PubMed · 6555232
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P A Collins. 1983. Hemostatic agents.. https://pubmed.ncbi.nlm.nih.gov/6555232/
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BACKGROUND: The outcomes of treatment of chronic suppurative otitis media (CSOM) are disappointing and uncertain, especially in developing countries. Because CSOM is the commonest cause of hearing impairment in children in these countries, an effective method of management that can be implemented on a wide scale is needed. We report a randomised, controlled trial of treatment of CSOM among children in Kenya; unaffected schoolchildren were taught to administer the interventions. METHODS: We enrolled 524 children with CSOM, aged 5-15 years, from 145 primary schools in Kiambu district of Kenya. The schools were randomly assigned treatments in clusters of five in a ratio of two to dry mopping alone (201 children), two to dry mopping with topical and systemic antibiotics and topical steroids (221 children), and one to no specific treatment (102 children). Schools were matched on factors thought to be related to their socioeconomic status. The primary outcome measures were resolution of otorrhoea and healing of tympanic membranes on otoscopy by 8, 12, and 16 weeks after induction. Absence of perforation was confirmed by tympanometry, and hearing levels were assessed by audiometry. 29 children were withdrawn from the trial because they took non-trial antibiotics. There was no evidence of differences in timing of withdrawals between the groups. FINDINGS: By the 16-week follow-up visit, otorrhoea had resolved in a weighted mean proportion of 51% (95% CI 42-59) of children who received dry mopping with antibiotics, compared with 22% (14-31) of those who received dry mopping alone and 22% (9-35) of controls. Similar differences were recorded by the 8-week and 12-week visits. The weighted mean proportions of children with healing of the tympanic membranes by 16 weeks were 15% (10-21) in the dry-mopping plus antibiotics group, 13% (5-20) in the dry-mopping alone group, and 13% (3-23) in the control group. The proportion with resolution in the dry-mopping alone group did not differ significantly from that in the control group at any time. Hearing thresholds were significantly better for children with no otorrhoea at 16 weeks than for those who had otorrhoea, and were also significantly better for those whose ears had healed than for those with otorrhoea at all times. INTERPRETATION: Our finding that dry mopping plus topical and systemic antibiotics is superior to dry mopping alone contrasts with that of the only previous community-based trial in a developing country, though it accords with findings of most other trials in developed countries. The potential role of antibiotics needs further investigation. Further, similar trials are needed to identify the most cost-effective and appropriate treatment regimen for CSOM in children in developing countries.
Eosinophilic keratoconjunctivitis was diagnosed in 7 horses at The Ohio State University between 1976 and 1994. All horses had moderate-to-severe blepharospasm, chemosis, and conjunctival hyperemia; epiphora; and extensive yellow-to-white caseous mucoid discharge. Corneal ulcers associated with this disease were perilimbal and extended centrally. All ulcers were covered with a white necrotic plaque firmly attached to the underlying cornea. Other ophthalmic abnormalities were not detected. Corneal scrapings examined cytologically contained numerous eosinophils interspersed between epithelial cells, few mast cells, and neutrophils. Microbial organism were not seen. Bacterial and fungal cultures were negative for ocular pathogens. The initial diagnosis of eosinophilic keratoconjunctivitis was made on the basis of clinical and cytologic findings. In 5 horses, the condition completely resolved after topical treatment with corticosteroid (0.05% dexamethasone) and triple antibiotic ointments. However, the duration of treatment was prolonged, with a mean treatment time of 64 days (range, 45 to 106 days). All corneal ulcers remained superficial, and despite the prolonged duration of treatment, none of the horses developed secondary bacterial or fungal keratitis. One horse underwent superficial keratectomy and had the shortest resolution time (14 days).
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