Otitis Media and mastoiditis in infancy

Abstract

Otitis media and mastoiditis occurring in infancy have long been recognized as most troublesome disorders and, of recent years, would appear to be receiving the attention they merit. The frequency of otitis media or otitis media and mastoiditis found both in the infants' wards and in the autopsy room of the Alder Hey Children's Hospital has led to this statistical and clinical enquiry into this common and frequently lethal occurrence.Of the 1,324 infants under one year admitted to this hospital during the year 1936, 195 (14 per cent.) suffered at one time or another from otitis media or otitis media and mastoiditis. In a certain proportion the ear infection was undoubtedly secondary to some other pathological process. The remainder were cases in which the ear infection appeared to be responsible for the child's illness and in which, in the majority, suitable treatment of the ear resulted in improvement. This latter and more interesting group is here called 'primary.' The difficulties of making such a classification will at once be apparent, and any case which seemed in any way doubtful has been included in the secondary group. The greatest difficulty was encountered in those associated with nutritional defect. A recent otitis occurring in an infant who had been under observation for some time for hypothrepsia or athrepsia was considered as secondary. A comparatively long history of otorrhoea or otitis and more recent failure to gain in weight was regarded as probably 'primary otitis.' Doubtful cases were placed in the group of secondary otitis. Some of these were perplexing.For example, a hypothreptic child was admitted with a history of insufficient feeding for the past five weeks. At first the tympanic membranes showed lack of lustre and nothing else. After two weeks, during which the infant was ill, fretful, pyrexial and vomiting, the tympanic membranes showed more definite OBSERVATIONS ON SECONDARY GROUP.-In the group associated with respiratory infections the greatest number of cases and the highest death rate (31 per cent.) occurs in the age group 3-9 months, while in the group associated with nutritional disturbance the greatest number occurs in the age group 0-6 months, i.e. the earlier months of life, with a death rate in this group of 45 per cent. In the group associated with nasopharyngitis, the greatest number is in the age group 0-6 months. The previous feeding of these children does not appear to influence the results noticeably. II. Primary otitis media and mastoiditisThe 'primary' group has been sub-divided as follows: (A) CLASSICAL MASTOIDmS.-This sub-group includes those instances in which the child was admitted with mild constitutional disturbance, a history of otorrhoea, evidence of pain in the ear shown by restlessness and rolling of head, with redness, swelling and oedema over the mastoid process, i.e. signs of exteriorization. There were seven such patients, among whom the other ear was involved in four.Treatment was by operation.(B) oTITs MEDIA AND LATENT MASTOIDITIS.-Here are included ...

A statistical note on gastro-intestinal disorders in infants

“…Operative treatment of these toxic babies with ' mastoiditis occulta ' and severe diarrhoea was undertaken in three cases only, two of whom died. From a previous series of cases treated in this hospital (McConkey and Couper, 1938) the conclusion was drawn that operative interference, apart from paracentesis of the tympanic membrane, did not improve the prognosis. The treatment adopted was that directed toward replacement of tissue fluids and relief of tension in the middle ear.…”

Observations on otitis media and mastoiditis in infancy

“…It is interesting that the incidence of otorrhoea is higher in the non-dehydrated cases than in the dehydrated cases. In 39 non-dehydrated cases (McConkey and Couper, 1938) 33.3 per cent. had otorrhoea on admission to hospital while in 33 dehydrated cases only 9 per cent.…”

“…In 1324 infants under one year (McConkey and Couper, 1938) it was found that 195 (14 per cent.) had suffered from aural infection.…”

Infantile diarrhoea: An Analysis of 216 Cases with Special Reference to Institutional Outbreaks

“…Thus Campbell and Cunningham (1941) in a series of 574 cases found 52-3 per cent. were admitted between June and October;Smellie (1939) reported that in Birmingham the incidence was highest from July to October, though not markedly so, while McConkey and Couper (1938) found August to October the worst months.…”