The discharging ear: A practical approach

No Abstract

Mite and cockroach sensitisation in patients with allergic rhinitis in the Free State

Background. Studies in patients with allergic rhinitis living in the Free State have shown grass pollens to be the predominant allergens, with house-dust mite sensitisation being less prevalent than in the coastal areas and a low rate of sensitisation to the storage mite Lepidoglyphus destructor. No studies have been conducted on sensitisation to the other storage mites, spider mites or cockroaches. We aimed todetermine the prevalence of sensitisation to various housedustmites, storage mites, spider mites and cockroaches in patients with allergic rhinitis living in the Free State.Methods. Fifty consecutive patients with allergic rhinitis attending the ear, nose and throat clinic at Universitas Hospital underwent skin-prick testing and/or ImmunoCAP RAST testing for common aero-allergens, house-dust mites, storage mites, spider mites and cockroaches.Results. Forty-six per cent of patients were sensitised to one of the house-dust mites, with house mite sensitisation being significantly more common in patients who had previously lived at the coast. Storage mites were not common aeroallergens, while 46% of patients were sensitised to the spider mite Tetranychus urticae. Blatella germanica was the cockroach species to which patients were most commonly found to be sensitised on ImmunoCAP RAST testing, with 38% of patients being sensitised to this aero-allergen.Conclusions. House-dust mites, T. urticae and the cockroach B. germanica appear to be important aero-allergens in the Free State. Storage mite sensitisation is not common

Paediatric chronic suppurative otitis media in the Free State Province: Clinical and audiological features

Background. Chronic suppurative otitis media (CSOM) is a chronic infection of the middle ear cleft. In sub-Saharan Africa >50% of cases occur in children <10 years of age.Objectives. To describe the otological, audiological and bacteriological findings in children with CSOM.Methods. We conducted a prospective study at the Ear, Nose and Throat (ENT) Clinic at Universitas Academic Hospital between August 2009 and December 2010. We included all children with CSOM over this period. Patients underwent ENT and paediatric examination, and were tested for HIV. Pus swabs were taken after an ear toilet for routine microbiology, fungal and Mycobacterium tuberculosis culture. We performed audiological testing after the otorrhoea had resolved.Results. Eighty-six children (113 ears) were included, with a median age of 4.6 years (range 1 - 12 years). The mean duration of otorrhoea was 161.7 weeks (range 4 - 572 weeks). Nine patients (10.5%) presented with coalescent mastoiditis and/or intracranial complications of CSOM. Of the 153 organisms identified, Gram-negative bacteria were present in 93 (82.3%) ears, with 94.8% of these being sensitive to quinolones. Only 1 case of tuberculous otitis media was identified. HIV infection was present in 54.6% of patients tested. There was a hearing loss in 44 (66.7%) of the tested affected ears.Conclusions. There was a long delay between the onset of symptoms and accessing ENT services. Most cases of CSOM were due to quinolone-sensitive Gram-negative aerobes. There was a high prevalence of cholesteatoma, hearing loss and other complications in children in this study

Effects of conjugated linoleic acid and high oleic acid safflower oil in the treatment of children with HPV-induced laryngeal papillomatosis: a randomized, double-blinded and crossover preliminary study

<p>Abstract</p> <p>Background</p> <p>Surgery is the mainstay therapy for HPV-induced laryngeal papillomatosis (LP) and adjuvant therapies are palliative at best. Research revealed that conjugated-linoleic acid (CLA) may improve the outcome of virally-induced diseases. The effects of Clarinol™ G-80 (CLA) and high oleic safflower oil (HOSF) on children with LP (concomitant with surgery) were evaluated.</p> <p>Design</p> <p>A randomized, double-blinded, crossover and reference-oil controlled trial was conducted at a South African medical university. Study components included clinical, HPV type/load and lymphocyte/cytokine analyses, according to routine laboratory methods.</p> <p>Participants</p> <p>Overall: ten children enrolled; eight completed the trial; five remained randomized; seven received CLA first; all treatments remained double-blinded.</p> <p>Intervention</p> <p>Children (4 to 12 years) received 2.5 ml p/d CLA (8 weeks) and 2.5 ml p/d HOSF (8 weeks) with a washout period (6 weeks) in-between. The one-year trial included a post-treatment period (30 weeks) and afterwards was a one-year follow-up period.</p> <p>Main outcome measures</p> <p>Changes in numbers of surgical procedures for improved disease outcome, total/anatomical scores (staging system) for papillomatosis prevention/viral inhibition, and lymphocyte/cytokine counts for immune responses between baselines and each treatment/end of trial were measured.</p> <p>Findings</p> <p>After each treatment all the children were in remission (no surgical procedures); after the trial two had recurrence (surgical procedures in post-treatment period); after the follow-up period three had recurrence (several surgical procedures) and five recovered (four had no surgical procedures). Effects of CLA (and HOSF to a lesser extent) were restricted to mildly/moderately aggressive papillomatosis. Children with low total scores (seven/less) and reduced infections (three/less laryngeal sub-sites) recovered after the trial. No harmful effects were observed. The number of surgical procedures during the trial (n6/available records) was significantly lower [(p 0.03) (95% CI 1.1; 0)]. Changes in scores between baselines and CLA treatments (n8) were significantly lower: total scores [(p 0.02) (95% CI −30.00; 0.00)]; anatomical scores [(p 0.008) (95% CI −33.00: -2.00)]. Immune enhancement could not be demonstrated.</p> <p>Conclusions</p> <p>These preliminary case and group findings pave the way for further research on the therapeutic potential of adjuvant CLA in the treatment of HPV-induced LP.</p