Tympanostomy tube insertion practice in under-18-year-olds in the South African private healthcare sector insured by Discovery Health.

BACKGROUND: The reported rates of tympanostomy tube insertion (TTI) in children vary significantly internationally. Lack of adherence to evidence-based clinical guidelines may contribute to these differences. OBJECTIVES: To study the rates of TTI in South Africa (SA) in children ≤18 years old in the private healthcare sector, both nationally and regionally, to compare these with international TTI rates, and to determine the use of preoperative audiometry and tympanometry. METHODS: A retrospective analysis was done of data obtained from the Discovery Health database. Rates of TTI were analysed nationally and regionally and in different age groups, as was the use of tympanometry and audiograms. RESULTS: The SA TTI rates were much higher than published international rates except for the 0 - 1-year age group in Canada and Denmark and the 0 - 15-year age group in Denmark. There was a statistically significant regional variation in TTI rates as well as in the use of preoperative audiometry and tympanometry. CONCLUSIONS: SA private sector TTI rates are high by international standards. Significant regional variations may indicate over- or underservicing in certain regions. Further investigation of causes for the high TTI rate and regional variations is recommended. Education of healthcare professionals on recognised indications for TTI may improve patient selection.

A comparison of morbidity in the Australian Defence Force with Australian general practice.

This study was designed to examine morbidity patterns among Australian Defence Forces members and to compare them with civilian general practice. The study was conducted in the outpatient departments of the Royal Australian Air Force (RAAF) No. 6 Hospital, Melbourne, Australia. The patients studied were male and female members of the RAAF (66%), Army (25%), and Navy (9%). The problems managed at all primary care consultations during 1993 and 1994 were coded using the Ninth Revision of the International Classification of Diseases (Clinical Modification). The codes were grouped and compared against a major study of Australian general practice. In the 6 Hospital study, 21,910 problems were managed at 19,909 consultations. The main differences found between the two studies were that service personnel had more medical examinations, more musculoskeletal and respiratory problems, and fewer psychological and cardiovascular problems. Most of the differences observed may reflect the Defence Force's recruitment selection criteria and the emphasis on physical fitness and diet.

HIV and STDs. Oral manifestations.

Many systemic diseases frequently have oral manifestations as one of their earliest signs, this is particularly so in the immunocompromised patient or as an indicator of a sexually transmitted disease. Without careful examination of the face, oropharynx and regional lymph nodes, diagnosis may be delayed, resulting in morbidity and in some cases mortality. This paper discusses oral lesions resulting from infection and their management.

Regional nerve blocks.

Regional nerve blocks are a valuable skill for general practitioners and surgeons who perform surgical procedures under local anaesthetic. Once mastered, these injections provide rapid anaesthesia with minimal pain, little distortion of the tissues and improved aesthetic results. This paper describes techniques applicable to lesions of the face, upper and lower limbs, and to achieve anaesthesia after a fractured rib.

Hypokalaemic paralysis in remote aboriginal communities.

Increasing weakness occurring over several days, involving the upper and lower limbs, and progressing to symmetrical paresis is a clinical presentation that raises many diagnostic issues. When faced with these circumstances most clinicians opt for a range of neurological possibilities. However, metabolic possibilities are equally important and are eminently treatable. There are a variety of reasons why potassium depletion presents as paralysis in Aboriginal Australians. The cause may not be apparent, although careful questioning may unearth clues that can lead to a diagnosis. Once the potassium level has been measured in the blood the diagnosis becomes obvious, but until that time the presentation can be confusing. Early serum potassium measurement is recommended with this clinical picture.

An approach to the assessment of falls in the elderly.

In assessing the elderly it should be remembered that about 75% of falls are unreported. It is essential therefore to inquire about falls and balance problems in any assessment of the aged. Falls are common during a severe acute illness such as stroke, pneumonia or any condition causing hypotension or severe pain; the elderly having little reserves to meet such stress. Vigilance on the part of the carer to prevent falls is essential at such times. Although trips or falls are inevitable in the elderly and are usually inconsequential, each reported fall needs careful evaluation. In many cases causes can be identified and corrected. This in turn will improve the quality of life by reducing the fear of falling and in so doing help avoid a serious fall with its possible long term consequences.

Oral ulceration. Things are not always what they seem.

Oral ulceration is a common complaint and is usually inconsequential. Nevertheless, when it appears for the first time in adult life, it may represent the manifestation of systemic disease. A full history and examination should be carried out and a full blood examination and ESR done. Any ulcer persisting for more than three weeks without responding to treatment should be biopsied.