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Associations among milk yield, yield persistency, conception, and culling of Israeli Holstein dairy cattle.

Genetic correlations among Predicted Differences for milk yield corrected for economic value of fat content, annualized yield, yield persistency, conception rate, and culling rate were estimated. Correlations were .43 between yield persistency and annualized yield, .42 between yield persistency and conception rate, and .1 between annualized yield and conception rate. For Predicted Differences for these traits computed separately for each of first three parities, correlations between pairs were highest for annualized yield and lowest for culling rate. Regression coefficients for conception rate from cow insemination records on daily yield preceding insemination and on absolute change of yield during month of insemination were significantly negative for the first three parities. A positive pleiotropic effect for yield, yield persistency, and conception rate was suggested; therefore, progeny testing for yield persistency may improve yield and conception rate. High yields and large changes of yield during month of insemination adversely affected conception rate of cows within herds.

Animals↗

Persistent posttraumatic cerebrospinal fluid leakage.

OBJECT: Persistent posttraumatic cerebrospinal fluid (CSF) leakage frequently complicates skull base fractures. Although many CSF leaks will cease without treatment, patients with CSF leaks that persist greater than 24 hours may be at increased risk for meningitis, and many will require surgical intervention. The authors reviewed their 15-year experience with posttraumatic CSF leaks that persisted longer than 24 hours. METHODS: The authors reviewed the medical records of 51 patients treated between 1984 and 1998 with CSF leaks that persisted for 24 hours or longer after traumatic head injury. In 27 patients (55%) spontaneous resolution of CSF leakage occurred at an average of 5 days posttrauma. In 23 patients (45%) surgery was required to resolve the leakage. Eight patients (16%) with occult CSF leaks presented with recurrent meningitis at an average of 6.5 years posttrauma. Forty-three (84%) patients with CSF leaks sustained a skull fracture, most commonly involving the frontal sinus, whereas parenchymal brain injury or extraaxial hematoma was demonstrated in only 18 patients (35%). Delayed CSF leaks, with an average onset of 13 days posttrauma, were observed in eight patients (16%). Among patients with clinically evident CSF leakage, the frequency of meningitis was 10% with antibiotic prophylaxis, and 21% without antibiotic prophylaxis. Thus, prophylactic antibiotic administration halved the risk of meningitis. A variety of surgical approaches was used, and no significant neurological morbidity occurred. Three (13%) of 23 surgically treated patients required additional surgery to treat continued CSF leakage. CONCLUSIONS: A significant proportion of patients with CSF leaks that persist greater than 24 hours will require surgical intervention. Prophylactic antibiotic therapy may be effective in this group of patients. Patients with skull base or frontal sinus fractures should be followed to detect the occurrence of delayed leakage. Surgery-related outcome is excellent.

Adolescent↗

Persistent hydrocephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified?

OBJECT: The authors evaluate the incidence of persistent hydrocephalus after early surgical management of pediatric posterior fossa tumors and the indicators for routine preoperative endoscopic third ventriculostomy (ETV). METHODS: Between 1989 and 2004, 160 children with a posterior fossa tumor were treated at Erasme Hospital in Brussels, Belgium. Hydrocephalus was present at admission in 114 of the patients. Thirty-one patients had severe hydrocephalus (Evans index [EI] > 0.4). Twenty-four of these and the 83 patients with mild hydrocephalus (EI between 0.3 and 0.4) were treated with early posterior fossa surgery (Group 1; 107 patients). In this group, 93 patients underwent a total or subtotal tumor resection associated with external ventricular drainage (Group 1A), and 14 underwent a stereotactic biopsy associated with an ETV (Group 1B). The 53 remaining patients underwent elective posterior fossa surgery (Group 2). Early tumor resection (Group 1A) resolved hydrocephalus in 85 (91%) of 93 patients, whereas an ETV resolved intracranial hypertension in 11 patients (Group 1B). In Group 1, persistent hydrocephalus affected 11 (10%) of 107 patients, seven of whom had symptoms and were treated (three with shunts and four with ETVs). Persistent hydrocephalus was more frequent in children with severe preoperative hydrocephalus (p = 0.002) and with medulloblastomas (p = 0.0154). A total of 22 technically successful ETV procedures were performed. The ETV success rate for controlling hydrocephalus was 81% (18 of 22) and the rate of severe complications was 9% (two of 22). CONCLUSIONS: An ETV is an efficient procedure for controlling hydrocephalus associated with posterior fossa tumor. The authors confirm that a routine postoperative ETV is indicated for treating persistent hydrocephalus. For preventing it, however, they recommend early posterior fossa surgery whenever possible. The low rate of persistent hydrocephalus does not justify adopting routine preoperative ETVs.

Child↗

Airway inflammation and allergen specific IgE production may persist longer than airway hyperresponsiveness in mice.

During the preclinical study of new therapeutic modality, we evaluate whether the treatment can reverse the established asthma phenotypes in animal model. However, few have reported on the long term persistence of asthma phenotypes upon re-challenge with allergen (secondary challenge) in animal model. We evaluated the persistence of asthma phenotypes by secondary challenge at different times in previously challenged murine asthma model. BALB/c mice sensitized by intraperitoneal injections of 20 micro g of ovalbumin and 1 mg of alum on days 1 and 14 were challenged initially by the inhalation of 1% ovalbumin for 30 min on days 21, 22, and 23. Each group of mice was rechallenged at 5, 7, 9, or 12 weeks after the initial challenge. Airway hyperresponsiveness, BAL fluid, airway histology and serum ovalbumin-specific IgE level were evaluated. Airway eosinophilia, airway inflammation and serum ovalbumin-specific IgE production persisted upon secondary allergen challenges at least 12 weeks after the initial challenge. However, airway hyperresponsiveness persisted only until mice were rechallenged 7 weeks after the initial challenge. Airway inflammation and allergen specific IgE production may persist longer than airway hyperresponsiveness in a mouse asthma model of secondary allergen challenge.

Allergens↗

Persistent infection of betanodavirus in a novel cell line derived from the brain tissue of barramundi Lates calcarifer.

In order to obtain an in vitro system for studying the mechanism of persistent infection of fish nodavirus, a novel cell line (BB) was established from the brain tissue of a barramundi, Lates calcarifer, which had survived viral nervous necrosis disease. The cell line has been subcultured > 100 times. The persistence of fish nodavirus designated as barramundi brain nervous necrosis virus (BBNNV) in the BB cells was demonstrated by: (1) the detection of the infectious virus in the culture supernatants, (2) the detection of NNV nucleic acids extracted from the BB cells, (3) the positive result of immunochemical staining using an NNV-specific monoclonal antibody and (4) their resistance to infection by another fish nodavirus grouper NNV (GNNV). No temperature-sensitive mutants were detected in the culture supernatant of the BB cells. Neither truncated genome (RNA1 or RNA2) nor smaller coat protein was found in the purified BBNNV particles, suggesting that defective interfering particles were unlikely to be important in the NNV-persistent infection in the BB cells. The result of the neutralization test indicated that the 5 antigenic determinants, recognized by GNNV-specific neutralizing antibodies, also existed on the coat protein of BBNNV. The BB cell line is the first cell line reported to be persistently infected with NNV, and would be a useful model for understanding the mechanisms of NNV-persistent infection in vitro and in vivo.

Animals↗

Cortical dynamics of lateral inhibition: visual persistence and ISI.

Psychophysical studies show that increasing the interstimulus interval (ISI) between two stimuli decreases persistence of the first stimulus. While some researchers account for these results with interactions of transient and sustained inhibition, this paper describes an alternative explanation. In a neural-network model of boundary detection called the boundary contour system, persistence is the result of feedback-generated reverberations. Mechanisms to control these reverberations include lateral inhibition, which computer simulations show allows persistence in the network to qualitatively match the psychophysical data. Additional simulations predict that increasing the duration of the second stimulus should cause persistence to increase with ISI. The model links psychophysical data on visual persistence with computational requirements of spatial vision and properties of cells in visual cortex.

Feedback↗

Prolonged antigen persistence within nonterminal late endocytic compartments of antigen-specific B lymphocytes.

Although Ag-specific B lymphocytes can process Ag and express peptide-class II complexes as little as 1 h after Ag exposure, it requires 3-5 days for the immune system to develop a population of Ag-specific effector CD4 T lymphocytes to interact with these complexes. Presently, it is unclear how B cells maintain the expression of cell surface antigenic peptide-class II complexes until effector CD4 T lymphocytes become available. Therefore, we investigated B cell receptor (BCR)-mediated Ag processing and presentation by normal B lymphocytes to determine whether these cells have a mechanism to prolong the cell surface expression of peptide-class II complexes derived from the processing of cognate AG: Interestingly, after transit of early endocytic compartments, internalized Ag-BCR complexes are delivered to nonterminal late endosomes where they persist for a prolonged period of time. In contrast, Ags internalized via fluid phase endocytosis are rapidly delivered to terminal lysosomes and degraded. Moreover, persisting Ag-BCR complexes within nonterminal late endosomes exhibit a higher degree of colocalization with the class II chaperone HLA-DM/H2-M than with the HLA-DM/H2-M regulator HLA-DO/H2-O. Finally, B cells harboring persistent Ag-BCR complexes exhibit prolonged cell surface expression of antigenic peptide-class II complexes. These results demonstrate that B lymphocytes possess a mechanism for prolonging the intracellular persistence of Ag-BCR complexes within nonterminal late endosomes and suggest that this intracellular Ag persistence allows for the prolonged cell surface expression of peptide-class II complexes derived from the processing of specific AG:

Animals↗

Stage-specific expression of surface antigens by Toxoplasma gondii as a mechanism to facilitate parasite persistence.

Toxoplasma persists in the face of a functional immune system. This success critically depends on the ability of parasites to activate a strong adaptive immune response during acute infection with tachyzoites that eliminates most of the parasites and to undergo stage conversion to bradyzoites that encyst and persist predominantly in the brain. A dramatic change in antigenic composition occurs during stage conversion, such that tachyzoites and bradyzoites express closely related but antigenically distinct sets of surface Ags belonging to the surface Ag 1 (SAG1)-related sequence (SRS) family. To test the contribution of this antigenic switch to parasite persistence, we engineered parasites to constitutively express the normally bradyzoite-specific SRS9 (SRS9(c)) mutants and tachyzoite-specific SAG1 (SAG1(c)) mutants. SRS9(c) but not wild-type parasites elicited a SRS9-specific immune response marked by IFN-gamma production, suggesting that stage-specificity of SRS Ags determines their immunogenicity in infection. The induction of a SRS9-specific immune response correlated with a continual decrease in the number of SRS9(c) cysts persisting in the brain. In contrast, SAG1(c) mutants produced reduced brain cyst loads early in chronic infection, but these substantially increased over time accompanying a hyperproduction of IFN-gamma, TNF-alpha, and IL-10, and severe encephalitis. We conclude that stage-specific expression of SRS Ags is among the key mechanisms by which optimal parasite persistency is established and maintained.

Animals↗

Prevalence of acute and persistent diarrhoea in north Gondar zone, Ethiopia.

OBJECTIVES: A study was conducted to determine the magnitude of dysentery and persistent diarrhoea in children aged under-five. DESIGN: A cross-sectional community-based survey was used to enroll the under-five children. A two-stage random sampling technique was applied to identify the households with under-five children. SETTING: The study was conducted from March to May 1997 in two districts of North Gondar Administrative Zone that is located in northwest Ethiopia. Two urban dwellers associations and twelve peasant associations were covered by the study. SUBJECTS: A total of 1101 under-five children were involved. MAIN OUTCOME MEASURES: Bloody diarrhoea and diarrhoea that persisted for fourteen days or more were the main outcome variables. RESULTS: One hundred and ninety seven (18%) of the under five children had diarrhoeal attacks within two-week recall period. Sixty five (33%) of these had persistent diarrhoea. The prevalence of persistent diarrhoea was 6%. Of those who had diarrhoea, forty four (22.3%) had dysentery. Access to protected water source was significantly lower in children with diarrhoeal diseases than without (chi 2 = 4.31, p < 0.05). Significantly a higher number of children with diarrhoea had recent attacks of diarrhoea than those without diarrhoea (chi 2 = 176.82, p < 0.00001). CONCLUSIONS: A particularly high prevalence of dysentery and persistent diarrhoea was observed. Establishment of a simple surveillance system and taking of control measures to reduce the burden of dysentery is recommended.

Acute Disease↗

Persistence of enterohemorrhagic Escherichia coli O157:H7 in soil and on leaf lettuce and parsley grown in fields treated with contaminated manure composts or irrigation water.

Outbreaks of enterohemorrhagic Escherichia coli O157:H7 infections associated with lettuce and other leaf crops have occurred with increasing frequency in recent years. Contaminated manure and polluted irrigation water are probable vehicles for the pathogen in many outbreaks. In this study, the occurrence and persistence of E. coli O157:H7 in soil fertilized with contaminated poultry or bovine manure composts or treated with contaminated irrigation water and on lettuce and parsley grown on these soils under natural environmental conditions was determined. Twenty-five plots, each 1.8 by 4.6 m, were used for each crop, with five treatments (one without compost, three with each of the three composts, and one without compost but treated with contaminated water) and five replication plots for each treatment. Three different types of compost, PM-5 (poultry manure compost), 338 (dairy manure compost), and NVIRO-4 (alkaline-stabilized dairy manure compost), and irrigation water were inoculated with an avirulent strain of E. coli O157:H7. Pathogen concentrations were 10(7) CFU/g of compost and 10(5) CFU/ml of water. Contaminated compost was applied to soil in the field as a strip at 4.5 metric tons per hectare on the day before lettuce and parsley seedlings were transplanted in late October 2002. Contaminated irrigation water was applied only once on the plants as a treatment in five plots for each crop at the rate of 2 liters per plot 3 weeks after the seedlings were transplanted. E. coli O157:H7 persisted for 154 to 217 days in soils amended with contaminated composts and was detected on lettuce and parsley for up to 77 and 177 days, respectively, after seedlings were planted. Very little difference was observed in E. coli O157:H7 persistence based on compost type alone. E. coli O157:H7 persisted longer (by > 60 days) in soil covered with parsley plants than in soil from lettuce plots, which were bare after lettuce was harvested. In all cases, E. coli O157:H7 in soil, regardless of source or crop type, persisted for > 5 months after application of contaminated compost or irrigation water.

Disease Outbreaks↗

Wild bird mortality and West Nile virus surveillance: biases associated with detection, reporting, and carcass persistence.

Surveillance targeting dead wild birds, in particular American crows (Corvus brachyrhynchos), plays a critical role in West Nile virus (WNV) surveillance in the United States. Using crow decoy surrogates, detection and reporting of crow carcasses within urban and rural environments of DeKalb County, Georgia were assessed for potential biases that might occur in the county's WNV surveillance program. In each of two replicated trials, during July and September 2003, 400 decoys were labeled with reporting instructions and distributed along randomly chosen routes throughout designated urban and rural areas within DeKalb County. Information-theoretic methods were used to compare alternative models incorporating the effects of area and trial on probabilities of detection and reporting. The model with the best empirical support included the effects of area on both detection and reporting of decoys. The proportion of decoys detected in the urban area (0.605, SE=0.024) was approximately twice that of the rural area (0.293, SE=0.023), and the proportion of decoys reported in the urban area (0.273, SE=0.023) was approximately three times that of the rural area (0.103, SE=0.028). These results suggest that human density and associated factors can substantially influence dead crow detection and reporting and, thus, the perceived distribution of WNV. In a second and separate study, the persistence and fate of American crow and house sparrow (Passer domesticus) carcasses were assessed in urban and rural environments in Athens-Clarke, Madison, and Oconee counties, Georgia. Two replicated trials using 96 carcasses of each species were conducted during July and September 2004. For a portion of the carcasses, motion sensitive cameras were used to monitor scavenging species visits. Most carcasses (82%) disappeared or were decayed by the end of the 6-day study. Carcass persistence averaged 1.6 days in rural areas and 2.1 days in urban areas. We analyzed carcass persistence rates using a known-fate model framework in program MARK. Model selection based on Akaike's Information Criteria (AIC) indicated that the best model explaining carcass persistence rates included species and number of days of exposure; however, the model including area and number of days of exposure received approximately equal support. Model-averaged carcass persistence rates were higher for urban areas and for crow carcasses. Six mammalian and one avian species were documented scavenging upon carcasses. Dead wild birds could represent potential sources of oral WNV exposure to these scavenging species. Species composition of the scavenger assemblage was similar in urban and rural areas but "scavenging pressure" was greater in rural areas.

Animals↗

Persistent intrahepatic right umbilical vein: a prenatal sonographic series without significant anomalies.

Umbilical venous anatomy variation is considered extremely rare. The intrahepatic persistent right umbilical vein represents one version in the spectrum of umbilical vein variations. Prior reports of a prenatally diagnosed persistent right umbilical vein suggest it is strongly associated with severe fetal anomalies including congenital heart disease and gastrointestinal malformations. Our experience contrasts with these findings. Nine cases of intrahepatic persistent right umbilical vein were identified via prenatal sonography between July 1992 and January 1994. The gestational ages of the fetuses ranged from 20 to 36 weeks. Targeted fetal surveys were performed in all nine fetuses and formal fetal echocardiograms were obtained in six. All nine infants have been delivered. In nine cases, the intrahepatic persistent right umbilical vein was an isolated observation with no abnormalities identified pre- or postnatally except one case of hypospadias. Formal fetal echocardiography was normal in all six of the fetuses studied. Given previous reports describing a high risk of congenital malformations in association with the presence of a persistent right umbilical vein, the sonographic finding of this anomaly should still prompt targeted fetal sonography and fetal echocardiography. However, our series indicates that this vascular variant may occur as an isolated abnormality and may not necessarily represent the ominous finding suggested previously.

Female↗

[Persistent symptomatology in workers industrially exposed to organophosphate pesticides].

OBJECTIVE: To describe the patterns of persistent symptomatology in workers industrially exposed to organophosphate pesticides. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study was performed. A questionnaire was applied to managers of a factory and to 89 workers, whose erythrocytic cholinesterase level was measured with the Magnotti and Lovibond method. Information is described through rates, central tendency measures and dispersion. Differences between groups were evaluated with the chi 2 test and the odds ratio was calculated. RESULTS: Persistent symptomatology was found in 6.3 per 10 workers. 50% had six or more symptoms. No significant differences were found as to the risk of suffering from persistent symptomatology with respect to age, length of service or position at work. However, the highest proportion of symptoms was found in workers of 31 to 40 years of age, with 6 to 13 years of service, from the maintenance area, working as general operators or supervisors. Among the 13 workers with previous intoxication, the prevalence of persistent symptomatology was 6.9 against 6.1 in workers who had not been intoxicated before. The risk of acute poisoning in workers with more than 14 years of service was 4 times greater than in workers with less than 14 years of service (p < 0.005). Average level of blood cholinesterase was normal (4.4 u/ml). CONCLUSIONS: Results show a relationship between exposure to organophosphate pesticides and presence of persistent symptoms. It is necessary to study the prevalence of this symptomatology in exposed and non-exposed populations.

Adult↗

[Ruptured persistent primitive hypoglossal artery aneurysm: case report].

Persistent primitive hypoglossal artery is less common than persistent primitive trigeminal artery. About one hundred examples of such hypoglossal arteries have been demonstrated by angiography. The origin of persistent primitive hypoglossal artery is the cervical segment of the internal carotid artery, usually at the level of the first to second cervical vertebrae. The artery then enters, with varying degrees of tortuosity, the anterior condyloid (hypoglossal) canal and joints the basilar artery immediately above its lower end. When enlargement of this canal is identified, the presence of a persistent primitive hypoglossal artery should be strongly suspected. The homolateral vertebral artery is frequently hypoplasia. A 66-year-old man was brought to our hospital due to faintness. CT showed thick subarachnoid hemorrhage. Angiography showed that a persistent primitive hypoglossal artery aneurysm was present, but the posterior communicating artery was absent. Right vertebral angiography showed extravasation due to re-rupture of the aneurysm. An operation was performed at day 0 using the left transcondylar approach despite deterioration of SAH grading. Intraoperative re-rupturing occurred and the lower cranial nerves clustered around the aneurysm, so the aneurysm was partially clipped on the dome. The second angiography was carried out at day 10, and there was no vasospasm. Palsy of the lower cranial nerves appeared transiently. A ventricle-peritoneum shunt was required due to normal pressure hydrocephalus, but the patient was discharged with no neurological deficits.

Aged↗

[Factors for postoperative persistent hypertension in patients with aldosterone-producing adenoma].

We determined the factors for postoperative persistent hypertension in the patients with aldosterone-producing adrenal adenoma (APA) in 53 patients with APA who were followed up for average 3.1 years. All had normal serum potassium concentration postoperatively. Blood pressure was normal in 37 patients (69.8%) but 18.7/12.7 kPa or more in 16 patients (30.2%) with persistent hypertension. Also compared were sex, age, history of hypertension, effect of reducing blood pressure to antisterone, preoperative blood pressure, time of persistent hypertension, serum potassium concentration, aldosterone concentration in 24 hour urine, amount of PRA, and the type of operation. The results showed that an APA patient aged 50 years or more appears to have a great chance of persistent hypertension than an APA patient under age of 40 years, and the odds ratio is 3:1. There was a significant difference between the mean age for persistent hypertension and for normal blood pressure, and varioas response of reducing blood pressure to antisterone (P < 0.05). It is suggested that for an older APA patient and the patient without of reducing blood pressure to antisterone, there are other factors for hypertension such as renal veinlet change or renal interstitial lesions except for hyperaldosteronism. We recommend renal biopsy (using kidney puncture) at the operating table for those patients in order to understand pathological change and guide treatment after operation.

Adenoma↗

Persistent otitis media with effusion: can it be predicted? A family practice follow-up study in children aged 6 months to 6 years.

BACKGROUND: Otitis media with effusion (OME) has a high rate of spontaneous resolution, and a policy of waiting and watching for 3 months is justified. The decision about further treatment should be individualized, depending on duration and symptoms. Knowledge of the determinants for persistent OME would be helpful for identifying patients with a need for active treatment or increased monitoring for complications. METHODS: A total of 433 children aged 6 months to 6 years were monitored for 3 months in the offices of 57 family physicians. A questionnaire pertaining to determinants was completed. The outcome measures were: presence of unilateral or bilateral OME or bilateral OME after 3 months. The outcome was determined on the basis of tympanometry results. We performed bivariate and multivariate analyses. RESULTS: The presence of an upper respiratory tract infection (URTI) at the follow-up visit was associated with finding OME at that visit. When a URTI was present, no other determinants for persistent OME were found. When absent, the determinants for persistent bilateral OME were: no history of adenoidectomy, an episode of acute otitis media (AOM) in the first year of life, and month of entry into the study (June-November). For persistent unilateral or bilateral OME, the only significant determinant was an episode of AOM in the first year of life. CONCLUSIONS: Childrenwith 1 or more of the following factors need special attention for prevention of the sequelae of persistent OME: no history of adenoidectomy, AOM in the first year of life, and the presence of bilateral OME in the period between June and November.

Acute Disease↗

Primary intestinal obstruction complicated by persistent descending mesocolon.

Persistent descending mesocolon is an uncommon developmental anomaly which results from failure of fusion of the descending mesocolon with the posterior parietal peritoneum. It is asymptomatic in most cases and rarely causes intestinal obstruction. We report here a case of primary intestinal obstruction complicated by a persistent descending mesocolon. A 66-year-old man without prior laparotomy was admitted with a diagnosis of small bowel obstruction. Pre-operative investigation demonstrated a segmental jejunal stenosis and a persistent descending mesocolon as possible causes of the obstruction. Laparotomy showed that the cause of the obstruction was the jejunal stenosis, not the persistent descending mesocolon. The stenosis was resected, but correction of the anomaly was not performed. The patient made an uneventful recovery after the operation. From our limited experience, persistent descending mesocolon need not be surgically corrected when it is not considered to be the cause of obstruction and another definite cause co-exists.

Aged↗

A quasi-randomised controlled trial of water as a quick softening agent of persistent earwax in general practice.

BACKGROUND: Earwax is a common problem in general practice. The incidence of complaints owing to earwax in general practice in the Netherlands is 39.3 per 1000 patients. AIM: To determine the feasibility of a strategy using water as a quick dispersant for persistent earwax, compared with the usual strategy using oil as a dispersant for three days in a general practice setting. DESIGN OF STUDY: Practice based, prospective controlled intervention study. SETTING: Forty-two patients (59 ears) in four general practices in the Netherlands. METHOD: Patients with persistent earwax were randomised into an intervention group and a control group. For patients in the intervention group, water drops at body temperature were dropped into the impacted ear and the auditory meatus was blocked with a wet wad of cotton. After the patient had waited for 15 minutes in the waiting room a series of attempts at syringing was completed. Patients in the control group received the usual strategy and were instructed to soften the earwax with oil each night before sleeping and to block the auditory meatus with a wad of cotton, for three days. They were asked to come back after three days for the second attempt of syringing. For both strategies the mean number of syringing attempts (and 95% confidence interval) was calculated and compared by testing the difference between the means using a t-test for independent samples. All ears in which the wax was still persistent after another five syringing attempts were given the value of 6 in the calculations. RESULTS: The mean number of syringing attempts needed per patient in the intervention group was 3.0 (95% CI = 2.4 to 3.6) and for the control group, the mean was 2.4 (95% CI = 1.7 to 3.1). The difference between means (0.6, 95% CI = 0.3 to 1.5) was not statistically significant (P = 0.18). CONCLUSION: A patient with persistent earwax can stay in the waiting room following the initial series of five attempts at syringing, with water instilled in the ear canal. After 15 minutes, the earwax is removed as easily as in the usual strategy using oil instilled for three days. The strategy using water as a dispersant for persistent earwax is quick and more convenient for the patient.

Cerumen↗