Objective-To examine the efficacy and safety of conservative management of mild otitis media ("the acute red ear") in children.Design-Double blind placebo controlled trial. Setting-17 group general practices (48 general practitioners) in Southampton, Bristol, and Portsmouth.Patients-232 children aged 3-10 years with acute earache and at least one abnormal eardrum (114 allocated to receive antibiotic, 118 placebo).Interventions -Amoxycillin 125 mg three times a day for seven days or matching placebo; 100ml paracetamol 120 mg/5 ml.Main outcome measures-Diary records of pain and crying, use of analgesic, eardrum signs, failure of treatment, tympanometry at one and three months, recurrence rate, and ear, nose, and throat referral rate over one year.Results -Treatment failure was eight times more likely in the placebo than the antibiotic group (14-4% v 1*7%, odds ratio 8-21, 95% confidence interval 1.94 to 34.7). Children in the placebo group showed a significantly higher incidence of fever on the day after entry (20% v 8%, p<0 05), mean analgesic consumption (0-36 ml/h v 0-21 ml/h, difference 0-14, 95% confidence interval 0-07 to 0-23; p=0.0022), mean duration of crying (1-44 days v 0 50 days, 0 94; 0 50 to 1-38; p<0-001), and mean absence from school (1-96 days v 0 52 days, 1-45; 0-46 to 2-42; p=0-0132). Differences in recorded pain were not significant.The prevalence of middle ear effusion at one or three months, as defined by tympanometry, was not significantly different, nor was there any difference in recurrence rate or in ear, nose, and throat referral rate in the follow up year.

Otitis media with effusion (OME) is both extremely common in young children, and variable in its duration and severity. This study aims to gather and consider new and reliable information about the incidence and prevalence of OME in British school children.Eight hundred and fifty-six school children aged five to eight years from four South West Hampshire schools were examined over a three-year period by tympanometry, a method used to detect OME (>90 per cent specificity and sensitivity) performed once per school term. Normal ears were recorded in 54.9 per cent of children throughout with 27 per cent recording evidence of effusion. However in only one out of 10 of the affected children did the fluid persist for a year or more. This impressive clearance is due in part to natural resolution, with the intervention of surgery occurring in about one in eight of the children with identified effusions.OME is more common in five-year-olds with an annual prevalence of 17 per cent compared to six per cent in eight-year-olds and is more common in the winter months. Because of the variability of the condition at least two screenings are recommended as a basis for good management.

Osteoporosis is a major healthcare problem which is conventionally assessed by dual energy X-ray absorptiometry (DXA). New technologies such as high resolution peripheral quantitative computed tomography (HRpQCT) also predict fracture risk. HRpQCT measures a number of bone characteristics that may inform specific patterns of bone deficits. We used cluster analysis to define different bone phenotypes and their relationships to fracture prevalence and areal bone mineral density (BMD). 177 men and 159 women, in whom fracture history was determined by self-report and vertebral fracture assessment, underwent HRpQCT of the distal radius and femoral neck DXA. Five clusters were derived with two clusters associated with elevated fracture risk. "Cluster 1" contained 26 women (50.0% fractured) and 30 men (50.0% fractured) with a lower mean cortical thickness and cortical volumetric BMD, and in men only, a mean total and trabecular area more than the sex-specific cohort mean. "Cluster 2" contained 20 women (50.0% fractured) and 14 men (35.7% fractured) with a lower mean trabecular density and trabecular number than the sex-specific cohort mean. Logistic regression showed fracture rates in these clusters to be significantly higher than the lowest fracture risk cluster [5] (p<0.05). Mean femoral neck areal BMD was significantly lower than cluster 5 in women in cluster 1 and 2 (p<0.001 for both), and in men, in cluster 2 (p<0.001) but not 1 (p=0.220). In conclusion, this study demonstrates two distinct high risk clusters in both men and women which may differ in etiology and response to treatment. As cluster 1 in men does not have low areal BMD, these men may not be identified as high risk by conventional DXA alone.