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PubMed2002

Patients' and doctors' views on respiratory tract symptoms.

OBJECTIVE: To explore the views of patients and doctors on respiratory tract symptoms. DESIGN: Transversal survey among patients and general practitioners. SETTING: Primary health care and community. SUBJECTS: 51 patients attending a general practitioner, 38 patients in the community, 7 general practitioners. MAIN OUTCOME MEASURES: Patients' and doctors' views on respiratory tract symptoms and differences between them: agreement with statements rated on a 5-point scale, ranging from "strongly disagree" to "strongly agree." RESULTS: Patients less than doctors endorsed the self-limiting character of cough, sore throat and earache (mean 3.1, 3.4 and 2.9 versus 4.1, 4.1 and 3.7) and patients--much more than doctors--rated antibiotics as being necessary for cough and sore throat (mean 2.7 and 2.9 versus 1.7 and 17) and believed that antibiotics speed recovery (mean 3.7 versus 2.0). However, there was little difference relating to the necessity to see a doctor after some time period. CONCLUSION: Patients appeared to differ from doctors in views on respiratory tract symptoms. The results stress the importance of exploring patients' views when being confronted by patients suffering from respiratory tract symptoms.

Anti-Bacterial Agents↗
PubMed1995

Race and gender as TMD risk factors in children.

The aim of this study was to record the prevalence in preschool children of oral/facial pain symptoms of clinical interest in the diagnoses of temporomandibular disorders (TMD) and to analyze the association with the race and gender factors. Children, 525 4-6 year olds, mean age 5.1 +/- 0.65 (SD), 326 Caucasian and 199 African American, from a preschool and kindergarten program in a low income industrial area, who participated in a voluntary oral health examination, were examined. Comparisons were made using Chi-Square test. An alpha-level of 5% was chosen, and the effect of making multiple comparisons was compensated for by Bonferroni correction. No gender differences were found, but racial differences were observed regarding six of the 10 variables. Twenty-five percent of the children had recurrent (at least one to two times per week) headache. Thirteen percent had recurrent earache, African-American children more often than Caucasian children (p approximately 0.0038). Thirteen percent had recurrent temporomandibular joint (TMJ) pain, and 11% had recurrent neck pain. Pain or tiredness in the jaws during chewing was reported by 29% of the children, more often by African-American than by Caucasian (p < 0.00001). Pain at jaw opening occurred in 13% of the children, more often in the African-American than in the Caucasian children (p approximately 0.00004). Palpation pain was found in the posterior TMJ area in 28%, in the lateral TMJ area in 22%, in the masseter area in 19%, in the anterior temporalis area in 15% and was found more often in all of those regions in the African-American than in the Caucasian children (p approximately 0.00001), except for the temporalis area. In conclusion, this study showed that mild, but distinct, TMD-related oral/facial pain symptoms occur already by ages 4-6 with significant differences in distribution observed between the African-American and the Caucasian races. While gender seems to play a negligible role in this age group, this does not necessarily mean that race is a causative factor. The pain symptoms may be caused by other factors with different distribution in the two racial subgroups.

Black People↗
PubMed1998

The treatment of temporomandibular disorders through repositioning splint therapy: a follow-up study.

The purpose of this study was to investigate the effectiveness of repositioning splint therapy as a conservative treatment modality for TMD patients. The treatment sequence of 160 randomly sampled TMD patients was monitored in order to assess different aspects of the patients' response to splint therapy. Included among these aspects were the pretreatment symptoms; the treatment duration required for initial and final alleviation of symptoms; the number of patients requiring surgery; and the particular appliance and its wear pattern utilized to maintain the treatment results. The treatment success was based on the remission of symptoms including but not limited to pain to palpation, headaches, earaches, jaw locking, and joint noises. Eighty-nine and four tenths percent (89.4%) of the patients experienced a complete remission of symptoms and did not require any surgical intervention. The average time for initial improvement was 22.3 days, while the average time for complete remission of symptoms was 4.3 months. The results of the study indicate that repositioning splint therapy is an effective treatment modality for the conservative treatment of temporomandibular disorders.

Acrylic Resins↗
PubMed2003

Association of clinical signs and symptoms with bacterial findings in acute otitis media.

In acute otitis media (AOM), a means of prediction of the bacterial pathogen based on symptoms and signs would be valuable in selecting appropriate antimicrobial treatment. Children in the control arm (n=831) in the Finnish Otitis Media Vaccine Trial were prospectively observed in a study clinic setting from the age of 2 to 24 months. In patients with AOM, myringotomy with aspiration was performed, and middle ear fluid samples were cultured for bacterial pathogens. Symptoms and signs of respiratory infections were thoroughly recorded. Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae were the most common bacterial pathogens. Pneumococcal AOM was associated with more-severe AOM characterized by fever and earache. AOM due to H. influenzae was associated with eye symptoms and findings. Accurate prediction of a bacterial cause of infection based on symptoms and signs of AOM was not possible, but a specific cause was predicted in some situations, with a high probability of applicability to clinical practice.

Acute Disease↗
PubMed2004

Association of clinical signs and symptoms with pneumococcal acute otitis media by serotype--implications for vaccine effect.

BACKGROUND: Clinical symptoms and signs in acute otitis media (AOM) may differ depending on the various pneumococcal serotypes causing the disease. Alteration in clinical presentation of AOM could be expected after wide-scale pneumococcal vaccinations if there were considerable differences between vaccine serotypes and nonvaccine serotypes. METHODS: In this study, data from 831 children in the control arm of the Finnish Otitis Media Vaccine Trial were used. The children were followed up prospectively in 8 study clinics from 2 to 24 months of age. If AOM was diagnosed, myringotomy was done, and middle ear fluid was aspirated for bacterial culture. Clinical symptoms and signs of AOM were routinely recorded on structured case report forms. RESULTS: Consistent with previous studies, 60% of pneumococcal episodes were caused by vaccine serotypes. There were no major differences between the clinical presentations of AOM due to different serotypes or serotype categories. However, earache was more often associated with AOM caused by vaccine and cross-reactive serotypes, compared with AOM caused by non-vaccine-related serotypes (42% vs. 29%; odds ratio, 1.66; 95% confidence interval, 1.02-2.70). CONCLUSIONS: Introduction of the currently available pneumococcal conjugate vaccine is unlikely to result in a remarkable alteration in the clinical presentation of pneumococcal AOM in infants.

Acute Disease↗
PubMed1994

Risk factors in otitis media with effusion. A 1 year case control study in 5-7 year old children.

What are the associations and risk factors for otitis media with effusion (glue-ear)? A 1 year case control study in 5-7 year old children from four south-west Hampshire schools examined some of the factors highlighted by the literature. A history of frequent ear problems over the previous year, a history of earache at any time in the child's life, bottle feeding, a red drum at otoscopy and the new finding of night cough all carried an increased relative risk.

Acoustic Impedance Tests↗
PubMed1999

Criteria, performance and diagnostic problems in diagnosing acute otitis media.

OBJECTIVE: We aimed to assess criteria when diagnosing acute otitis media and related performance in general practice in Denmark. Furthermore, we aimed to identify the scale of and the reasons for diagnostic uncertainty. METHODS: We conducted: (i) a survey among GPs assessing criteria; and (ii) prospective registration of acute otitis-media-related consultations performed by GPs assessing performance. The survey was sent to all 790 GPs in Funen, North Jutland and Ringkøbing counties, Denmark. A total of 568 (72%) of all GPs in the three counties responded. A total of 368 children with acute otitis media or previous acute otitis media visiting 151 GPs were studied. The main outcome measures were: (i) criteria for symptoms and findings suggesting the diagnosis acute otitis media, criteria for use of equipment and reasons for diagnostic uncertainty; and (ii) prevalence of symptoms and findings in diagnosed cases, equipment used and multivariate analysis of factors predicting diagnostic certainty. RESULTS: The symptoms of earache, fever, reduced hearing, findings of bulging eardrum, red eardrum and purulent otorrhea were important criteria used during both diagnosis of acute otitis media by the GPs and assessment of performance. In the prospective study, diagnostic certainty of acute otitis media was 67% (95% CI 58-76) in children under 2 years and 75% (95% CI 69-81) in older children. Diagnostic certainty was statistically related (P < 0.05) to a good view of the eardrum and the findings of purulent otorrhea or a bulging eardrum. Logistic regression revealed that the two most important factors predicting diagnostic certainty were a satisfactory view of the eardrum, with an odds ratio (OR) 11.0 (95% CI 4.1-29.5), and purulent otorrhea OR 10.1 (95% CI 3.1-32.9). Main reasons for diagnostic uncertainty given by GPs were differential diagnostic doubts, insufficient view of the eardrum and lack of knowledge. CONCLUSION: Danish GPs' criteria for the diagnosis of acute otitis media were stricter than criteria used internationally. The discrepancy between diagnostic criteria and performance was small. Diagnostic accuracy and certainty could be substantially improved by cleaning the ear canal when needed and by widespread use of pneumatic otoscopy.

Acute Disease↗
PubMed1985

Identification of respiratory virus antigens in middle ear fluids of children with acute otitis media.

Antigens of respiratory viruses were tested by immunoassay of the middle ear fluids and nasopharyngeal secretions of 137 children with acute otitis media. The following were found: (1) an epidemic of infection with respiratory syncytial virus (RSV) caused a significant increase in the occurrence of acute otitis media. (2) Fifteen percent of the children had RSV antigens in middle ear fluid, and in 7% RSV was the sole pathogen found. Adenovirus antigens were found in the middle ear fluid of 3% of the children. (3) Bacteriologic findings in otitis media related and unrelated to viral (RSV) infection were similar. These findings indicate that some episodes of otitis media are associated with viral infection and that the disease may be solely due to viral infection. Thus, at least during an epidemic of respiratory virus infections, treatment failures--e.g., fever and earache unresponsive to antimicrobial therapy--may be due to a viral etiology of acute otitis media.

Adenoviridae Infections↗
PubMed1991

Measles among the Amish: a comparative study of measles severity in primary and secondary cases in households.

An outbreak of measles among a predominantly unvaccinated and susceptible Amish population in Lebanon County, Pennsylvania, offered the opportunity to test the hypothesis that secondary cases in households are more severe than primary cases because the former have more intense exposure and receive a greater virus inoculum. Of 130 measles cases reported between April and June 1988, 119 (92%) constituted a study of disease severity. Severity was assessed by determining frequency and duration of symptoms, length of any hospitalization, and number of days in bed. In a univariate analysis, fewer secondary cases had conjunctivitis (relative risk [RR], 0.67; 95% confidence interval [CI], 0.48-0.96) and headache (RR, 0.37; CI, 0.15-0.86), but more had earache (RR, 9.69; CI, 1.8-202.9) compared with primary cases. Secondary cases had a shorter mean duration of coryza (4.0 vs. 5.0 days, Student's t test, P = .08). However, a logistic regression model that matched by family and controlled for age and sex indicated that there were no significant differences in measles severity among primary and secondary cases in households.

Adolescent↗
PubMed1982

Application of orthopedic principles in evaluation of the temporomandibular joint.

Temporomandibular joint dysfunction is often the cause of a variety of symptoms throughout the head and neck. Because such dysfunction plays an integral part in head pain and earache, differential diagnosis should include an evaluation of the temporomandibular joint. Dentists are the primary professionals involved in temporomandibular joint evaluation and treatment, but they are mainly concerned with nonmovable radio-opaque parts. Physical therapists, then, must learn more about this joint so they can assist dentists in restoring function to it. Principles of joint evaluation are presented relative to the temporomandibular joint so physical therapists can apply their expertise in joint and soft tissue management to assist dentists in restoring function to the temporomandibular joint.

Humans↗
PubMed2000

Otogenic intracranial inflammations: role of magnetic resonance imaging.

The clinical course of acute otitis media is usually short, and the process terminates because of the host's immune system, the infection-resistant properties of the mucosal linings, and the susceptibility of the major organisms (beta-hemolytic streptococcus or pneumococcus) to penicillin. However, a small proportion (1% to 5%) of untreated or inadequately treated patients may experience complications. Prior to the development of an intracranial complication of otomastoiditis, warning symptoms or signs may be evident; these include severe earache, severe headache, vertigo, chills and fever, and meningeal symptoms and signs. Increasing headache, particularly temporoparietal headache near the affected ear, often indicates an impending intracranial complication. This symptom, often the only indication of an epidural abscess, demands prompt investigation and medical and surgical intervention. In our experience, computed tomography (CT) permits accurate diagnosis of acute coalescent or latent (masked) mastoiditis and its associated complications. However, magnetic resonance imaging (MRI) remains the study of choice to evaluate otogenic intracranial complications. This article demonstrates the important role of MRI in diagnosing various stages of acute otomastoiditis and its associated complications.

Brain Diseases↗
PubMed1999

Management of lateral sinus thrombosis.

OBJECTIVES: Review the clinical signs and symptoms, management, bacteriology and outcomes of patients treated for lateral sinus thrombosis. STUDY DESIGN: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis. METHODS: All charts from 1993 through 1998 coded for sinus thrombosis, meningitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoidectomy were reviewed. Operative reports, radiological examinations, laboratory data, culture data and other pertinent data were reviewed. RESULTS: The presenting symptoms ranged from headache to mental status changes. All patients had a history of chronic ear disease and all had at least one additional intracranial complication. The range of additional intracranial complications included otitic hydrocephalus, epidural abscess, and brain abscess. All of the infections were polymicrobial, with a predominance of anaerobes. There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusion, ventriculoperitoneal shunt and nutritional supplementation. CONCLUSION: In patients with otologic disease, complaints of headache, earache or photophobia should warrant an evaluation. The presence of lateral sinus thrombosis mandates further investigation for additional intracranial complications. Conservative surgical intervention, consisting of removal of all perisinus infection and needle aspiration of the sinus, has been found to be effective. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of suspicion.

Adolescent↗
PubMed2002

Prevalence, rate of persistence and respiratory tract symptoms of Chlamydia pneumoniae infection in 1211 kindergarten and school age children.

BACKGROUND: is a common cause of respiratory disease, but little is known about asymptomatic infection, duration of persistent respiratory tract infection and seasonal changes of prevalence in a normal large sample size pediatric population. METHODS: We studied the prevalence of infection in 1211 children of 3 age groups: 3- to 4-year-old kindergarten children ( = 184) and schoolchildren attending first and second ( = 353) or seventh and eighth grade classes ( = 674). Polymerase chain reaction and enzyme immunoassay detection (PCR-EIA) of throat swabs were used. Respiratory tract symptoms (cough, rhinitis, earache or sore throat) were recorded in 1028 schoolchildren. Follow-up examinations in PCR-positive patients were performed until negative. RESULTS: PCR was positive in 68 children (5.6%) without significant age and gender related differences in prevalence. Epidemics were confirmed with a prevalence up to 24% in a primary school in December and April. In schoolchildren, asymptomatic infection was a common feature, reaching 54% (32 of 59) of PCR-EIA positives. The rate of asymptomatic infection was 6% (32 of 531 schoolchildren without symptoms). Of the 32 asymptomatic PCR-EIA positives, 26 (81%) were children attending seventh and eighth grade classes. In 3 children PCR-EIA remained positive at 3 to 5 weeks and became negative during the next 7 to 9 weeks. One of 2 schoolchildren with persistent infection was asymptomatic. CONCLUSIONS: We conclude that infection is common in the childhood population studied with seasonal variations in prevalence and epidemic-like occurrence. Asymptomatic infection occurs, especially in teenagers, but persistent infection is rare.

Adolescent↗
PubMed1997

The role of a secondary pediatric ambulatory care service within the community.

OBJECTIVE: To describe the establishment and function of a secondary pediatric ambulatory care service within the community, to assess the utilization of a pediatric community service ("The Center"), and to assess parents' degree of satisfaction with the quality of care in the center. DESIGN: Personal information and information regarding all visits was recorded and analyzed. A structured telephone interview was used to evaluate parents' satisfaction with the quality of care in the center. SETTING: A pediatric community centre managed by board certified pediatricians. The clinic offers primary and secondary care. PARTICIPANTS: A random sampling of parents of children who visited the center (n = 615). RESULTS: The number of children treated in the center increased five-fold within three years. Most visits took place during evening hours and over the weekends. The most common presenting symptoms were fever, respiratory and gastrointestinal complaints, earache, and trauma. Eighty-nine percent of parents were satisfied or very satisfied with the quality of care in the center; 95% were satisfied or very satisfied with the attitudes of physicians and nurses providing treatment. CONCLUSION: The center is widely utilized by parents with a great degree of satisfaction. The availability and extended working hours of the center provided medical care for a large number of children seeking "after hours" medical attention, as well as a backup for the primary care physicians. The center, therefore, provides a model for improved quality of medical care within the community.

Ambulatory Care↗
PubMed2005

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition.

UNLABELLED: The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition. METHODS: Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test. RESULTS: The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD. CONCLUSIONS: It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.

Bottle Feeding↗
PubMed1995

Prevalence of signs and symptoms of craniomandibular disorders and orofacial parafunction in 4-6-year-old African-American and Caucasian children.

Children, 4-6 years old, 153 Caucasian and 50 African-American, from a pre-school and kindergarten programme in a low income industrial area, who participated in a voluntary oral health examination, were questioned and examined for signs and symptoms of craniomandibular disorders (CMD) and of oral parafunctions. Most of the CMD signs and symptoms were mild. Eight per cent had recurrent (at least 1-2 times per week) TMJ pain, and 5% had recurrent neck pain, African-American children more often than Caucasian children (P < 0.05). Seventeen per cent had recurrent headache. Three per cent had recurrent earache. Pain or tiredness in the jaws during chewing was reported by 25% of the children, more often by African-American than by Caucasian children (P < 0.001) and more often by girls than by boys (P < 0.05). Pain at jaw opening occurred in 10% of the children, more often in the African-American than in the Caucasian group (P < 0.001). Thirteen per cent of the children had problems in opening the mouth. Deviation during opening was observed in 17% and reduced opening in 2%. Reduced lateral movements, locking or luxation were not observed in any child. Palpation pain was found in the lateral TMJ area in 16%, in the posterior TMJ area in 25%, in the temporalis and masseter areas in 10%, and pain for all regions was found more often in the African-American than in the Caucasian children (P < 0.01). Thirty-four per cent of the African-American, and 15% of the Caucasian children admitted to having ear noises (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗
PubMed1998

The use of out of hours health services: a cross sectional survey.

OBJECTIVES: To determine the use and costs of the principal out of hours health services in Buckinghamshire. DESIGN: Prospective cross sectional survey and cost description of patient contacts with out of hours services. SETTING: Buckinghamshire during March and April 1995. SUBJECTS: General practices, accident and emergency departments, ambulance services, and community nursing services. MAIN OUTCOME MEASURE: Contacts with patients and cost of out of hours services. RESULTS: 438 patient contacts/1000 population/year were recorded at an annual incremental cost of between 4.6 m Pounds and 7.2 m Pounds (depending on the costing of general practitioner services), for a population of 660,000. Of these contacts, 21,649 (45%) were with general practitioners. Night time contacts with all services diminished sharply after 10 pm. General practitioners considered that 40% of contacts were unnecessary or could have waited until morning. Over 70% of contacts were for upper respiratory tract infections, earache, gastroenteritis, and other minor ailments. Nursing care was predominantly for elderly people, and 33% of nursing contacts were to supervise medication. Accident and emergency care was predominantely for young adults, especially men, and 41% of attendances were for medical conditions. CONCLUSIONS: New models such as multidisciplinary primary care centres with telephone advice lines and triaging are required to ensure high quality, cost effective care that is responsive to the needs of both consumers and professionals.

Adolescent↗
PubMed1989

Effects of inhalable particles on respiratory health of children.

Results are presented from a second cross-sectional assessment of the association of air pollution with chronic respiratory health of children participating in the Six Cities Study of Air Pollution and Health. Air pollution measurements collected at quality-controlled monitoring stations included total suspended particulates (TSP), particulate matter less than 15 microns (PM15) and 2.5 microns (PM2.5) aerodynamic diameter, fine fraction aerosol sulfate (FSO4), SO2, O3, and No2. Reported rates of chronic cough, bronchitis, and chest illness during the 1980-1981 school year were positively associated with all measures of particulate pollution (TSP, PM15, PM2.5, and FSO4) and positively but less strongly associated with concentrations of two of the gases (SO2 and NO2). Frequency of earache also tended to be associated with particulate concentrations, but no associations were found with asthma, persistent wheeze, hay fever, or nonrespiratory illness. No associations were found between pollutant concentrations and any of the pulmonary function measures considered (FVC, FEV1, FEV0.75, and MMEF). Children with a history of wheeze or asthma had a much higher prevalence of respiratory symptoms, and there was some evidence that the association between air pollutant concentrations and symptom rates was stronger among children with these markers for hyperreactive airways. These data provide further evidence that rates of respiratory illnesses and symptoms are elevated among children living in cities with high particulate pollution. They also suggest that children with hyperreactive airways may be particularly susceptible to other respiratory symptoms when exposed to these pollutants.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pollutants↗