We studied the incidence of exudative otitis media in 488 patients followed up from birth. Forty-nine percent (240) of the patients had their initial episode of otitis media in the first year of life and only 12% (56) in the second year of life. Thereafter, the incidence decreased steadily. Patients having six or more episodes of otitis media before age 6 were termed "otitis prone." Fi f t y\ x=req-\ seven such patients were observed and this condition was found to be significantly related to the onset of otitis media in the firstyear of life and to the pneumococcal cause of the initial episode.
Fifty-eight infants and children with acute otitis media were prospectively studied for bacterial and viral pathogenesis and response to antibiotic therapy. Tympanocentesis for bacterial and viral cultures of middle ear fluids (MEF) was done before and 2-4 days after beginning treatment. Patients were followed until the end of antibiotic course. Bacteria were cultured from the preantibiotic MEF in 43 cases (74%). Viruses were cultured from the preantibiotic MEF in 11 cases (19%); all of these MEFs also contained bacterial pathogens. A significantly higher proportion of patients with both virus and bacteria (50%) failed to respond with clearing of bacteria 2-4 days into therapy compared with the group with bacteria alone (13%). The patients with persistently positive viral cultures of the MEF seemed to have purulent otitis of longer duration. Presence of virus in the MEF may interfere with bacteriologic and clinical responses to antibiotic. The mechanism of interference deserves further investigation.
Breast feeding was reported in 1992 by Lucas, et al. to provide advantages for the development of intelligence in children of low birth weight, possibly through nutrients or other biological factors found in human breast milk but not cow's milk. Research on breast feeding and intelligence in children of normal birth weight has yielded mixed results, probably because measurement of environmental influences has not been thorough and the range of intelligence components measured has been limited. Our research with 204 3-year-old children of normal birth weight included control measures for the environment and maternal intelligence (Hollings-head socioeconomic status, Home Observation for the Measured Environment, Shipley) and two measures of childhood intelligence (Stanford-Binet Fourth Edition and Peabody Picture Vocabulary Test-Revised). Controlling for environmental variables and maternal intelligence, initiation of breast feeding predicted scores on intelligence tests at age three. Breast feeding was associated with 4.6-point higher mean in children's intelligence.
Viruses--both alone and in combination with bacteria--have been shown to be a cause of acute otitis media (AOM). Moreover, the presence of virus in middle ear fluid (MEF) interferes with the bacteriologic response to antibiotic treatment in AOM. We studied various factors related to the eradication of bacteria from the MEF of infants and children who had AOM associated with a combination of bacteria and viruses. Of 622 cases of AOM diagnosed and treated between 1985 and 1991, 71 were due to such a combination. Bacteria were eradicated from MEF by 2-4 days of antibiotic treatment in 50 (70%) of these 71 cases; in the remaining 21 cases, the originally identified bacteria persisted or a new pathogenic bacterial species was detected after such treatment. These two groups of cases were compared with respect to the patients' age, sex, race, history of recurrent AOM, duration of respiratory symptoms, and compliance; the type of antibiotic treatment administered; the type of pathogenic bacteria and viruses identified in MEF; the presence of single or multiple pathogens; and the laterality of the disease. The only difference noted was in the type(s) of virus found in MEF. The presence of rhinovirus was associated with a higher rate of bacteriologic failure than was that of respiratory syncytial virus, parainfluenza virus, influenza virus, or other viruses. Our data suggest that the bacteriologic response to antibiotic treatment in bacterial-viral AOM may depend in part on the type(s) of virus present in MEF.
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