often. 4) CONCLUSIONS: Young children treated with ventilation tubes due to persistent otitis media with effusion have a higher risk of developing otorrhoea because of the tubes, and they have a higher risk of needing treatment with antibiotics.

Anti-Bacterial Agents↗

Cellular phones: are they detrimental?

The issue of possible health effects of cellular phones is very much alive in the public's mind where the rapid increase in the number of the users of cell phones in the last decade has increased the exposure of people to the electromagnetic fields (EMFs). Health consequences of long term use of mobile phones are not known in detail but available data indicates the development of non specific annoying symptoms on acute exposure to mobile phone radiations. In an attempt to determine the prevalence of such cell phones associated health manifestations and the factors affecting their occurrence, a cross sectional study was conducted in five randomly selected faculties of Alexandria University. Where, 300 individuals including teaching staff, students and literate employee were equally allocated and randomly selected among the five faculties. Data about mobile phone's users and their medical history, their pattern of mobile usage and the possible deleterious health manifestations associated with cellular phone use was collected. The results revealed 68% prevalence of mobile phone usage, nearly three quarters of them (72.5%) were complainers of the health manifestations. They suffered from headache (43%), earache (38.3%), sense of fatigue (31.6%), sleep disturbance (29.5%), concentration difficulty (28.5%) and face burning sensation (19.2%). Both univariate and multivariate analysis were consistent in their findings. Symptomatic users were found to have significantly higher frequency of calls/day, longer call duration and longer total duration of mobile phone usage/day than non symptomatic users. For headache both call duration and frequency of calls/day were the significant predicting factors for its occurrence (chi2 = 18.208, p = 0.0001). For earache, in addition to call duration, the longer period of owning the mobile phone were significant predictors (chi2 = 16.996, p = 0.0002). Sense of fatigue was significantly affected by both call duration and age of the user (chi2 = 24.214, p = 0.0000), while burning sensation was only affected by frequency of calls/day (chi2 = 5.360, p = 0.020). According to the 95% confidence interval of frequency and duration of calls, the study recommended not to increase the call duration more than four minutes and limit their frequency to less than seven calls/day with total duration of exposure less than 22 min./day.

Adult↗

Pseudoephedrine and air travel-associated ear pain in children.

BACKGROUND: Young children often appear bothered by ear pain during ascent and descent while traveling on commercial airplanes. While pseudoephedrine hydrochloride is effective in decreasing the risk for earache in adults with recurrent air travel-associated ear pain, such use in children has not been studied. OBJECTIVE: To assess the efficacy and side effects of prophylactic pseudoephedrine in children traveling by air. DESIGN: A placebo-controlled, double-blind clinical trial. SUBJECTS AND METHODS: Children aged 6 months to 6 years were included in this study. Pseudoephedrine hydrochloride (1 mg/kg body weight) or placebo was administered 30 to 60 minutes prior to departure on commercial air flights. Caregivers noted historical details and the degree of apparent ear pain, drowsiness, and excitability with ascent and descent. RESULTS: Ninety-one flights involving 50 children were studied, with ear pain being reported in 13 (14%) of flights. Ear pain was not associated with a history of air travel-associated ear pain, recent ear infection, or recent upper airway symptoms. Pseudoephedrine use was not associated with a decrease in ear pain during either ascent (4% with pseudoephedrine vs 5% with placebo; P approximately 1.00) or descent (12% with pseudoephedrine vs. 13% with placebo; P approximately 1.00). Pseudoephedrine use was, however, linked to drowsiness at takeoff (60% with pseudoephedrine vs. 27% with placebo; P = .003) but not at landing (P = .39). Treatment was not associated with excitability at takeoff (P = .09) or landing (P approximately 1.00). CONCLUSIONS: Ear pain is not uncommon in children traveling by commercial aircraft. The predeparture use of pseudoephedrine does not decrease the risk for in-flight ear pain in children but is associated with drowsiness.

Aircraft↗

Treatment of acute tonsillitis with a fixed-combination herbal preparation.

In an observational study involving 10 non-hospital-affiliated physicians, 48 patients between 6 and 73 years of age with symptoms of acute tonsillitis were treated with either a liquid or tablet formulation of a herbal compound of Phytolacca, Guajacum, and Capsicum. More than half of the patients reported marked alleviation of the principal symptom, moderate or severe difficulty in swallowing, within the first 5 days of treatment. Comparable improvements occurred in other outcome measures, including earache, headache, and fatigue. No adverse side effects were reported.

Acute Disease↗

A high prevalence of new onset otitis media during parent diagnosed common colds.

INTRODUCTION: Past studies suggest that the majority of new otitis media (OM) diagnoses is a complication of a colds/flu. A prospective format was used to determine the coincidence of otitis media and parent diagnosed cold/flu episodes in young children followed over a typical cold/flu season. METHODS: Eighteen families with children aged 1-8 years were followed from October 1 to April 30 using parent-completed daily diaries focused on cold/flu signs and weekly examinations using pneumatic otoscopy for diagnosis of the presence/absence of otitis media. RESULTS: Overall, 108 cold episodes were documented in 36 enrolled children with 20 colds (19%) occurring during a pre-existing OM episode and 40 colds (37%) complicated by a new OM episode. Conversely, there were 82 new OM episodes, 40 (49%) were associated with a cold in the individual child and 18 (22%) with a concurrent cold in a family member. The median duration of the OM episodes was approximately 2 weeks but this was longer for OM episodes where earache was reported. CONCLUSION: The results confirm past observation relating new OM episodes to a concurrent cold/flu but show these episodes to usually be of short duration. Two sources of potential bias were identified for point prevalence study formats: the presence of a pre-existing OM for a new onset cold/flu and the possibility of subclinical colds in patients with new OM episodes. These biases reinforce the need for longitudinal study formats to address this important relationship.

Child↗

Views on respiratory tract symptoms and antibiotics of Dutch general practitioners, practice staff and patients.

OBJECTIVES: To explore views on respiratory tract symptoms (cough, sore throat and earache) and antibiotics of GPs, practice staff, and patients. METHODS: In a nationwide study, 181 GPs, 204 practice staff members and 1250 patients from 90 practices participated by answering 14 items relating to views on respiratory tract symptoms and antibiotics in a written questionnaire. Differences in means were compared. RESULTS: Patients more than GPs endorsed the seriousness of respiratory tract symptoms, the need to consult a GP, the need to prescribe antibiotics, and the ability of antibiotics to speed up recovery. GPs were more than patients convinced of the self-limiting character of respiratory tract symptoms and of the fact that antibiotics have side effects. Practice staff took a middle ground in most of these views. CONCLUSIONS: Differences between GPs, practice staff and patients must be taken into account when exploring patients' complaints and advising on treatment. Education and knowledge programmes for practice staff might be advocated.

Adult↗

Congenital cholesteatoma.

We present a British series of eleven patients with primary cholesteatoma, including one patient with bilateral disease. Eight children presented with a history of hearing loss, while one child had had recurrent otitis media and another had had earache. Operative findings were: in five ears, cholesteatoma confined to the antero-superior segment with intact ossicles, in a further four, cholesteatomas extending throughout the mesotympanum with ossicular erosion in one, and in two ears posterior disease throughout the middle ear and mastoid, which had eroded the ossicles in both cases. The five cases of antero-superior cholesteatoma lend most support to Michaels' concept of epidermoid formation as a possible source of congenital cholesteatoma. With a greater awareness of the problem and careful examination of the antero-superior quadrant of the tympanic membrane, earlier diagnosis may be possible enabling removal of small intact cholesteatoma sacs and preserving the structures of the middle ear and therefore the hearing. A screening programme for infants included as part of their routine examination which would be undertaken by examiners who are trained to be more aware of the problem and skilled at otoscopy, would help in the earlier detection of such cases as is shown by reports from the U.S.A.

Child↗

Middle ear abnormalities during natural rhinovirus colds in adults.

To determine middle ear pressure (MEP) changes during natural rhinovirus colds, adults with illness for < or = 3 days were tested by digital tympanometer daily for 5 days (study 1) or every other day for 7 days (study 2). Abnormal MEPs (< -50 or > +20 mm H2O) were found in 72% of 36 patients in study 1 (P < .001, vs. baseline of 11%) and 76% of 55 patients in study 2 (P < .001, vs. 15% of 103 healthy controls). Major abnormalities (> or = +100 or < or = -100 mm H2O) were found in 61% of patients in study 1 (P < .001, vs. baseline of 0) and 47% in study 2 (P < .001, vs. control of 5%). MEP abnormalities usually resolved by day 14. Only 1 subject developed clinically apparent otitis media. Earache or respiratory symptom scores did not correlate with MEP abnormalities. These results indicate that natural rhinovirus colds in adults are frequently associated with marked but transient MEP abnormalities.

Adult↗