Topical ciprofloxacin is superior to topical saline and systemic antibiotics in the treatment of tympanostomy tube otorrhea in children: the results of a randomized clinical trial.

Objectives/hypothesis: To compare the clinical failure rates among children with otorrhea through tympanostomy tubes treated with topical or systemic antibiotics versus topical saline.

Study Design: Randomized, double-blind, controlled patient study.

Methods: A three-armed randomized clinical trial using topical ciprofloxacin or oral amoxicillin or topical saline.

Azithromycin Concentrations and Microbiology of Tonsils during Weekly Medication in Patients with Recurrent Tonsillitis.

This study was performed in order to assess whether 500mg of azithromycin given orally once per week could produce tonsil tissue concentrations above minimum inhibitory concentrations for key target pathogens in patients with recurrent tonsillitis. For the measurement of tissue concentrations an automated solid phase extraction (SPE) method for cleaning the tissue extracts was developed. Concomitantly, the influence of this treatment on the microbiological flora of the tonsillar surface was monitored.

Clinical trial design, nasal allergen challenge models, and considerations of relevance to pediatrics, nasal polyposis, and different classes of medication.

Clinical trials in allergic rhinitis present several specific difficulties. In seasonal pollen-related disease, there are variations between subjects in the extent of pollen sensitization, individual variations in exposure to pollen even within a set area because of lifestyle differences, and variations between different areas in pollen counts and weather patterns. Thus, large patient numbers are needed in multicenter trials to account for such variations when the standard endpoint is symptom reporting.

The natural history of recurrent acute tonsillitis and a clinical trial of azithromycin for antibiotic prophylaxis.

The pharmacokinetics of azithromycin (Zitromax), Pfizer Inc., USA) in tonsil tissue warranted the present trial. In 110 patients eligible for tonsillectomy because of recurrent acute tonsillitis, surgery was replaced by randomized medication with azithromycin 500 mg or placebo once per week for 6 months.

Tympanometry for diagnosis and treatment of otitis media in general practice.

Objective: The aim of this study was to evaluate the role of tympanometry for diagnosis, treatment and follow-up of otitis media in general practice.

Methods: The results from otoscopy performed by 40 physicians in general practice in Vejle County, Denmark were combined with the clinical condition and this was recorded as the preliminary decision about diagnosis, treatment and follow-up. Subsequently, tympanometry was performed in 3176 children aged between 1 month and 16 years; a total of 6352 tympanometries.

Glucocorticoid treatment for nasal polyps. The use of topical budesonide powder, intramuscular betamethasone, and surgical treatment.

Background: The treatment of nasal polyps is controversial, and medical treatment alone has been little investigated to our knowledge.

Objective: To examine the efficacy of therapy using only topical budesonide powder and topical budesonide powder supplemented with surgical removal or intramuscular betamethasone.

Design: Randomized, double-blind comparison of 2 dosages and additional treatment, if therapy failed.

Sequelae of secretory otitis media: changes in middle ear biomechanics.

A new method previously introduced investigating the pressure volume relationship of the middle ear system describes dynamic mechanical properties of the system: the variables measured are hysteresis, compliance, and P(ec0) expressing the zero position of the tympanic membrane. The present study investigates the mechanical properties in 69 adolescents treated with ventilation tubes during childhood due to secretory otitis media. The tympanic membranes displayed various degrees of atrophy, sclerosis, and retraction of the pars flaccida.

Infectious mononucleosis treated by an antihistamine: a comparison of the efficacy of ranitidine (Zantac) vs placebo in the treatment of infectious mononucleosis.

This study investigated whether the course of infectious mononucleosis was influenced by medication with ranitidine (Zantac). A double-blind, placebo-controlled study enrolled 117 patients and either ranitidine 300 mg or placebo were given twice daily for 2 wk. Patients were examined on day 5, 10, 15 and 30.

Nasal polyps treatment: medical management.

The objectives of medical management of nasal polyposis are 1) to eliminate nasal polyps and rhinitis symptoms, 2) to reestablish nasal breathing and olfaction, and 3) to prevent recurrence of nasal polyps. Although antibiotics are used for infectious complications of nasal polyposis, only glucocorticosteroids (steroids) have a proven effect on the symptoms and signs of nasal polyps. Topically applied steroids is the therapeutic modality that has been best studied in controlled trials.

Efficacy of topical corticosteroid powder for nasal polyps: a double-blind, placebo-controlled study of budesonide.

Budesonide has been used for a number of years as a topical nasal corticosteroid in the treatment of nasal allergy and nasal polyps. Recently, a new device for powder insufflation where no constituents or preservatives are included has been developed (Rhinocort Turbuhaler, Astra Draco AB, Sweden). The present investigation was designed in order to study the efficacy of topical budesonide powder as the only treatment of nasal polyps.

[Diagnosis and treatment of ear diseases in general practice. A controlled trial of the effect of the introduction of middle ear measurement (tympanometry)].

The diagnosis and treatment of diseases of the ear in general practice could be rendered optimal by employing tympanometry (measurement of the pressure in the middle ear) which is already known from specialist practice. This was investigated by means of a controlled investigation with cooperation between general practice, otologists and the health services in the County of Vejle. Following randomizing among 20 general practitioners, ten were trained in tympanometry (the test group) while ten did not change their principles for diagnosis and treatment (control group).

Tests of eustachian tube function and ear surgery.

Few objective measures exist to predict the outcome of ear surgery. Clinical and experimental experience has shown the key role of the Eustachian tube in this respect, but clinical testing is seldom performed. The present study confirms that Eustachian tube testing may be of clinical significance by comparing preoperative test results before myringoplasty with the late results of this operation.

Surgical versus medical treatment of nasal polyps.

Surgical removal of nasal polyps is associated with discomfort and risks for the patient, but is the treatment of choice to most otorhinolaryngologists. Medical treatment alone has been little investigated. In a prospective clinical trial surgical removal followed by continuous topical steroid treatment has been compared with a single dose of steroid deposit followed by continuous topical steroid treatment.

Surgical versus medical treatment of nasal polyps.

A randomized comparison of the usual surgical removal of nasal polyps versus systemic steroid treatment was performed in 53 patients. In all, continuous topical steroid treatment was given during the one year period of observation. In both groups the initial treatment resulted in a continuous increase in mean nasal expiratory peak flow as well as in the sense of smell; these two parameters showed a temporary statistically significant difference in favour of the medically treated group.

Obstructive sleep apnea initiated by a lax epiglottis. A contraindication for continuous positive airway pressure.

Treatment with nasal continuous positive airway pressure (CPAP) was attempted in a patient with severe obstructive sleep apnea. However, application of nasal CPAP gave the patient a feeling of being suffocated. This was later documented by cine-fluoroscopic examinations of the upper airways with and without nasal CPAP.

Gas composition of the normal and the ventilated middle ear cavity.

Epidemiologic and controlled studies indicate that late minimal hearing impairment is a sequelae after the use of a ventilation tube in early childhood. The patho-physiology is unknown, but abnormal middle ear gas composition might be important. Therefore it is mandatory to measure middle ear gas composition in order to understand the gas exchange in the normal middle ear, as well as the change in gas composition associated with ventilation tubes.

Preoperative swabs for the treatment of draining ears after middle ear surgery.

The value of a preoperative swab for the treatment of postoperative infection after middle ear surgery was investigated. In a selected group of 80 patients with postoperative infection a preoperative swab was available, and the variability was analysed for each species. The well-known pathogens Pseudomonas aeruginosa, Staphylococcus aureus, Proteus and Escherichia coli showed good correlation between pre- and postoperative swabs.

Sympathetic influence on the normal Eustachian tube. An experimental study in the rat.

A new variant of the inflation test of the Eustachian tube is presented; a constant air flow generator was constructed with minimal sensitivity to counterpressure, and variations in air pressure were measured, reflecting variations in Eustachian tube patency. By means of this test the effect of Otrivin (alpha 2-receptor stimulation) and Timacar (beta-receptor blocking) on the Eustachian tube was investigated with saline serving as reference. The following results were obtained: Otrivin lowers the opening pressure and the steady state pressure, and reduces the pressure drop during active opening.

Efficacy of perioperative ceftazidime in the surgical treatment of chronic otitis media due to Pseudomonas aeruginosa. Preliminary report of a prospective, controlled study.

A prospective open and controlled study of perioperative antibiotics was conducted in patients with chronic otitis media (COM). Drug efficacy was found in a subgroup of 26 patients, who were characterized by preoperative aural drainage culturing Pseudomonas aeruginosa. Fourteen of these patients were randomized to receive ceftazidime (cephalosporin) for 5 days at the operation, while 12 had no antibiotic treatment.

Sequelae of ventilation tubes following tonsillectomy.

The insertion of middle ear ventilation tubes results in persistent scarring in a significant number of the tympanic membranes incised. The present study was done in order to compare the occurrences of tympanic membrane sequelae following ventilation tube insertions in a group of patients with intact tonsils with that of a tonsillectomized group. The study population had been treated with ventilation tubes 3-5 years previously because of middle ear effusions.

Interpretation of sonotubometry. A critical view of the acoustical measurement of the opening of the eustachian tube.

The principle of sonotubometry for recording the opening of the Eustachian tube is based on the assumption that this opening increases the sound transmission from the nasopharynx to the external ear canal. However, the clinical validity of the method remains to be documented. In the present study the results in 37 normal ears were compared with those of 11 ears which showed signs of Eustachian tube dysfunction.

Ventilation tubes and cholesteatoma in children.

The previous use of ventilation tubes has been investigated retrospectively in a series of children whose ears had been operated on. Within a six-year period, 49 ears had a cholesteatoma documented, and in 14 of these a tube had been used. During the same period, 64 ears were operated on for chronic otitis media without cholesteatoma, and of these only three ears had been treated with a tube.

Ultrastructure of the tympanic membrane in the Rhesus monkey.

The tympanic membranes of 8 Rhesus monkeys (macaca mulatta) were investigated by transmission electron microscopy. The interface of the epidermis and the fibrous framework appeared rather smooth and the contact between the basal cell layer and the lamina propria was secured by a dermo-epidermal junction. Cross-sectioned fibrils varied in shape and thickness, the thin fibrils being quadrangular.