Abstract The purpose of this study was to evaluate the effect of antibiotic treatment and surgery on acute otitis media (AOM), and to evaluate quality of life (QoL) among children with AOM and their parents. To evaluate the effectiveness of antibiotics, a total of 82 children with AOM were randomized for antibiotic or placebo treatment for 7 days. The duration of middle ear effusion was measured by daily tympanometry screenings at home over 2 weeks. Duration was also measured at clinical visits, including at entry, after 3 days, after 7 days, and then weekly until both ears were healthy according to pneumatic otoscopy or otomicroscopy, or for a maximum of 2 months. Among the group receiving antibiotics, middle ear effusion disappeared 2.0 weeks earlier than among those receiving placebo (P<0.02). On day 14, 69% of children in the antibiotic group and 38% in the placebo group had normal tympanometry findings (P=0.02). On day 60, 5% of children in the antibiotic group and 24% in the placebo group had persistent middle ear effusion (P=0.01). The effect of surgery was assessed by randomly assigning 300 children with recurrent AOM, aged 10 months to 2 years, into 3 groups: 1. to receive ventilation tubes (VTs), 2. to receive VTs and adenoidectomy and 3. non-surgery. Follow-up of children occurred at clinical visits every 4 months for a 1-year period. If children suffered from upper respiratory symptoms or their parents suspected AOM during this period they were encouraged to receive additional follow-up care. Intervention was considered unsuccessful if a child had 2 AOM episodes in 2 months, 3 episodes in 6 months or persistent effusion lasting for 2 months. Intervention failed in 34% of children in the non-surgery group, 21% in the VT group (P=0.04 compared to non-surgery) and 16% in the group with VT and adenoidectomy (P=0.004 compared to non-surgery). QoL was assessed among 159 children participating in the study on the effect of surgery in children with recurrent AOM. We used disease-specific (Otitis Media-6) and generic instruments (Child Health Questionnaire-50) to measure QoL among children with AOM and their parents, and the effect of surgery on QoL. Children with AOM and their parents had a significantly poorer QoL than healthy children. QoL improved significantly at 1-year follow-up, but it did not reach the level observed in healthy children. Surgery did not have any additional impact on QoL. / Tiivistelmä Työn tavoitteena oli tutkia antibiootin ja kirurgian vaikutusta äkilliseen välikorvatulehdukseen sekä tutkia välikorvatulehduksia sairastavien lasten ja heidän vanhempiensa elämänlaatua. 82 äkillistä välikorvatulehdusta sairastavaa lasta satunnaistettiin saamaan joko antibiootti- tai lumelääkettä. Välikorvaeritteen poistumista seurattiin kotona päivittäisillä tympanometriamittauksilla kahden viikon ajan. Seurantakäynnit olivat yhden, kolmen ja seitsemän päivän kuluttua sekä viikoittain, kunnes korvat oli todettu terveiksi pneumaattisella otoskoopilla tai korvamikroskoopilla tai kahden kuukauden seuranta-aika päättyi. Välikorvaerite poistui kaksi viikkoa aikaisemmin antibiootti- kuin lumelääkkeellä (P<0.02). Tympanometria normalisoitui kahden viikon kuluttua 69 %:lla antibioottiryhmästä ja 38 %:lla lumelääkeryhmästä (P=0.02). 60 päivän kuluttua välikorvaeritettä oli 5 %:lla antibioottiryhmästä ja 24 %:lla lumelääkeryhmästä (P=0.02). Kirurgian vaikuttavuutta toistuviin äkillisiin välikorvatulehduksiin tutkittiin satunnaistamalla 300 10–24 kk:n ikäistä lasta saamaan ilmastointiputket tai sekä ilmastointiputket että kitarisanpoisto tai ei kumpaakaan. Seurantakäynnit olivat neljän kuukauden välein vuoden ajan tai aina kun lapset sairastuivat ylähengitystietulehdukseen tai vanhemmat epäilivät välikorvatulehdusta. Interventio katsottiin epäonnistuneeksi (äkillisiä välikorvatulehduksia 2 / 2 kk, 3 / 6 kk tai jatkuva erite 2 kk) 34 %:lla ilman kirurgiaa hoidetuista lapsista, 21 %:lla ilmastointiputkiryhmän lapsista (P=0.04 verrattuna ilman kirurgiaa hoidettuihin) ja 16 %:lla lapsista, joille tehtiin sekä kitarisan poisto että asetettiin ilmastointiputket (P=0.004 verrattuna ilman kirurgiaa hoidettuihin). Elämänlaadun, äkillisen välikorvatulehduksen sekä siihen liittyvän kirurgian välistä yhteyttä selvitettiin 159 lapsella, jotka osallistuivat kirurgian vaikuttavuutta selvittävään tutkimukseen. Elämänlaatua mitattiin sekä tautikohtaisilla (Otitis Media-6) että yleistä elämänlaatua (Child Health Questionnaire-50) mittaavilla kyselylomakkeilla. Äkillistä välikorvatulehdusta sairastavilla lapsilla ja heidän vanhemmillaan oli merkittävästi huonompi elämänlaatu kuin terveillä. Elämänlaatu parani merkittävästi vuoden seuranta-aikana, mutta ei saavuttanut terveiden tasoa. Kirurgia ei tuonut mitään lisähyötyä elämänlaatuun.

Despite advances in health promotion through efforts to reduce tobacco smoking, tobacco-related health conditions have continued to be significant. Exposure to secondhand smoke has been identified as a health risk also in addition to infant health risks related to maternal smoking. In contrast, breastfeeding has been found to promote infant health and is strongly encouraged. Despite literature supporting both of these statements, the combined effects of both breastfeeding and maternal smoking on infant wellbeing have not been delineated. Otitis media represents a common health problem among infants and young children. Tobacco exposure has been shown to increase its incidence while breastfeeding has been shown to reduce its occurrence. In the current study, a consecutive sample of all infants less than 5 years of age with otitis media and breastfed for at least 6 months was collected from a busy urban clinic for analysis. A survey tool was administered to those meeting study criteria. Primary analysis examined the odds ratio of developing otitis media among breastfed infants between those whose mothers smoked tobacco and those whose mothers did not. As a result, the association between the protective effects of breastfeeding and the detrimental effects of maternal smoking was evaluated in relation to the development of otitis media. Secondary variables including demographics, family history, past medical and birth history, and secondhand smoke exposure were also assessed. Results failed to demonstrate a significant difference in otitis media between the 2 cohorts in this study, and of the secondary variables, only cranio-facial deformities and/or a family history of these conditions resulted in higher otitis media occurrence. Further study with larger populations with higher tobacco use rates may offer additional insights into this matter.

The aim of this study was to develop a Gestalt play therapy based hospital preparation program for children undergoing the surgical procedures of grommet insertion, or grommet insertion and adenoidectomy, at Tygerberg Hospital. Literature was reviewed according to relevant topics, namely otitis media in children, Gestalt play therapy, theories of child development, and children's experience of illness and hospitalisation. Semi-structured interviews were conducted with four subject groups and the data obtained was qualitatively analysed. Research findings were discussed and integrated with reference to the literature. This information was applied in the development of the proposed program. The aim, underlying principles, objectives and components of the program were discussed and guidelines for implementation were provided. The program was implemented and evaluated in a single subject pilot study, which yielded a positive response. Recommendations for both practical implementation in a therapeutic context and further study in a research context were made. OPSOMMING Die doel van hierdie studie was om `n Gestalt spelterapie-gebaseerde hospitaalvoorbereidingsprogram te ontwikkel vir kinders wat die chirurgiese prosedures van ventilasiebuis-plasing of ventilasiebuis-plasing en adenoïdektomie by Tygerberg-hospitaal ondergaan. `n Literatuurstudie is uitgevoer rakende relevante onderwerpe; naamlik, otitis media in kinders, Gestalt spelterapie, kinderontwikkelingsteorieë, en kinders se ervaring van siekte en hospitalisasie. Semi-gestruktureerde onderhoude is met vier subjekgroepe uitgevoer en die data wat verkry is, is kwalitatief geanaliseer. Navorsingsbevindinge is bespreek en geïntegreer met verwysing na die literatuur. Hierdie inligting is toegepas in die ontwikkeling van die voorgestelde program. Die doel, onderliggende beginsels, doelstellings en komponente van die program is bespreek en riglyne vir die implementering daarvan is verskaf. Die program is geïmplimenteer en geëvalueer in `n enkelsubjek loodsstudie, waar `n positiewe respons verkry is. Aanbevelings vir beide praktiese implementering in `n terapeutiese konteks en verdere studie binne navorsingskonteks is gemaak. / Social Work / M.Diac.

The aim of this study was to develop a Gestalt play therapy based hospital preparation program for children undergoing the surgical procedures of grommet insertion, or grommet insertion and adenoidectomy, at Tygerberg Hospital. Literature was reviewed according to relevant topics, namely otitis media in children, Gestalt play therapy, theories of child development, and children's experience of illness and hospitalisation. Semi-structured interviews were conducted with four subject groups and the data obtained was qualitatively analysed. Research findings were discussed and integrated with reference to the literature. This information was applied in the development of the proposed program. The aim, underlying principles, objectives and components of the program were discussed and guidelines for implementation were provided. The program was implemented and evaluated in a single subject pilot study, which yielded a positive response. Recommendations for both practical implementation in a therapeutic context and further study in a research context were made. OPSOMMING Die doel van hierdie studie was om `n Gestalt spelterapie-gebaseerde hospitaalvoorbereidingsprogram te ontwikkel vir kinders wat die chirurgiese prosedures van ventilasiebuis-plasing of ventilasiebuis-plasing en adenoïdektomie by Tygerberg-hospitaal ondergaan. `n Literatuurstudie is uitgevoer rakende relevante onderwerpe; naamlik, otitis media in kinders, Gestalt spelterapie, kinderontwikkelingsteorieë, en kinders se ervaring van siekte en hospitalisasie. Semi-gestruktureerde onderhoude is met vier subjekgroepe uitgevoer en die data wat verkry is, is kwalitatief geanaliseer. Navorsingsbevindinge is bespreek en geïntegreer met verwysing na die literatuur. Hierdie inligting is toegepas in die ontwikkeling van die voorgestelde program. Die doel, onderliggende beginsels, doelstellings en komponente van die program is bespreek en riglyne vir die implementering daarvan is verskaf. Die program is geïmplimenteer en geëvalueer in `n enkelsubjek loodsstudie, waar `n positiewe respons verkry is. Aanbevelings vir beide praktiese implementering in `n terapeutiese konteks en verdere studie binne navorsingskonteks is gemaak. / Social Work / M.Diac.

Haemophilus parainfluenzae (Hp) and H. influenzae (Hi) are closely related members of the Pasteurellaceae family and are common commensal bacteria of the human nasopharynx. Whilst Hi is frequently implicated in meningitis, otitis media and respiratory tract infections, reports of pathogenic behaviour by Hp are very rare. Lipopolysaccharide (LPS) is a key component of the Gram negative cell wall, and its structure influences the ability of Haemophilus to interact with the host and evade immune clearance. A better understanding of the differences in LPS structure between Hi and Hp could help to ascertain which parts of the molecule are important for commensal and pathogenic behaviour. Hi LPS comprises lipid A, a conserved oligosaccharide inner core, and an oligosaccharide outer core that differs between strains. The latter is partly phase variable by the slipped strand mispairing during replication of DNA repeat tracts within several LPS biosynthesis genes. Very little was known about LPS in Hp so we investigated its biosynthesis and structure in a panel of 20 Hp carriage isolates. Using PCR, DNA sequencing and Southern analysis we demonstrated that Hp possesses homologues of the Hi lipid A and inner core LPS synthesis genes and a few of the genes for outer core synthesis; however, homologues of the Hi phase variable outer core genes were largely absent and did not contain repeat tracts. The results of immunoblotting and collaborative structural analysis were consistent with this data. Phosphocholine, a phase variable Hi LPS epitope that has been implicated in otitis media, was found to be absent in Hp LPS due to the lack of four genes required for its biosynthesis and incorporation. The introduction of these genes into Hp led to the phase variable addition of phosphocholine to the LPS, indicating that there is no fundamental reason why Hp could not use a similar mechanism of variation to Hi if it was advantageous to do so. SDS-PAGE data suggested the presence of O-antigens (repeated chains of sugars) in many of the Hp strains, an unusual feature for Haemophilus, and all of the strains were found to contain a potential O-antigen synthesis locus. Each locus encodes homologues of several glycosyltransferases in addition to either the Wzy polymerase- or ABC transporter-dependent mechanisms of O-antigen synthesis and transport. Comparisons of wild type and isogenic mutant strains showed that the O-antigen enhances resistance to complement-mediated killing and appears to affect adhesion to epithelial cells in vitro. Hp is a successful commensal organism but lacks the flexibility of adapting its LPS using repeat-mediated phase variation, potentially limiting its range of host niches.

Introduction: Les instillations nasales de solution saline isotonique (INSS) chez les enfants sont recommandées par les pédiatres et des oto-rhino-laryngologistes de notre institution dans le but de prévenir les otites moyennes aigues à répétition (OMAr). Cependant, aucune étude dans la littérature ne vient corroborer ou infirmer cette pratique. Objectifs: Déterminer l’efficacité des INSS dans la prévention des OMAr. Méthode: Projet pilote d’un essai clinique randomisé. Les enfants diagnostiqués avec des OMAr étaient éligibles. Les patients recrutés ont été randomisés en 2 groupes. Seul le groupe traitement procède aux INSS. L’issue primaire est l’incidence d’OMAr pendant une période de 3 mois. Résultats: Vingt-neuf patients satisfaisant les critères d’inclusion et d’exclusion ont consenti à participer. Le taux d’OMAr était inférieur dans le groupe traitement (p=0.03, chi-carré) Conclusion: Les INSS semblent efficaces dans la prévention des OMAr. Une étude multicentrique est indiquée pour vérifier la validité externe et confirmer la sécurité. / Introduction: Normal saline nasal cavity irrigations (NSNI) are commonly recommended by pediatricians and otolaryngologists to prevent recurrent acute otitis media (rAOM). However, no published scientific study corroborates or invalidates this practice. Goal: To determine the efficacy of NSNI to prevent rAOM. Method: Pilot randomized controlled clinical trial. All consecutive patients with a diagnosis of rAOM were eligible. Recruited patients were randomized in 2 groups. Only patients in the treatment group proceeded with NSNI. The primary outcome of the study was the incidence of rAOM observed during a 3 month period. Results: Twenty-nine patients met the inclusion and exclusion criteria and agreed to participate. There was a statistically significant lower incidence of rAOM in the treatment group (p=0.003, Fisher exact). Conclusion: Our results suggest that NSNI could effectively prevent rAOM. A larger scale randomized multicentre study is feasible, and it must be done in order to verify for external validity and to properly assess safety issues.

Introduction: Les instillations nasales de solution saline isotonique (INSS) chez les enfants sont recommandées par les pédiatres et des oto-rhino-laryngologistes de notre institution dans le but de prévenir les otites moyennes aigues à répétition (OMAr). Cependant, aucune étude dans la littérature ne vient corroborer ou infirmer cette pratique. Objectifs: Déterminer l’efficacité des INSS dans la prévention des OMAr. Méthode: Projet pilote d’un essai clinique randomisé. Les enfants diagnostiqués avec des OMAr étaient éligibles. Les patients recrutés ont été randomisés en 2 groupes. Seul le groupe traitement procède aux INSS. L’issue primaire est l’incidence d’OMAr pendant une période de 3 mois. Résultats: Vingt-neuf patients satisfaisant les critères d’inclusion et d’exclusion ont consenti à participer. Le taux d’OMAr était inférieur dans le groupe traitement (p=0.03, chi-carré) Conclusion: Les INSS semblent efficaces dans la prévention des OMAr. Une étude multicentrique est indiquée pour vérifier la validité externe et confirmer la sécurité. / Introduction: Normal saline nasal cavity irrigations (NSNI) are commonly recommended by pediatricians and otolaryngologists to prevent recurrent acute otitis media (rAOM). However, no published scientific study corroborates or invalidates this practice. Goal: To determine the efficacy of NSNI to prevent rAOM. Method: Pilot randomized controlled clinical trial. All consecutive patients with a diagnosis of rAOM were eligible. Recruited patients were randomized in 2 groups. Only patients in the treatment group proceeded with NSNI. The primary outcome of the study was the incidence of rAOM observed during a 3 month period. Results: Twenty-nine patients met the inclusion and exclusion criteria and agreed to participate. There was a statistically significant lower incidence of rAOM in the treatment group (p=0.003, Fisher exact). Conclusion: Our results suggest that NSNI could effectively prevent rAOM. A larger scale randomized multicentre study is feasible, and it must be done in order to verify for external validity and to properly assess safety issues.

Thesis (Ph.D.)--University of Melbourne, Dept. of Opthalmology, 2007. / Typescript. SAFE Strategy refers to Surgery for trichiasis, Antibiotics for active infection, Facial cleanliness and Environmental improvements. Includes bibliographical references (leaves 233-253). Also available electronically: http://eprints.unimelb.edu.au/archive/00003844.

Background: Humanmilk oligosaccharides (HMOs) support and concurrently shape the neonatal immune system through various mechanisms. Thereby, they may contribute to lower incidence of infections in infants. However, there is limited evidence on the role of individual HMOs in the risk of otitis media (OM), as well as lower and upper respiratory tract infections (LRTI and URTI, respectively) in children up to 2 years. Objective: To investigate whether individual HMO concentrations measured at 6 weeks of lactation were associated with risk of OM, LRTI or URTI up to 2 years in breastfed infants. Associations with OM, LRTI and URTI were determined for the most prominent human milk oligosaccharides including 13 neutral, partly isomeric structures (trioses up to hexaoses), two acidic trioses, and lactose. Design: HMO measurements and physician reported data on infections were available from human milk samples collected at 6 weeks postpartum (n = 667). Associations of HMOs with infections were assessed in crude and adjusted models using modified Poisson regression. Results: Absolute concentrations (median [min, max], in g/L) of 2′-fucosyllactose (2′-FL) tended (p = 0.04) to be lower, while lacto-N-tetraose (LNT) was higher in the milk for infants with OM in the 1st year of life (p = 0.0046). In the milk of secretor mothers, LNT was significantly higher in the milk for infants with OM (RR [95% CI]: 0.98 [0.15, 2.60]) compared to infants without OM (RR [95% CI]: 0.76 [0.14, 2.90]) at 1 year (p = 0.0019). No statistically significant milk group differences and associations were observed for OM, LRTI, and URTI (p > 0.0031). Conclusion: Our findings suggest that neither prominent neutral individual HMOs (ranging from 2′-FL to LNDFHs) nor acidic human milk sialyllactoses or lactose are significantly associated with a reduced or increased risk of infections in infants up to 2 years of age. Further research is needed to determine whether specific HMOs could potentially reduce the incidence or alleviate the course of distinct infections in early life.

The diagnosis and treatment of respiratory tract infections in ambulatory adults is challenging. The prevalence of these conditions outstrips the medical profession's efficiency and effectiveness in dealing with them. However, selecting diagnostic techniques that identify causative organisms and therapeutic agents targeted to those organisms should lead to a reduction in the morbidity and mortality associated with these illnesses.