The clinical features of 58 consecutive patients presenting with a new case of chronic otitis media were prospectively collected over a 15-month period. Twenty-three ears had a keratin filled marginal or attic defect (14 with cholesteatoma), 20 had a self-clearing marginal or attic defect, and 21 had a central tympanic membrane perforation (including one cholesteatoma). Twenty patients (35 per cent) had an abnormal finding in the opposite ear. The patients' ages were dispersed over a wide range of age groups with a mean age of 34 years. Hearing loss was the most common presenting symptom (78 per cent), followed by otorrhoea (64 per cent). A significant proportion of patients denied any history of otorrhoea. Our findings should alert the clinician to suspecting a new case of COM in patients with hearing loss of any age, with, or without, a history of otorrhoea, regardless of their background ear history or the duration of their symptoms.
A simple technique for closing small-to-medium sized perforations of the tympanic membrane in the Out-Patient Department has been described. Homograft temporalis fascia was used as a graft material. In a series of eighteen patients a closure rate of 78.2 per cent was obtained. The advantages of the method have been discussed.
The dynamic nature of advocacy presents a challenge for evaluators to rigorously assess cause‐and‐effect relationships linking advocacy efforts to policy change. Contribution analysis, developed by Dr. John Mayne, offers a nonexperimental impact evaluation method for testing and validating contribution claims in a policy context with multiple actors and influences. Using two case examples, the authors share how they applied the steps of contribution analysis to determine with greater confidence the extent to which an initiative or campaign contributed to a policy outcome. The authors provide observations and tips for advocacy and policy evaluators on how to create a succinct, evidence‐based story about the contribution claim and how coalitions can use these stories to inform strategic decision‐making.
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