New discovery and short-term effect analysis of tensor tympani muscle tenotomy for Meniere's disease under otoscope / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the feasibility and short-term effect of tensor tympani muscle Tenotomy in the treatment of Meniere's disease under otoscope. The possible pathogenesis was discussed and our views were put forward. Methods: The clinical data of 9 cases of Meniere's disease treated by otoscopic Tenotomy were analyzed retrospectively, including 2 males, 7 females, 5 right ones, 2 left ones and 2 bilateral ones. The average age was (56.33± 10.56) years, ranging from 38 to 75 years. We evaluated intraoperative findings and short-term postoperative efficacy, respectively evaluated postoperative aural fullness, tinnitus and hearing recovery, and evaluated postoperative vertigo attack in a short time. Results: Nine patients were completed the operation under general anaesthesia and otoscopy, and no serious complications occurred. We found new pathological changes in tympanic cavity in some cases during operation. There were rupture of round window membrane in 1 case, severe fibrous hyperplasia near the round window membrane and vestibular window and adhesion with ossicular chain in 1 case, fibrous cord and membranous hyperplasia near vestibular window and round window membrane in 1 case, fibrous hyperplasia and adhesion near the round window membrane in 2 cases, membranous hyperplasia and adhesion around vestibular window in 1 case. No fibrous hyperplasia was found in 3 cases in the tympanic cavity. The round window membrane can be exposed in 4 cases and failed in 5 cases. After 3 months of follow-up, we found that we found that 5/5 cases of aural fullness disappeared, 2/2 cases of earache disappeared, 3/8 cases of tinnitus improved, 5/8 cases presented with improvement and no aggravation, 3/3 cases of hearing allergy improved, 4/9 cases of hearing improved, and 5/9 cases showed no improvement or decrease. 9 patients were followed up for 3 months, of whom 8 patients had no vertigo, one patient suffered from vertigo twice within 3 months after operation, and the patient suffered from rupture of round window membrane. Conclusions: Endoscopic Tenotomy for Meniere's disease has obvious curative effect and quick recovery after operation. During the operation, we find that most of Meniere's patients have fibrous cord hyperplasia near the inner ear window membrane, which may be the pathological manifestation after repeated rupture and repair of the inner ear window membrane. The vertigo of Meniere's disease may be related to the destruction and repair of inner ear membrane structure caused by improper contraction or spasm of tympanic tensor muscle.

Is Alcohol Swabbing Sufficient to Clean Otoscopes in Hospitals? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An otoscope is a basic instrument used by otorhinolaryngologists. An inappropriately sterilized otoscope has been reported to be a possible bacterial vector for infection. In this regard, we decided to investigate contaminated otoscopes for possible bacterial contamination and evaluate the efficacy of the otoscope disinfection methods. MATERIALS AND METHOD: We randomly drew 22 otoscope cones from university hospitals and 10 from private hospitals. Cones were divided into three groups accordingly to their sterilization methods: group 1 was wiped with 70% isopropyl alcohol, group 2 was soaked for 20 min in 70% isopropyl alcohol, and group 3 was soaked in CIDEX solution. The samples were cultured twice, first before the disinfection process and then after the disinfection process. Otoscopes were cleaned for a week by employing these techniques. RESULTS: Most of the pre-sterilized otoscopes (20/22) were obtained from the hospitals which demonstrated contamination with microorganisms. Staphylococcus was the most common bacteria found (16/22). After a week of cleansing, no bacteria were seen in group 1 (0%, 0/8), whereas group 2 (14.3%, 1/7), and group 3 (28.6%, 2/7) still showed remaining microorganisms. The three methods were significantly effective on sterilizing microorganisms. CONCLUSION: An otoscope can be a vector for spreading infection. We found that disinfection by alcohol-swabbing alone is sufficient for sterilizing otoscope cones. Clinically, this information may be useful to otorhinolaryngologists. However, further studies are required to establish the most appropriate disinfection protocol to prevent infection from microorganisms.

Assessment of the light intensity of otoscopes utilized in teaching hospitals / Avaliação da intensidade da luz dos otoscópios em hospitais-escola

ABSTRACT INTRODUCTION: To attain an accurate otoscopic diagnosis, a functioning device with adequate capacity must be used. OBJECTIVE: Evaluate the light intensity of otoscopes, comparing it utilizing the batteries present at the moment of calibration and after new batteries were supplied. METHODS: Cross-sectional study of a historical cohort, which assessed 38 otoscopes, measuring the light intensity with the batteries present at the moment of assessment compared to the intensity with new batteries, as well as charge of the test batteries and the new batteries. RESULTS: The mean of the sum of new batteries' charge was 3.19 V, and of the test batteries was 2.70 V, representing a decrease of 18.02% in charge. The mean luminosity with the new batteries was 366.89 lumens, whereas in the test batteries it was 188.32 lumens, representing a decrease of 83.75% in the light intensity. Student's t-test was applied for data comparison, showing a statistical difference between the light intensity with the original batteries and the new batteries (p = 0.0001; CI = 0.95). CONCLUSION: There was a statistically significant difference between the proportions of light intensity in the otoscopes. A small variation in battery charge results in a great variation in light.

RESUMO Introdução: Para a realização de um diagnóstico otoscópico preciso deve-se utilizar um aparelho funcionando com uma capacidade adequada. Objetivo: Avaliar a intensidade luminosa dos otoscópios comparando a intensidade da luz comas pilhas encontradas no momento da aferição e com pilhas novas. Método: Estudo de coorte histórica com corte transversal, onde foram analisados 38 otoscópios, sendo realizada a aferição da qualidade luminosa com a pilha utilizada e comparado com uma pilha nova, e a aferição da carga das pilhas novas e em utilização no momento do exame. Resultados: A média da soma das cargas das pilhas novas foi de 3,19 V, e a das pilhas testes foi de 2,70 V, representando decréscimo de 18,02% na carga das pilhas. A média da luminosidade comas pilhas novas foi de 366.89 lúmens, e com a pilha teste foi de 188.32 lúmens, representando decréscimo de 83,75% na intensidade luminosa. Foi aplicado o teste T para comparação entre os dados, onde percebe-se diferença estatística entre a intensidade luminosa com pilhas testes e novas (p = 0,0000; IC = 0,95). Conclusão: Houve diferença estatisticamente significativa entre a proporção de intensidade da luz dos otoscópios. Uma pequena variação da pilha proporciona uma grande variação na luz.

Potencial cortical P3: nível de dificuldade para diferentes estímulos / P3 cortical potential: difficulty level for different stimulus

Objetivo Avaliar o nível de dificuldade de identificação dos estímulos verbais e não verbais, segundo classificação dos próprios participantes, e comparar com a latência do potencial cortical P3. Métodos Foram avaliados 30 sujeitos, com média de idade de 23 anos, normo-ouvintes. O potencial P3 foi pesquisado com estímulos não verbais (tone burst)e verbais (/ba/ x /di/, /ba/ x /ga/, /ba/ x /da/). Cada sujeito classificou os estímulos em "mais fácil" e "mais difícil".Resultados : A maioria dos indivíduos classificou o contraste /ba/ x /di/ como sendo o mais fácil de identificar e o contraste /ba/ x /ga/, como o mais difícil. Os sujeitos referiram que os estímulos de fala foram mais fáceis de identificar quando comparados com tone burst. O nível de dificuldade descrito pelos indivíduos influenciou nas latências dos estímulos /Di/ e /Da/, classificados como mais fáceis, e evidenciados na menor latência do P3.Conclusão O contraste /Ba/ x /Di/ foi considerado o de maior facilidade de percepção, sendo evidenciado pela menor latência do P3. Os contrastes de fala foram classificados mais fáceis quando comparados com os estímulos tonais. Essas comparações auxiliam o clínico na escolha do estímulo utilizado e no correto diagnóstico audiológico.

Purpose Evaluating the level of difficulty of identifying verbal and non-verbal stimuli, according to the classification of the participants, as well as comparing the latency of the P3 cortical potential.Methods Thirty subjects, with a mean age of 23 years and normal hearing, were evaluated. The P3 potential was performed with non-verbal stimuli (tone burst) and verbal (/ba/ x /di/, /ba/ x /ga/, /ba/ x /da/). Each subject had to classify stimulus in "the easiest" and "the most difficult".Results Most subjects rated the /ba/ x /di/ contrast as the easiest to identify and the contrast /ba/ x /ga/ the most difficult. The subjects reported that the speech stimulus were easier to identify when compared to tone burst. The difficulty level described by the subjects influenced the latencies of stimuli /Di/ and /Da/, ranked as the easiest and they were evidenced in the lowest latency of P3.Conclusion The /Ba/ x /Di/ contrast was considered the easiest for perception, being evidenced by the lowest latency of P3. The speech contrasts were classified as the easiest when compared with the tonal stimuli. These comparisons help the clinician in selecting the stimuli and in the correct audiological diagnosis.

Otoscopia: exame da orelha / Otoscopy: examination of ear

Otoscopia é o exame que permite ao médico avaliar o conduto auditivo e a membrana timpânica, além de diagnosticar enfermidades da orelha externa e da orelha média. A otoscopia, uma boa anamnese e um exame físico completo são fundamentais para o estudo das doenças da orelha. O presente trabalho faz uma revisão da otoscopia e de suas principais afecções.

Otoscopy is the examination of the external auditory meatus and the tympa nic membrane. It is used for the purpose of diagnosing diseases of the external and middle ear. The anmanesis and the clinical examination associated with ear examination (otoscopy) are essential in ear diaseases. The purpose of this study is to review the examination of the ear (otoscopy) and principal disease of the ear.

Effectiveness of adenoidectomy on tympanostomy tubes retention duration

The children with middle ear effusion need repeated re-tympanostomies. Adenoidectomy is an effective surgical intervention in the management of chronic otitis media with effusion in conjunction with insertion of tympanostomy tubes [TTs]. To find out whether TTs in different positions decrease the rate of re-tympanostomies study was done. The present study retrospectively evaluated the effectiveness of adenoidectomy on retention of Shepard TTs in antero-inferior quadrant [AIQ] and postero-inferior quadrant [PIQ] with chronic, persistent or recurrent otitis media. Eighty-five children [one-hundred and seventy ears] underwent bilateral myringotomy and TTs placement with and without adenoidectomy with informed consent. According to the TTs retention duration rate, there was a significant difference between adenoidectomy and non-adenoidectomy groups in AIQ. It was concluded that TTs placement in the AIQ in conjunction with adenoidectomy showed better improvement and prolonged ventilation. This study suggests that adenoidectomy is an effective surgical intervention in the management of otitis media especially when it is performed in conjunction with insertion of TTs. This significantly decreases tube extrusion rate especially in an AIQ, which might be due to improving eustachian tube function that consequently reduces repeated otitis media

Training of nurses in ear examination and hearing screening in the school setting (Phase II): A cross-sectional study

OBJECTIVES:To determine the agreement between 1) ear examination findings of the otorhinolaryngologist using an otoscope and trained elementary school nurses using a penlight, 2) hearing screening findings of the otorhinolaryngologist and elementary school nurses, both using the Philippine National Ear Institute (PNEI) Method of 512 Hz Tuning Fork Test (TFT) and 3) PNEI Method of 512 Hz TFT findings and screening audiometry findings.METHODS:In this continuing study, nurses residing in the venue of the study, and previously trained in ear examination using a penlight and hearing screening using the PNEI 512 Hz TFT, conducted these in school children who attended the hearing screening and medical mission. Otoscopy, PNEI Method of 512 Hz TFT, and screening audiometry were then conducted on the children by the otolaryngologist. The nurses and the otolaryngologist performed independent and blinded assessments.RESULTS:Eighteen nurses and ninety children participated in the study. Data subjected to Kappa statistics showed good agreement between nurses and otorhinolaryngologist's findings in the examination of the external canal and tympanic membrane and in PNEI Method of 512 Hz TFTs, and between the PNEI Method of 512 Hz TFT and screening audiometry.CONCLUSION:PNEI methods of penlight ear examination and 512 Hz TFT may be effective tools for early detection of common ear conditions and hearing screening in Filipino school children. These may be conducted in the school setting not only by otorhinolaryngologists but also by adequately trained school nurses.

Effect of Otitis Media and Cerumen Occlusion on Body Temperature Measured by Thermometers / 소아감염

PURPOSE: To examine the effect of unilateral otitis media and unilateral cerumen occlusion of the ear canal on thermometers. METHODS: One hundred eighty six children with unilateral otitis media, fifty children with unilateral cerumen occlusion, and fifty children with neither otitis media nor cerumen were enrolled. Temperature was measured in both ear canals using thermometers. After 15 minutes, second temperature was measured again in both ears. Unilateral otitis media was graded by video otoscope for 7 grades. Differences in temperatures between affected ears and unaffected ears were analyzed. RESULTS: No temperature difference between the normal and cerumen groups was observed. The mean temperature of the otitis media ear canal was 0.13+/-0.20degrees C higher than that of the intact ear canal (36.99+/-0.54degrees C vs 36.86+/-0.52degrees C; P<0.001). There was no statistically significant temperature difference between grades. CONCLUSION: Unilateral otits media can affect estimation of body temperature measured by thermometers.

Availability of Spectral Gradient Acoustic Reflectometry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Spectral gradient acoustic reflectometry (SGAR) determines the probability of middle ear fluid by measuring the response of the tympanic membrane to a sound. To assess the sensitivity and specificity of SGAR for the diagnosis of otitis media with effusion (OME) in the Korean population, we compared accurate diagnostic rates of OME obtained from SGAR and tympanometry. Pneumatic otoscope was used for diagnostic standard of OME. SUBJECTS AND METHOD: SGAR and tympanometry were performed on 488 ears from May 27th, 2008 to July 30th, 2008. Exclusion criteria were the presence of tympanic membrane perforation, and/or pressure equalization tubes, noncompliance, otorrhea, external auditory canal stenosis and signs of acute inflammation such as fever or otalgia. In all cases, pneumatic otoscopic examination was conducted and diagnostic accurate rates of OME were calculated in SGAR and tympanogram. RESULTS: Using spectral gradients of 3 or higher as breakpoints for indicating OME, in the case of pediatrics under 2 years old, with the sensitivity of 58.3%, specificity of 94.7%, positive predictive value (PPV) of 77.8% and negative predictive value (NPV) of 87.8%. In the case of the pediatrics between 2 and 12 years old, it showed the sensitivity of 67.2%, specificity of 90.3%, PPV of 74.5% and NPV of 86.8%. In the case of the pediatrics over 12 years old, they showed sensitivity of 87.3%, specificity of 88.8%, PPV of 67.6% and NPV of 96.3%. CONCLUSION: SGAR has the higher tendency of specificity and NPV, and will be a useful screeningtest with good portability and economical efficiency.

Validación de la audiometría de vía aérea (AVA) como instrumento de evaluación de hipoacusia en el adulto en Atención Primaria de Salud / Validation of air way audiometry (AVA) as evaluation instrument for hypoacusia in adults in Primary Health Attention

La hipoacusia en el adulto es una patología de alta prevalencia, con una derivación frecuente desde la Atención Primaria de Salud a los Servicios de Otorrinolaringología (ORL). Esto genera una gran demanda asistencial de recurso profesional ORL y tecnólogo médico en ORL. El objetivo de este estudio es validar la audiometría de vía aérea (AVA) realizada en el nivel primario de salud como método de evaluación de los pacientes adultos con sospecha de hipoacusia. Para ello se sometieron a un estudio transversal 36 pacientes adultos derivados con diagnóstico de hipoacusia desde un Consultorio de Atención Primaria y que cumplían con los siguientes criterios de inclusión: 1) mayor de 50 años, 2) otoscopía normal bilateral y 3) prueba de Rinne positiva bilateral. Fueron evaluados con dos métodos: audiometría de vía aérea (AVA) realizada en atención primaria, y audiometría tonal clásica (Gold Standard) en el Servicio de Otorrinolaringología del Hospital Clínico Regional de Valdivia. La sensibilidad y especificidad obtenida para la AVA en los pacientes que cumplían con los criterios de inclusión fue de un 96 por ciento y 92 por ciento, respectivamente. Se concluye planteando que la AVA aplicada en pacientes adultos con examen otológico básico normal en un Consultorio de Atención Primaria resulta una herramienta de gran utilidad para diferenciar los casos de audición normal o hipoacusia leve (AVA normal) que no requieren una evaluación inmediata por ORL. Esto permite priorizar la atención de aquellos casos con hipoacusia más severa o con posibilidad de patología auditiva que requiera de un mayor estudio (AVA normal).

Magnetic Resonance Imaging of the Mastoid Cavity and the Middle Ear: Prevalence and Clinical Significance of Incidental Abnormal Findings in a Non-ENT Adult and Pediatric Population / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study is to determine the prevalence of abnormalities in the mastoid cavity and middle ear in a non-ENT population, and to correlate with clinical data. SUBJECTIVES AND METHOD: Cross-sectional study. We prospectively evaluated a total of 100 adults and 30 children undergoing MRI scan for suspected intracranial pathology from May to July 2003. Patients who had previous history of mastoid/middle ear surgery and were suffering otitis media were excluded. The T2-weighted images were reviewed. The abnormalities found on MRI were divided into 1) mastoid cavity abnormality, and 2) middle ear abnormality. All patients were asked to complete a questionnaire pertaining to symptoms of mastoid/middle ear pathology and history of previous otitis media. Also, their ears were examined carefully by otoscope or otomicroscope. RESULTS: In both groups, most of abnormalities were found in the mastoid cavity. Analysis of the clinical data revealed that abnormal MRI findings of the mastoid cavity were significantly correlated to clinically significant mastoid/middle ear diseases in adults. CONCLUSION: Incidental MRI abnormalities in mastoid cavity and middle ear detected in a non-ENT population were relatively uncommon, compared to incidental paranasal sinus abnormalities. However, clinicians should remember the possibility of the pathologies that demand active treatment among these abnormalities, especially when high signal abnormality is found in the mastoid cavity of adults.

Clinical Value of a Video Otoscope in Diagnosis of Acute Otitis Media

PURPOSE: Acute otitis media(AOM) has variable clinical symptoms and is diagnosed with injection, bulging, and decreased mobility of tympanic membrane. There are many misdiagnoses because children who are suspected of having acute otitis media are uncooperative during diagnosis with an otoscope. An inaccurate diagnosis of acute otitis media when using an otoscope results in wasted of medical resourses and increased tolerance to antibiotics. Therefore, this study was conducted to evaluate the usefulness of a video otoscope as a tool of diagnosis of acute otitis media. METHODS: Among 416 patients who visited Pundang Jesaeng Hospital Emergency Medical Center with a complaint of otalgia from 1 October 2002 to 30 September 2003, we studied 51 patients who were followed up at the otorhinolaryngology depatment. Emergency Medicine residents recorded the findings for tympanic membrane by using an otoscope and by using a video otoscope. we used kappastatistics to carry out a prospective study in which the accuracy of diagnosis of AOM was analyzed by comparison with the confirmed diagnosis by an otolaryngologic specialist. RESULTS: In this study, the number of males was 24 (47%) and that of females was 27 (53%). Of the 51 Patients, 22 (43%) presented with rhinorrhea, 15 (29%) with cough, 11 (22%) with sputum, 10 (20%) with fever, 8 (16%) with a sore throat, 7 (14%) with otorrhea, 4 (8%) with hearing difficulty, 3 (6%) with irritability, 3 (6%) with tinnitus, 3 (6%) with vomiting and 2 (4%) with dizziness. A comparison of the diagnostic accuracy of AOM between otolaryngologic specialist and residents in emergency department, when was undertaken by using kappa statistics, and a diagnostic agreement of 65% (kappa=0.28) for the otoscope, and 76 %( kappa=0.45) for the video otoscope. The diagnostic sensitivity of acute otitis media by video otoscope was 75%, and specificity was 82%. CONCLUSION: When the tympanic membrane of the patient suspected of a having AOM is examined in an emergency medical center, video otoscopy should be a useful diagnostic tool for AOM owing to its high diagnostic accuracy.

Bioactive-glass powder obliteration of open mastoid cavity

Forty patients with chronic suppurative otitis media of the cholesteatomatous type were included in this study. Their open radical mastoid cavity were obliterated using a new bioactive glass powder; 30 of them as a primary procedure at the time of radical mastoidectomy and 10 as a secondary procedure later on. The study aimed to evaluate a new bioactive glass powder [particulates] as an obliterative material in open mastoid cavities. The results of this technique were promising. It was concluded that bioactive glass powder is a safe and effective biomaterial to be used as on obliterative material in open mastoid cavities

Aplicabilidad clínica del audioscopio en pesquisa auditiva / Clinical application of the audioscope in auditory screening

El objetivo de este estudio es evaluar si existe relación entre la audioscopia y la audiometría convencional como un procedimiento de screening auditivo. Ingresaron al estudio 41 adultos, todos funcionarios del Hospital Dr. Sótero del Río. Los resultados se analizaron con el parámetro estadístico Kappa. Encontramos una muy pobre correlación en las frecuencias de 500 hz (0.047), 100 hz (0.079) y baja correlación en las frecuencias 2000 Hz (0.404), 4000 Hz (0.446). El análisis de los resultados sugieren que la audioscopia es un método útil para screenning cuando la hipoacusia es severa a moderada, no pudiendo diferenciar entre audición normal y pérdida auditiva leve, no siendo útil para screening

The Causes and Frequency of Neonatal Septal Deformities / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal septal deformities have been reported at all ages and in all races. Many factors have been reported as being causative factors in nasal septal deformities. Among the factors, birth trauma was first reported by Metzenbaum as being a causative factor in nasal septal deformities, and has since been reported by many other authors. The aim of this study was to find if birth trauma is a cause of nasal septal deformities and to assess the frequency of neonatal septal deformities in Korean neonates. MATERIAL AND METHOD: The experiment was performed in a randomized group of neonates. A number of 602 neonates aged 1- 2 days have been examined in a two-month period. A number of 278 neonates were born by natural vaginal delivery (group A), 264 by elective cesarean section (group B) and 60 by emergency cesarean section (group C). The nasal septa of neonates were examined by otoscope, cotton wool test and strut test. RESULT: The septal deformities have been found in 66 neonates of group A (23.74%), in 32 of group B (12.12%) and in 11 of group C (18.33%). The Frequency of septal deformities was higher in group A compared to group B and C (p<0.05). In the group A neonates with septal deformity, however, the correlations between parity and septal deformity and between birth weight and septal deformity were not statistically significant (p <0.05). The overall incidence of septal deformities in the investigated neonates was 18.1% in this study. CONCLUSION: Birth trauma is a causative factor of neo natal septal deformities.

The Effects of Pregnancy Conditions on the Incidence of Nasal Septal Deformities in Neonates

BACKGROUND AND OBJECTIVES: To study the incidence of nasal septal deformities (NSD) in neonates and to identify pregnancy conditions related with NSD occurrence. MATERIALS AND METHODS: Prospective study of 131 women and their newborns. Incidences of neonatal NSD were looked for with a cotton wool test and through direct visual examination of the neonatal nasal cavity with an otoscope. Under study were arbitrary but possibly related factors of neonatal NSD : the mother's age, parity, medical history, the duration of total labor, the duration of second-stage labor, the delivery type, neonatal birth weight and gestational age. The contributions of these factors were analyzed statistically. RESULTS: The incidence of neonatal NSD as identified through otoscopic examination was 11.5%. All studied factors indicated no statistically significant relationship with neonatal NSD. CONCLUSION: Probable nasal trauma during pregnancy and delivery is likely not a factor in the occurrence of NSD in neonates.

Frecuencia de otitis media aguda en menores de 5 años bajo control / Frequency of acute medium otitis in controlled children under 5 years old

Con el objeto de determinar la magnitud y algunas características del comportamiento de la otitis media aguda (OMA), se analiza el seguimiento de 246 niños nacidos sanos y controlados en un consultorio del Área Norte de Santiago, desde el nacimiento hasta los 5 años; éstos son parte de un estudio sobre afecciones respiratorias. El diagnóstico se realiza bajo las normas del Ministerio de Salud el que se basa en la historia clínica y examen físico que es realizado por médico, que incluye ostocopía. Se calculó tasas de incidencia anual que variaron entre 16,3 por ciento en los menores de un año a 9 por ciento en los cuatros años. En el periodo de seguimiento el 33,3 por ciento los niños presento OMA. No se encontró diferencias por sexo. El 48,6 por ciento de los primeros episodios se presento antes de dos años de edad y en este periodo se registro el 53,6 por ciento de todos los episodios. Las tasas no difieren estadísticamente según existencia de hermanos ni consumo de cigarrillo en el hogar: La duración de la lactancia materna (LM) influyo significativamente en la tasa de OMA en los dos primeros años (37,9 por ciento en niños con menos de 4 meses de LM, 22,9 por ciento en los con 4 meses o mas). En los niños con OMA el promedio anual episodios aumentan de 1,3 en el primer año a 4,5 en el cuarto años. Se observo un máximo de 4 episodios en un año solo en un niño. El 37,9 por ciento de los episodios acompañaron IRA (Infección Respiratoria Alta) y el 35,7 por ciento IRA baja, en su mayoría bronquitis. Se concluye que la OMA afecta a un tercio de los menores de cinco años, especialmente lactantes

Which Medical instruments should a family practitioner purchase in preparing a private practice?

BACKGROUND: This study was designed to evaluate medical instrument purchases by Korean family practitianers in private practice. We then proposed guidelines for purchasing equipment for new physicians who are just beginning their private practice. METHODS: A questionnaire was sent to 646 family practitioners managing their private clinics. The questiannaire assessed current medical equipment purchases. They were then asked which instruments they would recommend or discourage others from purchasing. We analysed 123 returned questionnaires (19%). RESULTS: The number of instruments they have was between 4 to 26, and the average was 13. The most frequently owned items included in descending order: otoscope (89.9%), electrocardiograph(82.5 %), ophthahnoscope(78.9%), ultrasound(78%), ultraviolet sterihzer(73.2%) and microscope(69.9%). The instruments they recommended avoiding were sigmoidoscope(27.3%), cryo-therapy kit(25%), laser therapy kit(21.1%), thermo-hemorrhoidectomy instrument(20%), and defibrillator (20%). Instruments they recornmended purchasing were otoscope(87.0%), electrocardiograph (83.0%), ultrasound(74.8%), gastrofiberscope(65.9%), ultraviolet sterilizer(63.4%), microscope(57.7%), and plain radiographic unit(<100mA, 56.1%). The most frequent advice given in purchasing medical instruments was "Avoid over (purchasing) at the beginning". Some instruments were different in possession rate according to sex, age, and practice patterns. CONCLUSIONS: This study evaluated medical instrument purchases of Korean family practitianers in private practice. This compiled list may be of benefit to new physicians who are just opening their own clinic.

A Prevalence Study of Otitis Media with Effusion in Kindergarten Children in Puchun / 대한이비인후과학회지

The prevalence and related diseases of otitis media with effusion(OME) which is a very common disease in infants and young children were investigated in a group of 3 to 6 year old children. The study population includes 374 children with 185 boys and 189 girls enrolled in 7 kindergartens in Puchun city. The middle ear status was assessed by combination of findings of otomicroscope, pneumatic otoscope, impedence audiometry. The related diseases were evaluated by radiologic findings and questionnare with statistic analysis. Fifty-nine children were considered to have OME(prevalence: 15.8%) with peak at 3 years of age(30.6%). Of the 59 children with OME, fifty-four percent had bilateral involvement and all the remainder had unilateral involvement. The risk for otitis media with effusion increased in children with adenoid enlargement, tonsillar enlargement, and paranasal sinusitis, and this was confirmed to be statistically significant(p<0.01).