The effects of Otitis Media (OM) on the development of preschoolers are not fully known. This record review compared the Miller Assessment for Preschoolers (MAP) results of preschoolers with a history of OM treated with Ventilating Tubes (VTs) to preschoolers with no history of OM or VTs to investigate differences. No statistically significant differences were found, but the OM group were clinically more at risk for verbal delays. Children with a history of OM who are suspected of having developmental delays should be referred for an Occupational Therapy (OT) assessment. Occupational Therapists (OTs) consider the effects of OM and other risk factors for developmental delay holistically by looking at client factors, environments, performance skills and occupations. They can then intervene at all these different levels to maximise health and participation in life.

The surgical management of chronic otitis media is ever evolving. This is also the case at the Chris Hani Baragwanath Academic Hospital where in recent times, certain new techniques were adopted and other older ones revisited. This changed surgical approach was deemed to be necessary not only in view of the limited resources available to deal with a large patient load, but also to improve surgical outcomes in the local environment. The focus was mainly on the implementation of internationally accepted surgical techniques that have been shown to not only be effective and safe, but also simple and time-saving. Changes were mostly seen in the management of patients presenting with simple perforations and cholesteatoma. It is the objective of this study to formally assess the outcome and feasibility of this changed surgical approach, as well as to assess the outcomes of surgery as a whole. A retrospective clinical chart review was undertaken over an eighteen-month period from July 2009 to December 2010. All patients undergoing single stage surgery for chronic otitis media in this period were included, and grouped in terms of procedure performed, viz. Tympanoplasty, Tympanomastoidectomy and Canal wall down CWD mastoidectomy. All data were collected from an otological database, each case independently evaluated in terms of surgical and audiological outcomes after at least a 2 month follow up period. Only data acquired at the latest follow-up date were used. The follow up period ranged from 2 to 18 months. The Butterfly Cartilage Inlay Graft (BCIG) tympanoplasty technique was the predominant technique used for simple perforations of any size and location, and showed superior surgical outcomes to the more traditional Fascia underlay graft (FUG) technique. Surgical success (i.e. healed / intact tympanic membrane) in the FUG tympanoplasty group was 75%, compared to 93% in the BCIG group. One hundred percent of cases subjected to BCIG tympanoplasty achieved sociable hearing (ACT< 30dB) in the early post-operative period. We found the hearing improvement post-surgery to be directly related to the size of perforation (p= 0, 0195), and pre-operative hearing loss (p= 0, 0001 r= 0.93). None of the other variables studied influenced the audiological outcome achieved. In the study period, surgical techniques used for more severe Noncholesteatomatous chronic otitis media (NCCOM) were little changed from before. An evaluation of these cases focused on those with actively discharging ears to assess the outcome of Tympanomastoidectomy to achieve not only a dry ear, but also an intact tympanic membrane (TM) and hearing improvement (HI). Eighty-six percent of patients with discharging ears had dry ears post-operatively, 50% of which achieved an intact tympanic membrane and sociable hearing (ACT< 30dB). Graft failures in the tympanomastoidectomy group as a whole were mostly related to size of perforation (p= 0,047) and to the presence of discharge pre-operatively (p= 0,012). In the CWD mastoidectomy group, although evaluating both the large (completely exenterated mastoid)- and small cavity techniques, the focus was on the latter. With this technique, disease is surgically approached from its site of origin, and followed into the attic and mastoid. The resultant defect in the medial canal wall and mastoid is kept as small as possible, to avoid obliteration and the morbidity of an unnecessarily large cavity. Dry ears were achieved in 93% of patients. In cases where the TM was grafted, an intact tympanic membrane was achieved in 85% of patients. Significant hearing improvement (>10dB in two consecutive frequencies) was achieved in 33% of patients who had the tympanic membrane grafted to an intact stapes suprastructure (Type 3 tympanoplasty with or without a cartilage columella). These results compared favourably to the large cavity CWD technique in this series where obliteration and middle ear grafting were not performed on a regular basis. In this group, only 16% of patients had an intact tympanic membrane post-operatively, and 63% of ears were dry at latest follow up. Although statistical analysis did not show one technique to be superior to the other in achieving a dry ear post-operatively (p= 0,39), the results with the small cavity technique were very encouraging. Hearing improvement in both groups were variable and hearing preservation rather than augmentation was achieved in most. The lack of hearing improvement may not only have been related to the extensive disease encountered (80% extending beyond attic, 50 % stapes suprastructure erosion), but also to inadequate and infrequent reconstruction of the middle ear.

Dissertation (Ph.D.) -- The Institute for Clinical Social Work, 1995. / A dissertation submitted to the faculty of the Institute of Clinical Social Work in partial fulfillment for the degree of Doctor of Philosophy.

La OMC patología común en países subdesarrollados conlleva a elevar los gastos tanto de los sectores públicos como privados del sector salud, debido sobre todo a ser una patología con tratamiento quirúrgico. Así la reintervención quirúrgica en dichos pacientes por recidiva de la enfermedad, es decir nueva presencia de perforación timpánica elevaría en mayor medida el gasto tanto económico como social al comportarse como una enfermedad con un fondo discapacitante. Por tal motivo la finalidad de la presente tesis es determinar los factores asociados a la recidiva de la OMC en pacientes reoperados, lo cual nos permitirá tenerlos en cuenta en futuras intervenciones quirúrgicas sobre todo a aquellos pacientes que se intervienen por primera vez, conllevando a una disminución en los costos hospitalarios y reincorporación del paciente al sector productivo. / Tesis de segunda especialidad

No description available.

DESCRIPCIÓN DEL PROBLEMA: El Servicio de Otorrinolaringología atiende en consulta externa alrededor de 60 a 70 pacientes diarios, de los cuales el 30% tiene Otitis Media Crónica. Generalmente el tiempo de enfermedad que presentan los pacientes están comprendidos entre 05 y 45 años. La mayoría de pacientes requieren intervención quirúrgica, por lo cual es importante la VALORACIÓN PREOPERATORIA como pronóstico en los pacientes que serán sometidos a SOP. Cabe destacar, que los pacientes que acuden al hospital son de condición económica baja y hacen el esfuerzo posible para operarse, sin embargo, los resultados postoperatorios no suelen ser óptimos dando como consecuencia abandono del paciente al tratamiento a seguir y probables complicaciones óticas. Nosotros, como médicos tratantes, sufrimos decepciones en cuanto a los resultados postoperatorios alcanzados, al no poder solucionar el problema de salud como estaba planificado y eso indudablemente se debe a una serie de factores que debemos tener en cuenta al realizar la valoración preoperatoria como pronóstico de cada paciente. HIPOTESIS: La adecuada valoración preoperatoria del paciente con Otitis Media Crónica en el Servicio de Otorrinolaringología del Hospital Nacional Dos de Mayo determinará el Pronóstico postoperatorio del paciente. OBJETIVOS: 1.OBJETIVO GENERAL: Determinar factores de mal pronóstico en pacientes postoperados de Otitis Media Crónica en el Servicio de Otorrinolaringología del Hospital Nacional Dos de Mayo. 2.OBJETIVOS ESPECIFICOS: - Identificar los pacientes de Otitis Media Crónica. - Identificar y describir signos y síntomas frecuentes de los pacientes que son sometidos a operación. - Clasificar a los pacientes que serán sometidos a SOP según la clasificación de pronóstico de Bellucci. - Comparar los criterios de valoración preoperatoria con resultados del postoperatorio. - Analizar la congruencia de la valoración preoperatoria con resultados del postoperatorio. / Tesis de segunda especialidad

No description available.

Otitis media is often treated surgically through the use of a procedure termed myringotomy with insertion of a ventilation tube (MVT). From fiscal year 1992/3 to 1997/8, some 132,000 such operations were performed in Ontario, Canada, on young people < 20 years old. This study quantifies the small area variation (SAV) in MVT surgical rates across the 49 counties and 478 postal areas of Ontario; examines the rate variation as a function of variations in physician practice style, physician supply, physician demographic characteristics, urbanrural differences, and population socio-economic status; and identifies economic and policy-related implications of SA V. Physician practice style was assessed using responses from a comprehensive provincial survey of referring physicians (OPs and paediatricians) and specialists/surgeons concerning their opinions of the indications for, and treatment of, otitis media, with particular reference to MVT surgery. Other data were obtained from physician databases and Canada census statistics. The variation in age-gender standardized MVT rate across the counties is highly statistically significant, as demonstrated by Chi-square tests, and by comparison of simulated and observed values of variation statistics (the EQ, CV, and SCV) that show much higher inter-area variation than that expected by chance alone. Multivariate regression modelling of inter-county MVT rate variation across the counties showed six variables to be significant determinants of surgical rate. MVT rate is a positive function of physician propensity to refer patients to surgeons, the percentage of North American-trained referring physicians, and the supply of paediatricians; and a negative function of the supply of surgeons, and the median licence years of referring physicians and surgeons respectively. These variables explain 74 % of the SA V in MVT rate for the 35 counties for which the regression model applies. Over 40 % of the explained variation is accounted for by differences across the counties in the propensity of physicians to refer patients to surgeons. Socio-economic status (as measured by an index of deprivation) was not a significant predictor of inter-county MVT rate. When examined at the FSA (postal forward sortation area) level within counties, the effect of socio-economic status was small overall but locally significant for five counties. Urban counties, although better equipped with medical care resources, including the supply of physicians, generally maintain lower MVT rates than rural counties. This is interpreted as being due to inter-county referral flow from rural GPs and paediatricians to specialists operating in urban counties, particularly those counties containing teaching centres and training hospitals. In addition, the higher surgical rates in rural areas are also associated with a higher percentage of North American-trained referring physicians working in such areas. The large regional variations in MVT rates, and the determinants of such variations, have implications for health care providers and policymakers. Between 1992/3 and 1997/8, the welfare loss resulting from MVT surgical rate variation that was due to variation in physician variables (physician opinion, demographics, and supply) amounted to around $7.5 Million per year (or about three-quarters of the annual MVT surgical spend). More than 40 % of the welfare loss was attributable to inter-county variation in physician propensity to refer patients to surgeons. This welfare loss could in theory be reduced by the production and dissemination of information such as clinical guidelines, aimed at modifying physician behaviour and reducing variation in physician practice style (in particular, reducing variation in physician propensity to refer). However, published findings indicate that such change strategies are generally ineffective in modifying physician behaviour.

This study was designed to describe those indicators for the surgical insertion of pressure-equalization (PE) tubes given highest priority in clinical practice by board-certified otolaryngologists. A questionnaire was mailed to 1000 otolaryngologists practicing in the United States. The respondents rated the importance of 22 items on a six-point scale. These items were grouped into four categories: medical history, physical examination, audiologic evaluation, and related factors. The return rate was 52.7%. The five items receiving the highest ratings were "persistence of fluid for 3 or more months per episode," "presence of speech-language delay," "bilateral conductive hearing loss of 20 dB or more," "total number of episodes of otitis media," and "lack of response to suppressive antibiotic therapy."

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed for children in the United States. Previous trials evaluating an optional antibiotic prescription are limited and have significant limitations. None have evaluated an optional prescription in the urgent care setting. We conducted a randomized, controlled trial in an urban emergency department in which children aged 6 months to 12 years diagnosed with AOM were randomly assigned a "wait-and-see prescription" (WASP) or a "standard treatment prescription" (STP). Structured phone interviews were conducted 4-6, 11-14, and 30-40 days after enrollment to determine the proportion of each group that filled the antibiotic prescription and outcomes related to the clinical course. Substantially more parents in the WASP group (N=138) did not fill the antibiotic prescription compared to the STP group (N=145) (62% vs. 13%; P<0.001). There were no statistically significant differences between the groups in the frequency of subsequent fever, otalgia or unscheduled visits for medical care. Within the WASP group, both fever (OR = 4.0, 95% confidence interval, 1.7-9.5) and otalgia (OR = 4.5, 95% confidence interval, 1.7-11.5) were associated with filling the prescription. The WASP approach substantially reduced unnecessary use of antibiotics in children and is a reasonable alternative to routine use of antimicrobials for treatment of AOM.