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Objective-To measure the time to spontaneous resolution of severe chronic otitis media with effusion (glue ear) in children and study the effects of adenoidectomy, adenotonsillectomy, and ventilation tubes (grommets).Design-Randomised controlled study over 12years. Setting-Paediatric otorhinolaryngology clinics and in-patient unit.Subjects-228 children aged 2-9 years with pronounced hearing loss from glue ear and persistent bilateral middle ear effusions confirmed on three occasions over three months.Interventions-Children were randomly allocated to adenotonsillectomy, adenoidectomy, or neither procedure. In all groups a Shepard type ventilation tube was inserted in one randomly chosen ear. Follow up was annually for five years and then less often for up to seven years four months. For analysis the two operated groups were combined.Main outcome measures-Otoscopic clearance of fluid, change in tympanogram, and improvement in mean audiometric hearing threshold.Results-Survival analysis showed appreciable otoscopic and tympanometric resolution of fluid with ventilation tubes alone and adenoidectomy alone compared with no surgery. Further improvement was seen after combination ofboth treatments.Mean audiometric hearing thresholds improved with fluid resolution. Resolution was delayed in younger children and in those whose parents smoked, irrespective of treatment. Whereas a single insertion of a Shepard tube resolved the glue for a mean (SD) period of 9.5 (5.2) months, the effect of adenoidectomy was sustained throughout follow up.Conclusions-Treatment of glue ear considerably shortened the time to fluid resolution, combined adenoidectomy and tube insertion being better than either procedure alone. Resolution was longer in younger children and those whose parent(s) smoked, irrespective oftreatment.

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A total of 85 children on the waiting list for grommet insertion aged between 3 and 10 years with bilateral chronic otitis media with effusion (OME) were assigned at random to an observation or treatment group. Those in the treatment group were given the Otovent@device to use three times a day for the duration of the study and both groups were then seen at monthly intervals for 3 months for pneumatic otoscopy and tympanometry. Statistically significant improvement was seen in those using the treatment with a compliance of more than 70%. This was detected on the outcome measures of tympanometry and pneumatic otoscopy after 1, 2 and 3 months. No side effects were demonstrated.used regularly under supervision. Keywords OME grommet insertion autoinflation non-surgical treatmentWe conclude that autoinflation is an effective short-term treatment for children with OME when

Two hundred and twenty-two children with bilateral otitis media with effusion were followed for 5 years. A ventilation tube was inserted into one ear only and reinserted if the condition had not resolved. The need for reinsertion in 139 children in whom the adenoids were also removed was compared with the 83 children treated by tube insertion alone. In the combined group in year 1, 91% required one tube compared with 62% treated with only a tube. By year 5, 66% of the combined group required one tube compared with 32.5% in those without adenoidectomy. There was some relationship between tube reinsertion and age, and also with parental smoking. It is possible that the combination of adenoidectomy with tube insertion may prove more cost-effective than tube insertion in selected cases alone. In addition, once adenoidectomy becomes more established as a day case procedure, the cost benefit will be more advantageous in those children treated with adenoidectomy and a tube compared with those treated with only a tube.

There is only limited knowledge of the factors which influence the outcome of otitis media with effusion in children in the long-term. This randomized controlled study assessed the therapeutic effect of adenoidectomy and adenotonsillectomy during a 5-year follow-up. Numerous pre-treatment independent variables concerning the child's upper and lower respiratory tract, atopic status and parental habits were assessed in relation to two dependent outcome measures. These were otoscopic clearance of effusion and no peak/peak tympanometric change. A total of 222 children was studied and reviewed annually for 5 years. Four of 43 independent variables were found to be repeatedly significant in relation to outcome: (a) whether or not adenoidectomy was performed; (b) age at operation; (c) history of earache prior to operation; and (d) parental smoking habits. The results provide further evidence of a beneficial effect of adenoid removal and the importance of the age at which surgery is advised. They also suggest the need to investigate further the relationship of superadded acute suppurative otitis media with otalgia and the outcome of chronic otitis media with effusion. Finally, avoidance of parental smoking will have a beneficial effect on children's middle ear disease.

Two hundred and twenty-two children with chronic, bilateral middle ear effusions were assessed during a 2 year follow-up period. At initial myringotomy the middle ear aspirate was found to be serous in 44 children and mucoid in 178 children. Evaluation at 1 and 2 years post-operatively showed no difference in otoscopic fluid clearance or mean hearing threshold at either follow-up time in relation to either type of fluid. There was no greater need for ventilation tube reinsertion in either group during the overall follow-up period. There was found to be no significant difference between the children with serous or mucoid effusions in relation to a range of pre-operative and operative variables. The study suggests that outcome in terms of fluid clearance and hearing thresholds is independent of the fluid type and there appears no greater need for revision ventilation tube insertion in relation to the findings at myringotomy. The type of effusion found on aspiration prior to ventilation tube insertion has no prognostic value. Children with serous fluid should be managed in an identical manner to those in which the fluid is thicker and mucoid in character.

The growing prevalence of venous leg ulcers in an ageing population presents challenges for wound care and management. The Lindsay Leg Club model is an alternative approach to the management of leg health that can improve patient outcomes. This article reports on an audit of a relational database located within the Leg Club Network, containing records of more than 17 000 patients (known as members) who attended a Leg Club in a 5-year period (2014-2019). Overall, over 266 000 member leg assessments and treatments were entered into the database. The average nurse-member attendance time was 28 min, with a skill mix of 23% senior nurses, 70% qualified and associate nurses, and 7% nurses in supervisory roles. Healing rates averaged 62% after 12 weeks. Recurrence rates were 20% after 12 weeks. Annual clinical and volunteer hours averaged 821 and 800 h, respectively. Staffing costs were £28 per wound treatment or leg assessment with a typical duration of 27 min; 71% of members were aged 70 to 94 years old, which indicates the need for a service that caters to the specific requirements of this age group. However, no data on psychosocial and well-being outcomes were recorded. Their inclusion in further developments of this database is recommended.