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PubMed1987

Ambulatory evaluation of sleep disturbance and therapeutic effects in sleep apnea syndrome by wrist activity monitoring.

A new wrist actometer was used to obtain ambulatory activity-rest recordings in 18 patients with sleep apnea syndrome (SAS) and in 22 control subjects. A movement index (MI) and a fragmentation index (FI) during sleep time were computed, giving an estimate of the stability of sleep. In control subjects, we observed a clear differentiation between night and day activity levels. The distribution of MI and FI was very narrow, with a mean +/- SD of 13.9 +/- 5.4 and 16.1 +/- 5.8%. No correlation of MI and FI with body mass index, even in heavily obese subjects, was found; MI and FI decrease significantly with age. A diagnosis of SAS was made by standard all-night polysomnography. Patients with SAS had a significantly higher MI and FI than did control subjects (p less than 0.001). With respect to polysomnographic diagnosis of SAS, the sensitivity of activity recordings was 89%, whereas the specificity was 95%. Five patients were studied after treatment, and decreases in MI and FI at home were in good agreement with the improvement in their sleep as assessed clinically and by polysomnography. We conclude that this technique is useful for an objective measurement of sleep restlessness and fragmentation, and for a simple evaluation of therapeutic effects under real life conditions in SAS.

Adult↗

PubMed2003

Sleep apnea and Down's syndrome.

OBJECTIVE: Obstructive sleep apnea has been reported to occur in 20-50% of children with Down's syndrome in case series of patients referred for evaluation of suspected sleep apnea. In this population-based controlled study, we aimed to investigate whether sleep apnea is related to Down's syndrome. MATERIAL AND METHODS: Every child aged 2-10 years with Down's syndrome residing in the Umeå healthcare district (n = 28) was invited to participate in the study, with their siblings acting as controls. Successful overnight sleep apnea recordings and echocardiography were performed in 17/21 children with Down's syndrome and in 21 controls. RESULTS: Obstructive sleep apnea could not be diagnosed, either in children with Down's syndrome or in the control children. The apnea-hypopnea index in the children with Down's syndrome was 1.2 +/- 1.5 and did not differ from that in controls. Snoring and hypertrophy of the tonsils were more common in children with Down's syndrome than in controls. Children with Down's syndrome slept for a shorter time (p < 0.001) and changed body position more often (p < 0.05) than the control children. CONCLUSIONS: Snoring, restless sleep and hypertrophy of the tonsils were common among children with Down's syndrome. Obstructive sleep apnea was, however, not related to Down's syndrome in the present population-based controlled study.

Case-Control Studies↗

PubMed2004

Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in istanbul.

STUDY OBJECTIVES: Snoring during sleep is an important manifestation of obstructive sleep apnea syndrome (OSAS). Although clinical history is not sufficiently sensitive and specific to distinguish primary snoring from OSAS, snoring is indicative of upper airway obstruction and may be associated with the presence of diurnal symptoms. Our study aims were to determine the prevalence of snoring in primary school children in Istanbul, and to evaluate the diurnal symptoms and conditions that may be associated with sleep problems. DESIGN, SETTING, AND SUBJECTS: A parental questionnaire was used to assess the sleep and wake behavioral patterns in children. Eight representative schools in each of 9 school districts randomly selected from the 32 school districts in Istanbul were visited. RESULTS: The response rate was 78.1%; 2,147 of 2,746 questionnaires were fully completed, returned, and analyzed. The prevalence of habitual snoring was 7.0%. Habitual snorers had significantly more nighttime symptoms, such as observed apneas (odds ratio [OR], 16.9; 95% confidence interval [CI], 10.0 to 28.8; p < 0.0001), difficulty breathing (OR, 17.8; CI, 10.9 to 29.2; p < 0.0001), restless sleep, parasomnias, and nocturnal enuresis, compared to occasional and nonsnorers. There were also increased prevalence of daytime symptoms, such as falling asleep while watching television (OR, 1.8; CI, 0.9 to 3.7; p = 0.01) and in public places (OR, 2.1; CI, 1.2 to 3.8; p = 0.03), and hyperactivity (OR, 2.7; CI, 1.8 to 3.9; p < 0.0001). Exposure to cigarette smoke and the presence of asthma and hay fever increased the likelihood of habitual snoring. Children with a higher risk for OSAS (habitual snoring, apnea, and difficulty breathing during sleep) were also compared to nonsnorers. Although nighttime symptoms were more likely in the high-risk group, the risk of daytime symptoms increased as well. CONCLUSIONS: Habitual snoring is a significant problem for children and may be associated with diurnal symptoms. Exposure to cigarette smoke at home and the presence of asthma and hay fever increase the likelihood of habitual snoring.

Adolescent↗

PubMed2006

[Arousal response in child patients in obstructive sleep apnea].

OBJECTIVE: To analyze arousal response of Polysomnography (PSG) in children with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHOD: Fourty-eight children with sleep disorder were studied with 32 guide Polysomnography and analyzed by Polysmith. Sleep structure and arousals of preschool-aged and school-aged children with OSAHS were compared with those of primary snore patients. RESULT: The mean value of AHI of preschool aged children with OSAHS was (10.6+/-8.9) h, of AI was (4.0+/-7.1) h, of HI was (6.6+/-4.6) h; The sleep structure between OSAHS group and primary snore group was not significant (P > 0.05). The mean value of ArI with AHI was (8.2+/-5.9) h, of ArI with LM was (19.6+/-5.8) h, whole ArI was 49.3+/-20.4 in preschool-aged children with OSAHS; The mean value of ArI with AHI was (7.6+/-6.3) h, of ArI with LM was (14.3+/-7.6) h, whole ArI was 49.9+/-14.9 in school-aged children with OSAHS. Those of OSAHS children were higher than that of primary snore patients (P < 0.05). CONCLUSION: Although OSAHS in children is characterized by a restless sleep, the structure is perfect and mildly affected by OSAHS. The ArI with AHI, with LM and the whole ArI in OSAHS children is higher than those of primary snore patients.

Arousal↗

PubMed2000

Oral preanaesthetic medication for children: double-blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone.

Anxiolysis and sedation with oral midazolam are common practice in paediatric anaesthesia. However, good or excellent results are seen in only 50-80% of cases. For this reason, we investigated if addition of a low dose of oral ketamine (MIKE: ketamine 3 mg kg-1, midazolam 0.5 mg kg-1) resulted in better premedication compared with oral midazolam 0.5 mg kg-1 or ketamine 6 mg kg-1 alone, in a prospective, randomized, double-blind study. We studied 120 children (mean age 5.7 (range 2-10) yr) undergoing surgery of more than 30 min duration. After oral premedication in the ward and transfer, the child's condition in the induction room was evaluated by assigning 1-4 points to the quality of anxiolysis, sedation, behaviour at separation from parent and during venepuncture (transfer score). On days 1 and 7 after operation, parents were interviewed for changes in behaviour (eating, sleep, dreams, toilet training), recollection and satisfaction, using a standardized questionnaire. The groups were similar in age, sex, weight, intervention and duration of anaesthesia. The transfer score was significantly better in the MIKE group (12.5 (95% confidence interval (CI) 11.9-13.1)) than in the ketamine or midazolam groups (10.6 (9.8-11.4) and 11.5 (10.7-12.3), respectively). Success rates for anxiolysis and behaviour at separation were greater than 90% with the combination, approximately 70% with midazolam and only 51% with ketamine alone. The incidence of salivation, excitation and psychotic symptoms was low in all groups. Vertigo and emesis before induction were significantly more frequent after ketamine premedication. During recovery, there were no differences in sedation or time of possible discharge. After 1 week, parents reported nightmares (ketamine five, midazolam three, MIKE one), restless sleep (five/four/four) or negative memories (three/four/one). There were no major or continuing disturbances in behaviour or development. In summary, significantly better anxiolysis and separation were observed with a combination of ketamine and midazolam, even in awake children (sedation was not successful according to the preset criteria), than with midazolam or ketamine alone. Duration of action and side effects of the combination were similar to those of midazolam. The combination of both drugs in strawberry flavoured glucose syrup (pH 4.5 approximately) is chemically stable for 8 weeks.

Anesthesia Recovery Period↗

PubMed2004

Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area.

OBJECTIVE: Respiratory health of Indigenous and minority ethnic groups in affluent countries is poorer than their non-minority counterparts and sleep disorders are no exception. In children, obstructive sleep apnoea has the potential to result in serious long-term consequences. In 1999, we studied 1650 children and adolescents living in the Torres Strait and the Northern Peninsula Area, Australia. Here we report prevalence of snoring in these communities and relate its association with asthma symptoms. METHODS: A population-based cross-sectional study was conducted in the Torres Strait region. Five indigenous communities were randomly selected and information was collected using a structured face-to-face interview based on a standardized questionnaire. There was a 98% response rate, and 1650 children, 0-17 years of age, were included in the study. RESULTS: Overall, the prevalence of snoring was 14.2% (95% CI 12.5-15.9); 3.6% (95% CI 2.7-4.6) reported snorting, and 6% (95% CI 4.9-7.2) reported restless sleep. The prevalence of snoring was significantly higher among males (17.1% for males and 10.8 for females, P = 0.005). Children were five times more likely to have experienced snoring and snorting if they reported wheezing in the last 12 months. CONCLUSION: We conclude that the prevalence of symptoms suggestive of obstructive sleep problems is relatively high in children of this region. This highlights the need for awareness among the community patients and physicians about the problem of obstructive sleep-disordered breathing, especially in children with asthma, and for the need for further studies to measure prevalence of sleep breathing disorders among Indigenous Australians.

Adolescent↗

PubMed2003

Different sleep characteristics in restless legs syndrome and periodic limb movement disorder.

OBJECTIVE: Periodic limb movements in sleep (PLMS) may or may not be associated with restless legs syndrome (RLS). The number of PLMS is commonly used to assess the clinical severity and sleep quality of patients with RLS. It is still unclear whether the sleep disorder of periodic limb movement disorder (PLMD) is different from the sleep disorder in RLS. METHODS: We compared the polysomnograms (PSGs) of 27 prospectively recruited RLS patients and 26 retrospectively recruited age- and sex-matched PLMD patients without RLS symptoms. RESULTS: The PLM index and the index of arousal-associated PLMS (PLMAI) were significantly higher in PLMD, whereas the index of EEG arousals not associated with any sleep-related event was significantly higher in RLS. In PLMD patients, the PLMI correlated negatively with the percentage of PLMS associated with an arousal, whereas this correlation was positive in RLS patients. Further, RLS patients spent significantly more time in wake-after-sleep onset, had more rapid eye movement sleep (REM) and less sleep stage I. CONCLUSIONS: We conclude that the sleep disorder in RLS differs from that in PLMD. Spontaneous, not PLM associated EEG arousals should be included in the assessment of the sleep structure of patients with RLS, particularly in studies concerned with drug-efficacy.

Female↗

PubMed1997

Snoring children: factors predicting sleep apnea.

Many snoring children present obstructive symptoms according to their parents. The seriousness of the symptoms and the possibility of the obstructive sleep apnea syndrome (OSAS) in these children may be difficult to judge on the basis of the clinical findings and the patient's history only. In order to evaluate snoring children's relative risk (RR) to have OSAS, their symptoms and signs, as reported by the parents, and clinical findings were compared with the results of overnight polysomnography (PSG). An obstructive apnea index (AI) > or = 1 in PSG was regarded as the criterion for OSAS. The mean AI was 1.55 (range 0-15), and 29 children had a pathological AI, while 49 had a normal PSG recording. Apneic episodes every night detected by the parents was the most important single risk factor for OSAS (RR 3.6, 95% confidence interval (CI) 1.7-7.7). The RR ratio decreased when apneas appeared less frequently, but any detected apnea was still a single risk factor (RR 1.4, CI 1.2-1.8). The other risk factors of night-time symptoms were constant snoring (RR 1.5, CI 1.0-2.1) and restless sleep (RR 2.1, CI 1.1-4.0). Of the daytime symptoms, absence of excessive sleepiness was a protective factor against OSAS (RR 0.3, CI 0.1-1.0). Previous adenoidectomy was found to be a risk factor (RR 1.7, CI 1.1-2.7), as was tonsillar enlargement (RR 1.4, CI 1.1-1.8). These two findings suggest that the epipharyngeal space does not play a central role in the development of OSAS in children. OSAS cannot be reliably diagnosed without PSG, which is the most important examination for snoring children with obstructive symptoms. For clinical decisions, the consideration of risk factors is essential.

Adenoidectomy↗

PubMed2002

A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea.

A common clinical dilemma faced by sleep physicians is in deciding the level of severity at which patients with obstructive sleep apnea (OSA) should be treated. There is particular uncertainty about the need for, and the effectiveness of, treatment in mild cases. To help define the role of nasal continuous positive airway pressure (CPAP) treatment in mild OSA we undertook a randomized controlled cross-over trial of CPAP in patients with an apnea- hypopnea index (AHI) of 5 - 30 (mean, 12.9 +/- 6.3 SD). Twenty-four-hour blood pressure and neurobehavioral function were measured at baseline, after 8 wk of treatment with CPAP, and after 8 wk of treatment with an oral placebo tablet. Twenty-eight of 42 patients enrolled in the study completed both treatment arms. Baseline characteristics were not different between those who completed the study and those who did not complete the study. Patients used CPAP for a mean (SD) of 3.53 (2.13) h per night and the mean AHI on the night of CPAP implementation was 4.24 (2.9). Nasal CPAP improved self-reported symptoms of OSA, including snoring, restless sleep, daytime sleepiness, and irritability (in-house questionnaire), more than did placebo, but did not improve objective (Multiple Sleep Latency Test) or subjective (Epworth Sleepiness Scale) measures of daytime sleepiness. We found no benefit of CPAP over placebo in any tests of neurobehavioral function, generic SF-36 (36-item Short Form Medical Outcomes Survey) or sleep-specific (Functional Outcomes of Sleep Questionnaire) quality of life questionnaires, mood score (Profile of Moods States and Beck Depression Index), or 24-h blood pressure. However, the placebo tablet resulted in a significant improvement in a wide range of functional variables compared with baseline. This placebo effect may account for some of the treatment responses to CPAP observed previously in patients with mild OSA.

Adult↗

PubMed1996

Obstructive sleep apnea syndrome (OSAS) in children: diagnostic challenges.

Obstructive sleep apnea syndrome (OSAS) is increasingly recognized in the pediatric population. It is characterized by a combination of partial upper airway obstruction and intermittent obstructive apnea that disrupts normal ventilation and sleep. It is estimated to occur in 1-3% of children with a peak age of 2 to 5 years. Common symptoms include habitual snoring, difficulty breathing during sleep, restlessness, and witnessed apnea. Adenotonsillar hypertrophy is the most common associated condition in otherwise normal children, but cranialfacial abnormalities, neuromuscular diseases, and obesity are also predisposing factors. Severe OSAS can have serious neurobehavioral and cardiorespiratory consequences including excessive daytime sleepiness, growth failure, school failure, behavioral problems, cor pulmonale, or even death. Diagnosis is based on data from the history, physical exam, and laboratory studies that confirm the presence and severity of the upper airway obstruction. Polysomnography has been the diagnostic tool of choice. Treatment depends on the severity of symptoms and the underlying anatomic and physiologic abnormalities. Since childhood OSAS is usually associated with adenotonsillar hypertrophy, the majority of cases are amenable to surgical treatment. However, there is increasing pediatric experience with CPAP therapy when tonsillectomy and adenoidectomy are either unsuccessful or inappropriate.

Adenoidectomy↗

PubMed2003

Seven cases of neonatal appendicitis with a review of the English language literature of the last century.

Neonatal appendicitis (NA) is a very rare surgical condition. The aim of this study is to once again draw attention to this subject by collecting our cases with NA and cases of NA reported separately in English-language literature over the period from 1901 to 2000. We performed a retrospective chart review of patients admitted to our hospital, with the clinical diagnosis of NA from 1990 to 2000. A survey of the English-language literature together with our own 7 cases revealed a total of 141 cases of NA during the period of 1901-2000. 128 cases had sufficient information for analysis. The patients are grouped and discussed according to these 3 time- periods: 1901-1975, 1976-1984 and 1985-2000. The incidence, etiology, and presenting signs and symptoms of appendicitis in newborns are discussed. Despite the similar perforation rates in the 3 time- periods (73%, 70%, 82%), mortality rate in NA has decreased from 78% in the 1901-1975 period, to 33% in the 1976-1984 period, and to 28% in the 1985-2000 period. A newborn baby presenting with continuous vomiting, refusal to feed, and, showing signs of pain through irritability, restlessness, sleep disturbance, and a distended abdomen; one should strongly suspect an abdominal disorder, perhaps appendicitis.

Appendicitis↗

PubMed2006

A suggested clinical score to predict the severity of adenoid obstruction in children.

Chronic nasal obstruction in children is a very common disorder. Obstructing adenoid is usually the first to blame. Though the clinical assessment is essential, it is often considered unreliable or insufficient. We conducted a prospective clinical study to validate a clinical score predicting the severity of adenoid obstruction in symptomatic children. The clinical score (CS) included mouth breathing, snoring, restless sleep, frequent waking-up at night and obstructive breathing during sleep. Each item received a score of 0 or 1. The palatal airway was evaluated on a lateral nasopharyngeal x-ray. The degree of obstruction was assessed intra-operatively by a laryngeal mirror using a 3-grade scale. The volume of each adenoid specimen was measured. Eighty-six patients were enrolled, 51 boys and 35 girls, aged 13-181 months (mean 52, median 45). The CS correlated very well with the intra-operative findings (p < 0.01) and with the degree of palatal airway obstruction (p < 0.05) but not with the volume of the adenoid removed (p > 0.05). The CS was higher in children younger than 3 years (CS > 3 in 85.7% vs. 29.2%), having more frequent obstructive breathing during sleep (71.43% vs. 21.54%). A CS of three or higher, predicted severe obstruction in 96.5% of patients, as detected intra-operatively. The suggested CS is simple to use and is highly reliable in identifying children in need for adenoidectomy, in the context of normal anterior rhinoscopy and tonsils less than grade three.

Adenoids↗

PubMed1985

Psychosocial characteristics of adolescent smokers before they started smoking: evidence of self-selection. A prospective study.

Evidence of noncomparability of self-formed smoker and nonsmoker groups of adolescents from the Child Health and Development Studies of the University of California, Berkeley, was found in a study of antecedent psychosocial characteristics (observed at age 10) before the adoption of the smoking habit. With possible confounding factors controlled, eventual smokers showed significantly greater prevalence than nonsmokers of Type A personality traits, extraversion, psychoticism, anger, and restless sleep. Eventual smokers were lower in socioeconomic status than nonsmokers, and also exhibited significantly lower mean scores for the Raven Progressive Matrices and Peabody Picture Vocabulary tests. For each trait, the trends of the data were consistent in boys and girls. Since many of these traits are shown to "track" into adult life, where they are then related to coronary heart disease, the role of self-selection requires further consideration in causal inferences about smoking and coronary heart disease.

Adolescent↗

PubMed1992

Clinical correlates of response to DST. The Dexamethasone Suppression test in depression: a World Health Organisation collaborative study.

From 9 centres 293 patients took part in the WHO-collaborative study on Dexamethasone-Suppression-Test (DST) in depression to examine the relationship of psychopathological and psychiatric history information to cortisol-levels and suppression/non-suppression status. Differences between the centres were large and significant on nearly all of the measures. The predictor analyses generally suffered from numerically weak correlations with many variables correlating to sex and age. Therefore analyses of the data were adjusted for centre-, sex-, and age-influences. The best predicting features of cortisol were 'fitful, restless sleep', 'change of bodyweight' and 'affective disorders in blood relatives'. The last 2 items together with 'hypersomnia' and 'ideas of insufficiency' were the best predictors of suppression/nonsuppression status. However, statistical evidence did not seem to be strong enough to describe a typical symptom profile of a depressive cortisol suppressor or nonsuppressor.

Age Factors↗

PubMed2005

Hospice care in a cohort of elders with dementia and mild cognitive impairment.

The objectives of this study were to identify the characteristics associated with hospice enrollment, to determine whether enrollment in hospice was associated with less pain and psychiatric symptoms, and to assess caregiver satisfaction with care near death in a sample of patients with dementia and mild cognitive impairment (MCI). Participants included decedents with dementia or MCI and other medical illnesses whose deaths were expected (n = 81) during a 3-year prospective, longitudinal, community-based cohort study. A total of 29.6% (n = 24) of participants received hospice care prior to death. Participants in hospice experienced less pain compared to those not in hospice, but this did not reach statistical significance (41.7% vs. 62.5%, P = 0.085). They were 65% more likely to be free of psychiatric symptoms (including restlessness, sleep problems, agitation, nervousness, and aggression toward others) during their final illness prior to death (OR = 0.35; 95% CI 0.13-0.96). In this cohort of people with dementia and MCI who died, several markers of quality of care suggest that hospice care can be beneficial for patients with dementia or MCI.

Aged↗

PubMed2005

Activity changes and marked stereotypic behavior precede Abeta pathology in TgCRND8 Alzheimer mice.

Alzheimer's disease (AD) is not only characterized by cognitive decline and neuropathological changes, but also by non-cognitive behavioral symptoms like restlessness, sleep disturbance, and wandering. These symptoms are categorized in the "Behavioral and Psychological Symptoms of Dementia" (BPSD). We investigated transgenic and wildtype mice of an APP transgenic mouse model of AD (TgCRND8) with respect to 24 h activity and spontaneous home cage behavior at 30, 60, 90 and 120 days of age. At all test days, transgenic and wildtype animals differed significantly with respect to activity patterns. In addition, activity rhythms changed distinctly in transgenic mice with increasing age. Transgenic mice also clearly showed more stereotypic behavior, which correlated significantly at 90 and 120 days of age with elevated corticosterone metabolite concentrations in fecal samples. Activity patterns in TgCRND8 mice resemble altered rhythms of activity in AD patients. Stereotypic behaviors may be caused by the same mechanisms as non-cognitive behavioral symptoms of AD. Thus, it is likely that analogies to BPSD that precede Abeta pathology are found in APP-overexpressing TgCRND8 mice.

Adrenal Medulla↗

PubMed2003

Personality and depressive symptoms: a multi-dimensional analysis.

BACKGROUND: The relationship of temperamental aspects of personality to symptoms of depression in a community-based sample of 804 individuals was examined using a multi-dimensional approach to account for heterogeneity in symptom patterns. METHOD: The Temperament and Character Inventory (TCI) was used to assess personality and the Center for Epidemiologic Studies Depression scale (CES-D) was used to measure depressive symptoms. Canonical correlation analysis was used to relate CES-D item combinations to temperament traits in multiple dimensions. The relationships between temperament and various conditions correlated with depression were examined using logistic regression. RESULTS: Temperamental aspects of personality are related not only to total CES-D score, but also to the patterns of CES-D items endorsed by subjects. High Harm Avoidance is related to total CES-D score; high Reward Dependence combined with high Persistence is associated with restless sleep and subjective symptoms; high Reward Dependence combined with low Persistence is negatively associated with appetite loss and low energy; high Novelty Seeking is related to maintenance of positive affect and inability to concentrate. High Novelty Seeking is also associated with past suicide attempts, after adjusting for total CES-D score. LIMITATIONS: Cross-sectional data prevent analysis of causation; the severest cases of clinical depression may not be represented in a general population sample. Depressive symptoms are self-reported. CONCLUSION: Substantial differences in level of symptoms and in symptom patterns exist among individuals in a continuum of depressed states and those differences are partially explained by temperament traits.

Adolescent↗

PubMed2003

The symptoms and clinical course of acute bullous myringitis in children less than two years of age.

OBJECTIVE: the most characteristic symptom of acute bullous myringitis (inflammation of the tympanic membrane) is a sudden onset of severe ear pain. However, in infants and young children a precise symptom history is more difficult to obtain and the symptoms may be less specific. Our objective was to determine the occurrence of different symptoms, signs and the recovery of symptoms during the course of acute bullous myringitis in children less than 2 years. We also evaluated whether there were any specific features in bullous myringitis in comparison with acute otitis media (AOM). METHODS: 2028 children (aged 7-24 months) at primary care level in a prospective longitudinal cohort study in the Finnish Otitis Media Vaccine Trial. RESULTS: during the follow-up there were 86 office visits with bullous myringitis in 92 ears and 1876 office visits with acute otitis media in 2683 ears. Middle ear fluid developed in 97% of cases of bullous myringitis during the course of disease. Earache was present in 58% and fever (>or=38 degrees C) in 62% of cases of bullous myringitis. The symptoms of upper respiratory tract infection (rhinitis in 93% and cough in 73% of events) were present in a majority of cases. Earache, fever, rubbing of the ear, restless sleeping, excessive crying and poor appetite were present more often in bullous myringitis than in acute otitis media. The symptoms were relieved in 1-2 days in a majority of cases. There were no recognized cases of bullous myringitis in ears with patent tympanostomy tubes. CONCLUSIONS: acute bullous myringitis in children represents a special form of AOM with more severe symptoms. Earache and fever were more common in bullous myringitis than in AOM. However, the condition resolved rapidly and the short-term outcome was good.

Acute Disease↗