[Diseases in children in Greenland: middle ear infections in particular].
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
P Homøe
Publications and source records attributed to P Homøe.
Nasopharyngeal bacteria found on blood agar plates from healthy children in Greenland.
We have systematically studied the aerobic nasopharyngeal bacteria isolated from swabs by unselective subculturing on 5% horse blood agar and chocolate agar in 70 healthy children aged 0-1, 3-5 and 8 years in Nuuk and Sisimiut, Greenland. The purpose was to provide a basis for a better understanding of the infectious pathology and blind antibiotic treatment against potential pathogens thereby improving standard antimicrobial treatment of upper respiratory tract infections (URTI) and otitis media (OM) among children in Greenland. The study serves also as a baseline for future microbiological and immunological research projects. The children were clinically examined for any infectious diseases and a medical history was obtained which allowed for selection of children without a history of severe clinical infection. Nasopharyngeal swabs obtained via the oral route were instantly spread on 5% blood agar and chocolate agar culture plates and incubated aerobically. Subsequently, potentially pathogenic as well as non-pathogenic bacteria were identified by conventional methods. Healthy children in Greenland carry grossly the same aerobic bacterial flora as children in other parts of the world but potentially pathogenic bacteria were found in very high frequency (94%). Staphylococcus aureus, Streptococcus pneumoniae and Moraxella catarrhalis were found in higher frequencies in the youngest children. Haemophilus influenzae non-b was found in high frequencies in all age groups (67-76%). H. influenzae type b was carried by 11.4%. Group A streptococci were found more frequently in older children and in children from Sisimiut. Of M. catarrhalis strains 88% produced beta-lactamase. Neisseria meningitidis, Mycoplasma pneumoniae and chlamydiae were not detected at all. The high carrier frequency of potentially pathogenic bacteria in healthy children in Greenland may be related to the high frequency of URTI's and episodes of OM among children in Greenland.
Bacteria, Aerobic↗
Prevalence of otitis media in a survey of 591 unselected Greenlandic children.
In an unselected survey in two Greenlandic towns, 591 children were examined to study the prevalence of otitis media (OM). The attendance rate in Nuuk was 80%, while 93% participated in Sisimiut. The children were three-, four-, five- and eight-years-old and represented 18% of children in these age groups in all Greenland. In total, 51.7% in Nuuk and 54.1% in Sisimiut presented pathologic middle ear affections ranging from slight to severe. The prevalence rates of chronic OM (COM) were 6.8% in Nuuk and 11.7% in Sisimiut (P = 0.055) but without significant age or sex difference. The acute OM point prevalence rate was between 1.5% and 0.4%. The prevalence rate of middle ear effusion (MEE) was between 23.0% and 28.2%. Secretory OM was significantly more prevalent in the younger age groups. The odds ratio of having COM was significantly higher in children with two Greenlandic born parents (3.07) than in children with only one Greenlandic born parent. A follow-up study after one year in Sisimiut revealed unchanged or aggravated middle ear disease in 56.8% of 82 children with middle ear pathology at the primary survey. Thus, OM persists as a major health problem among Greenlandic children, although the general socio-economic and medical conditions have improved during the last decades. Proposals are provided for increased otologic efforts.
Acute Disease↗
Estimation of otitis media in ancient populations. A study of past and present Greenlandic Inuit.
Examination of disease patterns in the past has often been difficult due to lack of morphological evidence. This study presents a new unbiased method for estimation of occurrence of infectious middle ear disease (IMED) in childhood. The method is based on the relation between IMED in childhood and small or asymmetric pneumatized cell areas in the temporal bones as seen on standardised X-rays. A polychotomous logistic regression model was applied on 434 pneumatized cell areas in temporal bones from 34 adult living Greenlandic Inuit, 56 adult crania from the 18th to the 19th century, A.D. and 127 adult Inuit crania from the pre-European colonization period (before A.D. 1721) of Greenland. The occurrence of IMED as designated by the model was eight out of 34 (23.5 per cent) in living Inuit, 10 out of 56 (17.9 per cent) in crania from the 18th to 19th century and six out of 127 (4.7 per cent) in crania from the pre-colonization period. These frequencies differed significantly (p < 0.002). The mean area size also differed significantly, thus indicating a change in occurrence of IMED and a decrease in area sizes from past to present in Greenland.
Adolescent↗
High rate of nasopharyngeal carriage of potential pathogens among children in Greenland: results of a clinical survey of middle-ear disease.
Nasopharyngeal and middle-ear colonization with bacteria and viruses, including Mycoplasma pneumoniae and chlamydiae, was investigated in a survey of 54 children with acute otitis media (AOM) and 201 control children without AOM in Greenland. In total, 98% with AOM and 91% without AOM carried potentially pathogenic bacteria in the nasopharynx. Two or more potentially pathogenic species were carried by 78% with AOM and 57% without AOM. Haemophilus influenzae was found in 92% and 77%, respectively, but only Streptococcus pneumoniae was found significantly more often in the nasopharynx of children with AOM than in age-matched controls (P < .03). The two species were found in 22 of 24 ear-discharge specimens. Nine children (three with AOM) had chlamydiae in the nasopharynx, and seven of them reported rhinitis. Enteroviruses or rhinoviruses were detected in 23 nasopharyngeal specimens from 39 children with AOM, in 13 such specimens from 39 children without AOM (P = .040), and in 4 of 14 ear-discharge specimens. The potentially pathogenic load in the nasopharynx was massive, suggesting an association with the high prevalence of otitis media among children in Greenland.
Bacterial Infections↗
Hearing in elementary school children in Nuuk and Sisimiut, Greenland.
The study is a retrospective evaluation of audiometric screening tests and registration charts of 167 school children in the towns Sisimiut and Nuuk, Greenland. The children were from 5 to 14 years old. The test performed was pure tone air conduction audiometry at frequencies from 250 to 8000 Hz. In total 43% of the children had hearing thresholds exceeding hearing loss (HL) of 20 dB at one or more frequencies in either one or both ears. The threshold elevations were most common and more severe at the high frequencies (6000-8000 Hz). At the mid frequencies (500-2000 Hz) a HL greater than 20 dB was found in 32/166 (19%) of the children, seven (4%) of whom were bilaterally affected. Seventeen children (10%) had HL at two or all frequencies in the mid frequency range. HL was significantly more frequent in Sisimiut in total 95% CI = 11-40%; (p < 0.002). In Sisimiut 7/78 (9%) of the children had chronic otitis media (COM) and one had grommets. In Nuuk 5/89 (5.5%) had COM and one had congenital unilateral HL. All children with COM had HL. Audiometric screening in Greenland is indispensable for identification of children with hearing impairment and to ensure their rehabilitation.
Adolescent↗
Pneumatization and otitis media in Greenlandic Inuit before European colonization.
A total of 127 Greenlandic Inuit crania from before the European colonization of Greenland and deriving from the West (W), Southeast (SE), and Northeast (NE) coast of Greenland were examined for sequelae of infectious middle ear disease (IMED) and for a relationship between the size of the pneumatized cell area in the temporal bones and cranial morphology. IMED was inferred from the area size of the pneumatized cell system as seen on x-rays. The crania were classified into IMED or non-IMED by applying a statistical model on the distribution of areas. The model designated six crania (4.7%, 95% CI: 1.8-10.0%) as having had IMED, four from the W, one from the SE, and one from the NE. This is lower than the present frequency of IMED in Greenland. One cranium revealed pathology resembling that caused by chronic inflammation (e.g., from cholesteatoma or cancer). The area sizes differed significantly between sexes and between regions, as did some of the cranial measures. This indicated a relationship between cranial morphology and the area size. However, in a multiple regression analysis, cranial morphology only explained 5 to 7% (R2) of the variability in the areas.
Archaeology↗
[Bone-anchored auricular prosthesis].
During the period February 1989-September 1991, 15 patients with absent or defective pinna were treated with a bone-anchored auricular prosthesis at the ENT-department, Rigshospitalet, Copenhagen. These patients were followed up from the hospital records and by means of a questionnaire. Altogether 40 titanium implants have been inserted, of which one implant was found not to be integrated at the time of the second-stage surgery. Five patients underwent additional surgery, one patient because of non-integration of a screw, and four patients on account of soft-tissue reactions. From the questionnaire replies it appears that all patients found the cosmetic result and the technique concerning mounting of the prosthesis very satisfactory. Nearly half the patients found that the care of the skin around the abutments caused considerable problems. Three patients had experienced unintended losses of the prosthesis. In conclusion, treatment with a bone anchored auricular prosthesis has considerable advantages compared to treatment with a prosthesis attached by adhesive. Furthermore the use of a bone-anchored prosthesis should be considered a viable alternative to surgical reconstruction because of the outstanding aesthetic result and because the surgical procedure puts less strain on the patient. The disadvantage of the method is the lifelong daily care of the skin and the dependence on the health services.
Adult↗
Statistical model estimating the occurrence of otitis media from temporal bone pneumatization.
In order to investigate the relationship between the pneumatization of temporal bones and the occurrence of otitis media in Greenlandic Inuit, 36 Greenlandic Inuit were examined by radiography of the temporal bones. The pneumatized cell area was measured planimetrically. All subjects answered a questionnaire on infectious middle ear disease (IMED), and an objective otologic examination was performed. Nine persons of 34 (26%) reported IMED in childhood, and there was IMED reported in all pneumatized areas below 400 mm2. Based on bilateral area measures, a polychotomous logistic regression model was applied. The occurrence of IMED was shown to be associated with smaller areas, and unilateral IMED was associated with pronounced asymmetry. The model has enabled risk assessment, and 8 persons were designated by the model as having had IMED with a sensitivity of 67% (confidence interval 30% to 93%) and a specificity of 92% (confidence interval 74% to 99%). When the model was applied to a historical anthropological Inuit material from 1700 to 1800 AD, 6 of 56 crania were designated as having had IMED. This method has improved the accuracy of estimating the occurrence of IMED in ancient populations.
Adolescent↗
Cholesteatomas in Greenlandic Inuit. A retrospective study and follow-up of treated cases from 1976-91.
Chronic otitis media is frequent among the Inuit in Greenland, but reports of cholesteatomas are rare. To describe cholesteatoma in Greenland, we have performed a retrospective study and follow-up of Greenlandic Inuit treated at the ENT-department, Rigshospitalet, Denmark in the period 1976-91. We found 35 Greenlandic Inuit with cholesteatoma, the first in 1976. Median age was 19 years. The total incidence was calculated to 5 per 100.000 per year, or 2 new cases per year. The geographical distribution showed less cholesteatomas among the people with a traditional way of life in the Hunter region. The complication rate was 11%. The extension and pathology of the cholesteatomas indicated late and infrequent contact with an ENT specialist. The follow-up study revealed 53% dry ears with intact tympanic membrane, and 47% with intermittent ear discharge. Residual or recurrent cholesteatoma was found in 46% of the patients, less frequently when the primary operation included mastoidectomy with canal wall-down technique. We recommend this operation in most Greenlandic Inuit with cholesteatomas.
Adolescent↗
A computer program for planimetric analysis of digitized images.
Planimetrical measurements are made to calculate the area of an entity. By digitizing the entity the planimetrical measurements may be done by computer. This computer program was developed in conjunction with a research project involving measurement of the pneumatized cell system of the temporal bones as seen on X-rays. By placing the X-rays on a digitizer tablet and tracing the outline of the cell system, the area was calculated by the program. The calculated data and traced images could be stored and printed. The program is written in BASIC; necessary hardware is an IBM-compatible personal computer, a digitizer tablet and a printer.
Anthropometry↗
CT-scanning of ancient Greenlandic Inuit temporal bones.
Additional morphological evidence of former infectious middle ear disease (IMED) was found by CT-scanning in 5 of 6 Greenlandic Inuit crania strongly suspected for former IMED due to earlier examination revealing either bilateral hypocellularity or asymmetry of the pneumatized area of the temporal bones. The CT-scans showed sclerosing and obliteration of the air cells and even destruction of the cellular septae, and a high degree of irregularity of the cells. Sclerosing of the surrounding bone tissue was also found. The findings in one cranium were dubious and could both be regarded as a congenital malformation or an infection in infanthood. CT-scan confirms and even adds to the results of conventional X-ray of temporal bones making hypotheses of paleopathology more reliable. The findings also support the environmental theory of pneumatization of the air cell system in the temporal bones.
Air↗
Pneumatization of the temporal bones in a Greenlandic Inuit anthropological material.
The degree of pneumatization of the temporal bones correlates with exposure during childhood and adolescence to infectious middle ear diseases (IMED), both acute and chronic. The pneumatized area as seen on cranial X-rays can be measured. This was applied to an anthropological material in order to develop methods for assessing ancient populations' exposure to IMED. Fifty-six Greenlandic Inuit (Eskimo) crania were examined. The crania were sexed and measured. X-rays were taken bilaterally, using the projection of Runström II, and the pneumatized area was measured planimetrically by computer. In blind trials it was found that the inter- and intraobserver variation was non-significant; that the degree of pneumatization of the temporal ossa did not reflect cranial size or sexual dimorphism; and that the pneumatized areas correlated bilaterally. Asymmetry in the size of the pneumatized areas, an indicator of exposure to IMED, was found in 5 crania (9%).
Female↗
[Intracranial injury caused by a nail gun. Safety measures in handling pneumatic tools].
Explore the source record for details and available documents.
Brain↗