An epidemiological approach to the etiology of middle ear disease in The Netherlands.
ABSTRACT The etiology of middle ear disease in Nijmegen, The Netherlands was studied on the basis of a data set collected in a prospective epidemiological study on otitis media with effusion (OME) in a cohort of 1439 preschool children. A factor analysis was used to evaluate two hypotheses: (1) that OME, acute otitis media (AOM), common cold and tonsillitis are manifestations of the same pathological entity, and (2) that a group of children can be distinguished who develop these conditions more frequently than average. The results only partly supported these hypotheses. The correlation between OME, AOM, common cold and tonsillitis was lower than expected from a review of the literature. Common cold appeared to be the ubiquitous ENT disease in childhood and, depending on the child's predisposition, could be accompanied by OME, AOM or tonsillitis. The course of middle ear and upper airway disease showed a gradual scale from "healthy" to "ill" with most of the children suffering from these conditions at an average frequency.
- SourceAvailable from: nih.gov[Show abstract] [Hide abstract]
ABSTRACT: To see whether there is a relation between grommet insertion operation and tonsillectomy rates, otolaryngology services, and deprivation scores in Scotland. Analysis of routine 1990 NHS data on grommet insertions and tonsillectomies in Scottish children aged 0-15 years compared with data on general practitioner and otolaryngology services and Carstairs deprivation scores. All 15 Scottish health boards. All children aged 0-15 (1,021,933). Tonsillectomy was more common than grommet insertion operations in Scotland (6182:4850). Health boards with high grommet insertion rates were more likely to have low tonsillectomy rates (Spearman's rank correlation -0.59; 95% confidence interval -0.87 to -0.03). Grommet insertion rates varied fourfold (from 2.4/1000 to 9.2/1000) and tonsillectomy rates twofold (from 3.6/1000 to 8.0/1000) across Scottish health boards. Variation between health boards had changed over the 15 years 1975-90. Variation in grommet insertion rates did not reflect variation in the supply of otolaryngology consultants (Spearman's rank correlation -0.25). There was a non-significant tendency for high general practitioner referral rates to be associated with high grommet insertion rates, low tonsillectomy rates, and less deprived areas (Spearman's rank correlation coefficients 0.50, -0.53, and -0.43). Deprivation (measured by Carstairs scoring for each health board) was associated with higher tonsillectomy rates (Spearman's rank correlation 0.41; 95% confidence interval -0.22 to 0.80) and significantly lower grommet insertion rates (-0.73; -0.92 to -0.28). Social factors as well as differences in disease prevalence and medical practice need to be considered when studying variation in childhood grommet insertion and tonsillectomy rates.BMJ Clinical Research 05/1994; 308(6937):1129-32. DOI:10.1136/bmj.308.6937.1129 · 14.09 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: In order to estimate the co-morbidity between ear infections and related childhood diseases, data about the occurrence of recurrent ear infections, tonsillitis, sinusitis and atopic diseases from a population based sample of 7992 Norwegian twins were analysed. Correlational results revealed two general clusters, one consisting of upper respiratory tract infections (URI), the other defined by the atopic diseases. Overall, associations between the diseases were greater in males. The sizes of the correlations within each subgroup of infections were moderate, but significant, ranging from 0.191 to 0.363. Similar results were found for the relationship within the subgroup of atopies, with correlations ranging from 0.134 to 0.466. The correlations between the infectious and atopic diseases were weak. Both ear infections and tonsillitis seemed to be predisposing factors for sinusitis. The relative risk of sinusitis among individuals with a history of ear infections was 3.4 (1.9–6.2) and 1.9 (1.2–3.0) for males and females, respectively. Ear infections conferred an increase in tonsillitis, estimated at 2.3 (1.6–3.0) and 2.0 (1.2–3.6) for males and females, respectively. In conclusion, the present study finds evidence for a common predisposition of upper respiratory infections as well as for atopic diseases, but only moderate correlation between the subgroups. Specifically, between ear infections and hay fever there was no covariation.International Journal of Pediatric Otorhinolaryngology 05/1996; 35(2-35):127-141. DOI:10.1016/0165-5876(95)01299-0 · 1.32 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Global population trends, health care economics and disease patterns are reviewed. The world's population has doubled twice in the twentieth century, and will grow by at least a further 2 billion before stabilizing in the middle of the next century. There is gross maldistribution of wealth and health care expenditures: 20% of the population control 80% of the gross domestic product, the same 20% of the population spend 87% of the total global health care funds. Extreme poverty facilitates all manner of diseases. Globally, infections remain the most important causes of disease. Of these, upper respiratory infections are an important cause of hearing loss and learning handicap in children world-wide. Epidemic meningitis in Africa and parts of Asia is a preventable major cause of death and deafness. There are about 80,000 otolaryngologists in the world and they too are maldistributed, with most in Europe and the Americas. This is exacerbated when looked at from the standpoint of children, most children live where there are fewest otolaryngologists: the differences are greater than two orders of magnitude. This greatly affects the role and scope of paediatric otolaryngology. The discipline is small and rapidly evolving. Suggestions are made for sharing training.International Journal of Pediatric Otorhinolaryngology 11/1999; 49 Suppl 1:S1-9. DOI:10.1016/S0165-5876(99)00123-8 · 1.32 Impact Factor