Ear Infections - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

EAR INFECTIONS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AM...

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EAR

INFECTIONS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2003 by ICON Group International, Inc. Copyright 2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Ear Infections: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83900-X 1. Ear Infections-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on ear infections. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON EAR INFECTIONS ....................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Ear Infections .............................................................................. 21 E-Journals: PubMed Central ....................................................................................................... 27 The National Library of Medicine: PubMed ................................................................................ 30 CHAPTER 2. NUTRITION AND EAR INFECTIONS ............................................................................. 47 Overview...................................................................................................................................... 47 Finding Nutrition Studies on Ear Infections............................................................................... 47 Federal Resources on Nutrition ................................................................................................... 51 Additional Web Resources ........................................................................................................... 51 CHAPTER 3. ALTERNATIVE MEDICINE AND EAR INFECTIONS ....................................................... 53 Overview...................................................................................................................................... 53 National Center for Complementary and Alternative Medicine.................................................. 53 Additional Web Resources ........................................................................................................... 57 General References ....................................................................................................................... 60 CHAPTER 4. DISSERTATIONS ON EAR INFECTIONS ......................................................................... 61 Overview...................................................................................................................................... 61 Dissertations on Ear Infections.................................................................................................... 61 Keeping Current .......................................................................................................................... 62 CHAPTER 5. CLINICAL TRIALS AND EAR INFECTIONS ................................................................... 63 Overview...................................................................................................................................... 63 Recent Trials on Ear Infections.................................................................................................... 63 Keeping Current on Clinical Trials ............................................................................................. 64 CHAPTER 6. PATENTS ON EAR INFECTIONS.................................................................................... 67 Overview...................................................................................................................................... 67 Patents on Ear Infections ............................................................................................................. 67 Patent Applications on Ear Infections ......................................................................................... 79 Keeping Current .......................................................................................................................... 85 CHAPTER 7. BOOKS ON EAR INFECTIONS ....................................................................................... 87 Overview...................................................................................................................................... 87 Book Summaries: Federal Agencies.............................................................................................. 87 Book Summaries: Online Booksellers........................................................................................... 88 The National Library of Medicine Book Index ............................................................................. 90 Chapters on Ear Infections........................................................................................................... 91 CHAPTER 8. MULTIMEDIA ON EAR INFECTIONS ............................................................................ 95 Overview...................................................................................................................................... 95 Video Recordings ......................................................................................................................... 95 Bibliography: Multimedia on Ear Infections................................................................................ 96 CHAPTER 9. PERIODICALS AND NEWS ON EAR INFECTIONS ......................................................... 97 Overview...................................................................................................................................... 97 News Services and Press Releases................................................................................................ 97 Newsletter Articles .................................................................................................................... 101 Academic Periodicals covering Ear Infections ........................................................................... 102 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 103 Overview.................................................................................................................................... 103 U.S. Pharmacopeia..................................................................................................................... 103 Commercial Databases ............................................................................................................... 104 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 109 Overview.................................................................................................................................... 109

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NIH Guidelines.......................................................................................................................... 109 NIH Databases........................................................................................................................... 111 Other Commercial Databases..................................................................................................... 113 APPENDIX B. PATIENT RESOURCES ............................................................................................... 115 Overview.................................................................................................................................... 115 Patient Guideline Sources.......................................................................................................... 115 Finding Associations.................................................................................................................. 126 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 129 Overview.................................................................................................................................... 129 Preparation................................................................................................................................. 129 Finding a Local Medical Library................................................................................................ 129 Medical Libraries in the U.S. and Canada ................................................................................. 129 ONLINE GLOSSARIES................................................................................................................ 135 Online Dictionary Directories ................................................................................................... 137 EAR INFECTIONS DICTIONARY ............................................................................................ 139 INDEX .............................................................................................................................................. 183

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with ear infections is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about ear infections, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to ear infections, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on ear infections. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to ear infections, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on ear infections. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON EAR INFECTIONS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on ear infections.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and ear infections, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “ear infections” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Otitis Media and Language Development: A Meta-Analysis Source: American Journal of Speech-Language Pathology. 10(1): 65-80. February 2001. Contact: Available from American Speech-Language-Hearing Association (ASHA). Subscription Sales Coordinator, 10801 Rockville Pike, Rockville, MD 20852-3279. (888) 498-6699. Fax (301) 897-7358. Website: www.asha.org. Summary: A substantial contemporary research literature on the impact of otitis media (middle ear infection) with effusion (OME) on language development in young children currently exists. Compared to the reports of earlier retrospective research on the topic, the results of the more recent prospective studies may be viewed as less conclusive and more equivocal. However, the negative impact of OME on young children's language development appears to be a widely held belief. This article reports on a project that

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used the methodology of meta analysis on this body of literature. The results of this meta analysis show that the magnitude of the statistical population effect of OME is markedly low. Nevertheless, the authors note that the findings of low population effects in this meta analysis may be related to certain aspects of the primary research. Among these factors are failure to determine research participants' hearing levels, other intrinsic or extrinsic individual differences among the research participants, as well as the sensitivity of language measures used. The authors remind readers that their research was limited to an examination of the relationship of OME to young children's speech perception or speech production, and conclusions based on the results of this meta analysis should not be extended to those domains of oral language performance. One clear clinical implication of this meta analysis is that children suspected of having OME must have more attention paid to their hearing abilities, and important aspects of quality of life, in addition to the evaluation and diagnosis of OME. 1 figure. 4 tables. 75 references. •

Acute Otitis Media: Part I. Improving Diagnostic Accuracy Source: American Family Physician. 61(7): 2051-2056. April 1, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: According to the author of this journal article on diagnostic accuracy, acute otitis media (AOM) is overdiagnosed. Symptoms are neither sensitive nor specific for the diagnosis of otitis media (middle ear infection); fever and ear pain are present in only one half of patients. Undue reliance on one feature (redness of the tympanic membrane, or eardrum) and failure to assess tympanic membrane mobility with pneumatic otoscopy contribute to inaccurate diagnoses. Adequate visualization of the tympanic membrane is often impaired by low light output from old otoscope bulbs and blockage of the ear canal by cerumen (earwax). Distinguishing AOM from otitis media with effusion (OME) is clinically important because antibiotics are seldom indicated for the latter condition. A key differentiating feature is the position of the tympanic membrane: it is usually bulging in AOM and in a neutral position or a retracted position in OME. Tympanometry and acoustic reflectometry can be useful adjunctive tools to confirm the presence of fluid in the middle ear. Selective use of tympanocentesis (surgical drainage of fluid) in cases of refractory or recurrent middle ear disease can help guide appropriate therapy and avoid unnecessary medical or surgical interventions. 3 tables. 23 references.

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Acute Otitis Media: Bacteriology and Bacterial Resistance in 205 Pediatric Patients Source: International Journal of Pediatric Otorhinolaryngology. 56(1): 23-31. November 30, 2000. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636. Fax (212) 633-3680. E-mail: [email protected]. Summary: Acute otitis media (AOM, middle ear infection) is one of the most frequent diagnoses in children below the age of 2 years. Treatment is usually based on information included in the literature concerning bacteriology. This article reports on work undertaken to define the most frequent germs in the etiology (cause) of AOM in pediatric patients in Argentina. Cultures in middle ear secretions obtained through tympanocentesis (eardrum sampling) were tested in 205 patients. The results obtained were similar to those published in previous reports in which Streptococcus pneumoniae and Haemophilus influenzae proved to be the predominant germs. However, there are

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certain discrepancies concerning the incidence of Moraxella catarrhalis and this has a direct impact on the total percent of resistant strains, thus modifying treatment approaches for the therapy of AOM. The authors also studied the antibiotic sensitivity profiles of the most frequent etiologic agents. 4 figures. 5 tables. 24 references. •

Role of Viruses in the Pathogenesis of Acute Otitis Media Source: Pediatric Infectious Disease Journal. 19(5 Supplement): S17-S23. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Although acute otitis media (AOM, middle ear infection) is generally considered a bacterial infection and therefore usually treated with antibiotics, pathogenic bacteria can be isolated from the middle ear fluid (MEF) in approximately 70 percent of cases of AOM. The fact that about one third of AOM cases remain without a proven bacterial etiology, together with vast clinical experience connecting AOM with viral upper respiratory tract infections (URIs) has prompted investigators to search for the role of viruses in the pathogenesis of this condition. This article reports on some of the convincing evidence available to support the crucial role of respiratory viruses in the development of AOM. The author covers epidemiology, Eustachian tube dysfunction, alteration of the host's immune defense, the effect of viral infection on bacterial colonization and adherence, the presence of viruses in MEF, and viral vaccines in the prevention of AOM. The author concludes that respiratory viral infection appears to initiate the cascade of events that finally leads to the development of AOM (this progression is summarized in a chart). The pathogenesis of AOM is complicated, involving a network of factors, some probably not yet identified, which affect each other in a time dependent manner. 1 figure. 1 table. 75 references.

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Acute Otitis Media in Children: What Next When First-Line Therapy Fails? Source: Consultant. 38(11): 2681-2684, 2687-2690. November 1998. Contact: Available from Cliggott Publishing Company. 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831-0010. (203) 661-0600. Summary: Although amoxicillin continues to be the drug of first choice for patients with acute otitis media (AOM), the presence of drug-resistant pathogens may cause treatment failure. This article outlines strategies to be employed when first line therapy fails in children with AOM. Streptococcus pneumoniae is the most common pathogen found in middle ear fluid (MEF), followed by Hemophilus influenzae and Moraxella catarrhalis. Beta-lactamase inhibitors, such as clavulanate, are effective against H. influenzae and M. catarrhalis, but not against penicillin-resistant pneumococci. Trimethoprimsulfamethoxazole (TMP-SMX) and azithromycin show high levels of activity against all three common pathogens, as measured by their concentrations in MEF. The author concludes that azithromycin, amoxicillin and clavulanate combinations, and TMP-SMX appear to be reasonable choices for second-line treatment of AOM, based on their bacteriologic efficacy, cost, taste, ease of administration, and side effects. The author cautions that pneumococci resistant to penicillin may also be resistant to oral cephalosporins and TMP-SMX, so these drugs are best avoided in patients in whom resistance is suspected. 2 figures. 3 tables. 26 references. (AA-M).

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Sensorineural Hearing Loss in Chronic Otitis Media Source: Clinical Otolaryngology and Allied Sciences. 24(3): 220-222. June 1999.

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Contact: Available from Blackwell Science Ltd. Journal Subscriptions, P.O. Box 88, Oxford, OX2 0NE, United Kingdom. +44 1865 206126. Fax +44 1865 206219. Summary: Although many studies have demonstrated an association between chronic otitis media (COM) and sensorineural hearing loss (SNHL), there still remains disagreement about the relationship. This article reports on a retrospective study that was conducted to examine the relationship between sensorineural hearing loss and chronic otitis media. Forty one patients met the following criteria: unilateral COM and no history of head injury, meningitis or previous otological surgery. The differences in preoperative bone conduction threshold between diseases and control (contralateral normal) ear were statistically significant and varied from 5.24 to 9.02 dB across the frequency range. The higher frequencies are more affected than the lower frequencies, but the sensorineural loss is significant across the frequency range. The effect of duration of disease on the degree of SNHL was also analyzed but no correlation was found. The presence of cholesteatoma and or ossicular erosion was not associated with a significantly increased risk of sensorineural hearing loss. 1 figure. 3 tables. 15 references. •

Environmental Tobacco Smoke and Otitis Media Source: Otolaryngology-Head and Neck Surgery. 111(1): 6-8. July 1994. Summary: Although the role of environmental tobacco smoke in the genesis of pulmonary disease in children is recognized, less attention has been paid to the role of environmental tobacco smoke in the development of childhood otitis. This article reviews current data regarding environmental tobacco smoke, with particular emphasis on its effects on the ear and eustachian tube. The author also discusses current American Academy of Otolaryngology-Head and Neck Surgery Foundation educational efforts in this area. 18 references. (AA-M).

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Acute Otitis Media: Part II. Treatment in an Era of Increasing Antibiotic Resistance Source: American Family Physician. 61(8): 2410-2416. April 15, 2000. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237. Website: www.aafp.org. Summary: Antibiotic resistance is increasing among the pathogens that commonly cause acute otitis media (AOM, middle ear infection). This article is the second in a series on AOM. The author notes that this increase in antibiotic resistance may require changes in the traditional antibiotic treatment of AOM. Risk factors for resistant pathogens include recent antibiotic treatment of AOM, children in day care facilities, wintertime infections, and AOM in children less than 2 years of age. Amoxicillin remains the antibiotic of first choice, although a higher dosage (80 mg per kg per day) may be indicated to ensure eradication of resistant Streptococcus pneumonia. Oral cefuroxime or amoxicillin clavulanate and intramuscular ceftriaxone are suggested second line choices for treatment failure. Compliance with antibiotic regimens is enhanced by selecting agents that require less frequent dosing (such as one or two times a day) and by prescribing shorter (five days or less) treatment courses. Selective use of tympanocentesis if the patient does not respond to empiric therapy can help confirm the diagnosis and guide effective therapy. 2 figures. 2 tables. 30 references.

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Update on Otitis Media in Children Source: Volta Review. 9(5): 97-117. November 1999.

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Contact: Available from Alexander Graham Bell Association for the Deaf and Hard of Hearing. Subscription Department, 3417 Volta Place, NW, Washington, DC 20007-2778. Voice/TTY (202) 337-5220. Website: www.agbell.org. Also available as individual copies from Publication Sales Department, 3417 Volta Place, NW, Washington, DC 20007-2778. Voice/TTY (202) 337-5220. Website: www.agbell.org. PRICE: $22.95 plus shipping and handling. Summary: Except for viral upper respiratory infections, acute otitis media (middle ear infection) is the most common disease in children. This chapter on otitis media in children is from a monograph that was written by assembling the leading experts from all over the country to present to both the consumer and the professional the latest information on the diagnosis and management of hearing loss in children and adults. The author notes that treatment is often controversial, especially the treatment of persistent otitis media with effusion (OME). The author begins by defining terms used in the chapter, then discusses the health care costs associated with acute otitis media and with OME. The next section considers epidemiology, including genetic predisposition, craniofacial growth abnormalities, infectious load, maternal lifestyle, prone sleeping position, secondary smoke exposure, living in a developing nation, and breast milk. Other topics covered include pathogenesis, diagnosis, microbiology, and treatment options, including antibiotics, steroids, allergy control, autoinflation, mechanical ventilation with or without tube placement, and adenoidectomy. 147 references. •

Middle Ear Infections in Children: Brouhaha Over Treatment Leads To ConsensusFor Now Source: Science News. 146(21): 332-333. November 19, 1994. Summary: In this article, the author reviews the recent history of treatments for middle ear infections in children, and describes the present consensus. Topics covered include statistics on how many children get ear infections; the different types of ear infections, including otitis media with effusion (OME); the controversy over the use of antibiotics to treat otitis media; tympanostomies, including patient selection; guidelines for the treatment of OME in children ages 1 to 3, as developed by the U.S. Department of Health and Human Services; development of a vaccine against otitis media caused by bacteria; determining which antibiotics to administer and for how long; and the regional development of resistance to antibiotics.

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Five vs. Ten Days of Antibiotic Therapy for Acute Otitis Media in Young Children Source: Pediatric Infectious Disease Journal. 19(5): 458-463. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Many publications in recent years have argued in favor of shortened therapy for acute otitis media (AOM, middle ear infection). However, doubt persists regarding children younger than 2 years, and some authors therefore resist short course therapy to children older than 2 years. This article reports on a study that compared five versus ten days of antibiotic therapy for AOM in young children (cefpodozime proxetil, 8 mg per kg per day). Between October 1996 and April 1997, 450 children (mean age, 14.3 months) were enrolled in the study; 227 children in the 5 day group (followed by a 5 day placebo period) and 223 in the 10 day group. Clinical success was obtained on Days 12 to 14 after the beginning of treatment in 175 (84.1 percent) of the 208 children receiving the 5 day regimen, and in 194 (92.4 percent) of the 210 children receiving the 10 day regimen. The superiority of the standard regimen (10 days) was more marked among children cared

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for outside their homes (92.5 percent versus 81.5 percent). Clinical success persisted on Days 28 to 42 among 134 (85.4 percent of the 157 assessable patients in the 5 day group, and in 144 (83.7 percent) of the 172 assessable patients in the 10 day group. The authors conclude that the 10 day regimen resulted in a higher success rate at the conclusion of therapy, but there were no differences between the two study groups 4 to 6 weeks after enrollment in the study protocol. 5 tables. 23 references. •

Clinical Course, Complications and Sequelae of Acute Otitis Media Source: Pediatric Infectious Disease Journal. 19(5 Supplement): S37-S46. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Motivated by the introduction of a new vaccine to prevent pneumococcal infections in infants and children, this article reviews the state of knowledge of the clinical course, complications, and sequelae of acute otitis media (AOM, middle ear infections) caused by this organism (the most common cause of AOM). The author first describes the clinical course of AOM in which the child has been treated with an antimicrobial agent. Thus, the clinical course will not truly be the natural history of the disease. Even though today some clinicians suggest withholding antibiotics or practicing selectivity in prescribing these agents in some or even in all children who have AOM, the current recommendation from official organizations is to prescribe a course of an antimicrobial agent that has been demonstrated to be safe and effective. These recommendations are accompanied by the caution that an acute middle ear infection be diagnosed correctly and distinguished from otitis media with effusion (OME). The usual recommendation is 10 day course of most of the approved oral antibiotics; amoxicillin remains the initial agent of choice. After detailing the clinical course, the author describes the suppurative complications and sequelae of otitis media (OM) that occur within the temporal bone and intracranial cavity. 5 figures. 5 tables. 61 references.

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Review of Consensus Reports on Management of Acute Otitis Media Source: Pediatric Infectious Disease Journal. 18(12): 1152-1155. December 1999. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Much of the current dialog about management of acute otitis media (AOM, middle ear infection) is driven by concern about multidrug resistant strains of Streptococcus pneumoniae and beta lactam producing Haemophilus influenzae. This article offers a review of consensus reports on the management of AOM. Many pediatric infectious disease experts have expressed opinions about the use of antimicrobial agents for AOM, but two publications have been of particular importance and influence in providing guidance. First, an article on otitis media was included in a supplement to Pediatrics (January 1998) entitled 'Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections;' and second, a report from the Drug Resistant Streptococcus pneumoniae Therapeutic Working Group of the CDC was published, entitled 'Acute Otitis Media: Management and Surveillance in an Era of Pneumococcal Resistance.' The recommendations provided a guide to management decisions and choice of antimicrobial agents for initial therapy and relapse and recurrence after initial therapy. The two papers represent important responses from national organizations about techniques to limit the increasing incidence of antibiotic resistance among the bacterial pathogens responsible for AOM. This review article

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considers the questions raised by the recommendations and their current relevance in the management of AOM. 2 tables. 14 references. •

Acute Otitis Media in an Era of Drug Resistance: Implications for NP Practice Source: Nurse Practitioner. 24(10 Supplement): 10-14. October 1999. Contact: Available from Nurse Practitioner. Circulation Department, P.O. Box 5053, Brentwood, TN 37024-5053. (800) 490-6580. Fax (615) 377-0525. Website: www.tnpj.com. Summary: Nearly two thirds of all children will have at least one episode of acute otitis media (AOM) by age 2 years. AOM is the most common indication for pediatric outpatient and antibiotic therapy. Written for nurse practitioners, this article outlines the recommendations for treatment of AOM in an era of drug resistance. The author describes the risk factors for AOM, how to reduce AOM risks, the characteristics of the most common bacterial organisms that cause AOM, the most common causative viruses in AOM, clinical findings in AOM and in recurrent otitis media, clinical features of treatment failure, factors that influence the development of drug resistant pathogens, the role of macrolides (including azithromycin and clarithromycin) in the treatment of AOM, the role of injectable antibiotics in the treatment of AOM, the use of second line therapies in the treatment of AOM, complications that can arise from acute or recurrent otitis media (including otitis media with effusion and hearing loss), the role of decongestants and antihistamines in the treatment of acute and recurrent otitis media, and recommendations for follow up treatment. The author stresses that minimizing AOM risk factors and prescribing the most appropriate and effective AOM therapy, while limiting inappropriate antimicrobial use is an important part of pediatric primary care. 2 tables. 14 references.

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Otitis Media: Back to Basics Source: Pediatric Infectious Disease Journal. 17(12): 1105-1113. December 1998. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Otitis media is the most common disease diagnosed during childhood, accounting for 20 to 40 percent of office visits in the first 5 years. Otitis media is also the primary reason for the dispensing of antibiotics in the United States and as a result contributes substantially to the development of antibiotic resistance. This continuing education article reviews the basics of diagnosing and caring for patients with otitis media (middle ear infection, OM). The authors differentiate acute otitis media (AOM) from otitis media with effusion (OME); describe the expected frequency and duration of OM episodes as well as the total time spent with middle ear disease; discuss the use of the term 'otitis prone,' and discuss factors that lead to the development and recurrence of OM. AOM is symptomatic and should be treated with antibiotics. OME is asymptomatic and need not be treated with antibiotics unless it persists beyond 3 months. In an effort to reduce the frequency of OM, physicians should encourage breastfeeding, discourage maternal smoking, discourage pacifier usage in the older infant, and recommend smaller day care programs whenever possible. Appended to the article are review questions for readers to self test their knowledge. 4 figures. 6 tables. 83 references.

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Evidence of Bacterial Metabolic Activity in Culture-Negative Otitis Media with Effusion Source: JAMA. Journal of the American Medical Association. 279(4): 296-299. January 28, 1998. Summary: Otitis media with effusion (OME) can lead to significant hearing loss in children. Although previous studies have shown that bacterial DNA is present in a significant percentage of effusions determined sterile by culturing, whether the DNA represents viable organisms (bacteria) or fossilized remains is unknown. This article reports on a study undertaken to determine if bacterial messenger RNA (mRNA) is present in chronic pediatric middle ear effusions that contain bacterial DNA but are considered sterile by standard cultural methods. Bacterial mRNAs have a half-life measured in seconds to minutes; therefore, detection of bacteria-specific mRNAs would be evidence that metabolically active organisms are present. A total of 93 effusions from pediatric outpatients seen for myringotomy and tube placement for chronic OME were studied. Eleven (11.8 percent) of the 93 specimens tested positive by culture, PCR (polymerase chain reaction) and RT-PCR (reverse transcriptase, polymerase chain reaction), for Haemophilus influenzae. A total of 29 specimens (31.2 percent) were positive by PCR but negative by culture for H influenzae; all 29 of these specimens were positive for H. influenzae-specific mRNA (tested by RT-PCR). The authors conclude that the RT-PCR based system can detect the presence of bacterial mRNA in a significant percentage of culturally sterile middle ear effusions, establishing the presence of viable, metabolically active, intact organisms in some culture-negative OME. 1 figure. 2 tables. 19 references. (AA-M).

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Relationship Between Otitis Media with Effusion and Allergy Source: Current Opinion in Otolaryngology. 5(1): 46-48. February 1997. Summary: Otitis media with effusion (OME) is one of the leading causes of acquired hearing loss in children. The role of allergy in various disorders of the respiratory tract is well known. However, the relationship between allergy and the pathogenesis of OME is still under investigation. This article reviews and summarizes recent research in this area. Studies with favorable as well as unfavorable results regarding an allergic etiology continue to provide information about the multifactorial nature of the disease process. The authors review epidemiology studies, studies on pathophysiology, and clinical studies and case reports. The authors conclude that an important consideration in the treatment of OME is to recognize its multifactorial etiology (many causes). In addition to the immature immune response seen in young children, viral infection, allergy, and imbalance of the normal nasopharyngeal flora all appear to contribute to the progression of OME. Certainly, all children with OME do not necessarily have an allergic cause. However, there appears to be a sizable subgroup of children with OME in whom allergy may play a role. 18 references (5 annotated). (AA-M).

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What Role for Antibiotics in Otitis Media and Sinusitis? Source: Postgraduate Medicine. 104(3): 93-99, 103-104. September 1998. Contact: Available from Postgraduate Medicine. P.O. Box 459, Hightstown, NJ 085209201. (609) 426-7070. Fax (609) 426-7087. Summary: Patients often expect to be given antibiotics for any illness affecting the ears and sinuses, regardless of whether such treatment is warranted. This article, the fourth of four articles on common ear, nose, and throat (ENT) problems, discusses the role for

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antibiotics in treating otitis media (middle ear infection) and sinusitis (sinus infection). The authors caution that bacterial resistance to antibiotics is rising. They outline the types of otitis media and sinusitis that should be treatment with antibiotics and the agents that are currently the most effective for each condition. The authors review the established classification and treatment guidelines for these conditions. First-line treatment for both uncomplicated acute otitis media and acute sinusitis is amoxicillin. Erythromycin ethylsuccinate and sulfisoxazole or TMP-SMZ may be used in patients who are allergic to penicillin. Beta-lactamase-stable agents should be given when no response occurs within 48 to 72 hours. In cases where penicillin-resistant pneumococcus is suspected, high-dose amoxicillin, with or without clavulanate, or clindamycin should be considered. Antibiotics are not indicated for initial treatment of otitis media with effusion (OME), but may be considered for effusions lasting longer than 3 months. Prophylactic antibiotics should be considered only for recurrent acute infections occurring three or more times within 6 months or four or more times with a year. 4 tables. 27 references. (AA-M). •

Potential of Bacterial Vaccines in the Prevention of Acute Otitis Media Source: Pediatric Infectious Disease Journal. 19(5 Supplement): S72-S78. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Patients with acute otitis media (AOM, middle ear infection) compose a large part of the daily practice of most general practitioners and pediatricians. Prevention of even a small portion of the AOM cases would have a major impact from both the public health and economics point of view. In this article, the published data on the role of the three most significant causative agents of AOM are reviewed; these agents are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Although other bacteria may also cause AOM (e.g., Streptococcus pyogenes, Staphylococcus aureus, and several Gram negative bacteria), they are not discussed in this article. This is in part because of their minor and somewhat controversial role as true pathogens in AOM, but mostly because the development of vaccines has not progressed to the point where one might consider them viable candidates. The authors present recent data from two Finnish prospective studies to illustrate the potential impact of pneumococcal conjugate vaccines in the prevention of AOM. In addition, the authors review the development of other new vaccines based on antigens from S. pneumoniae, H. influenzae, and M. catarrhalis. These vaccines are still in the preclinical phase of development, so their eventual impact on AOM remains speculative. 4 tables. 83 references.

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Randomized Controlled Trial of Point-of-Care Evidence to Improve the Antibiotic Prescribing Practices for Otitis Media in Children Source: Pediatrics. 107(2): [e15]. February 2001. Contact: Available from American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (888) 227-1773. Fax (847) 434-8000. E-mail: [email protected]. Website: www.pediatrics.org. Full text of this article is available at www.pediatrics.org/cgi/content/full/107/2/e15. Summary: Prescribing practices for otitis media (middle ear infection) are not consistent with current evidence based recommendations. So contend the authors of this research study that was undertaken to determine whether point of care evidence delivery regarding the use and duration of antibiotics for otitis media decreases the duration of

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therapy from 10 days and decreases the frequency of prescriptions written. The study used a point of care message system (a computer prescription writer software program) as the intervention. Intervention providers had a 34 percent greater reduction in the proportion of time they prescribed antibiotics for less than 10 days. Intervention providers were less likely to prescribe antibiotics than were control providers. The authors conclude that the point of care information system integrated into pediatric outpatient care can significantly influence provider behavior for a common condition. 1 figure. 2 tables. 21 references. •

Otitis Media in Children: Diagnosis, Treatment, and Prevention Source: Postgraduate Medicine. 107(3): 239-241, 245-247. March 2000. Summary: The diagnosis and treatment of middle ear infections (otitis media) and effusions continues to be a large part of daily practice for physicians who treat infants and children. This guideline article offers an opportunity for readers to review and compare approaches to this routine problem and to consider some of the details that are easily overlooked in the daily rush between examination rooms. The author begins with appropriate identification of symptoms, then delineates the criteria that differentiate acute otitis media (AOM) from otitis media with effusion (OME). The author then outlines the management strategies to be used with each type. The guideline also mentions important ways to stem the tide of middle ear infections each winter, such as preventing the spread of viral upper respiratory tract infections, avoiding smoke exposure, and encouraging mothers to breastfeed. The author stresses that overtreating and undertreating are equally dangerous pitfalls and do a disservice to pediatric patients and their families. 1 figure.

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Clinical Epidemiology of Otitis Media Source: Pediatric Infectious Disease Journal. 19(5 Supplement): S31-S36. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: The impact of otitis media (OM, middle ear infection) on public health is considerable. This article explores the clinical epidemiology of OM. OM, with its peak incidence in the first 2 years of life, is the most commonly diagnosed pediatric disease. Between 1993 and 1995, OM was the most common diagnosis during office visits among 1 to 4 year olds. OM constituted 18 percent of physician visits, compared with 14 percent of visits for well child care, 11 percent of visits for upper respiratory infection, 8 percent of visits for injury, and 5 percent of visits for sore throat and tonsillitis. Thirty percent of children younger than 24 months in a large managed care organization were treated with tympanostomy (ventilation) tubes in 1994, and cost of OM treatment in the United States was estimated at $3.8 billion in 1995. Additionally, OM was one of the most common reasons for postponing vaccination for diphtheria, tetanus, pertussis, polio, measles, mumps, and rubella; postponement of the vaccine increases a child's risk for these preventable diseases. The authors conclude that identified host characteristics are useful in targeting high risk children, and well defined environmental factors present potential avenues of primary prevention. Vaccines currently being field tested offer promise for primary prevention, and strategies for risk factor reduction should be tested and implemented. 33 references.

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Nonimmune Strategies for Prevention of Otitis Media Source: Pediatric Infectious Disease Journal. 19(5 Supplement): S89-S92. May 2000.

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Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: The strategies for the prevention of otitis media (OM, middle ear infection) include parent education, immunoprophylaxis, chemoprophylaxis, surgery, and the use of innovative materials such as oligosaccharides and xylitol. This article reviews the available data, benefits and limitations of each of the nonimmune techniques available for prevention. In contrast to immunoprophylaxis, which protects against disease due to specific pathogens, the nonimmune strategies for prevention are generic and may have broad impact on the incidence of middle ear infections. Risk factors include age (infants are more prone to ear disease), family history, not breastfeeding, day care exposure, and smoking in the home. Prevention strategies include modifying risk factors where possible, the use of antimicrobial agents for decreasing the rate of colonization or intensity of bacterial pathogens, surgery (placement of ventilation tubes), the use of oligosaccharides, and the use of xylitol. The author stresses that all modes of prevention should be included in a strategy for the child who has severe and recurrent infections and who is 'otitis prone' because of known or unknown anatomic, physiologic, or immunologic deficits. 2 tables. 23 references. •

Routine Antibiotics: Are They Really Needed for Acute Otitis Media? Source: JAAPA. Journal of the American Academy of Physician Assistants. 11(10): 41-42, 45. October 1998. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645-1742. (800) 432-4570. Summary: This article considers the use of routine antibiotics in the treatment of acute otitis media (ear infection). The author states that otitis media is overdiagnosed and overtreated, and explains his reasons for this conclusion. The author discusses antibiotic use in the U.S. compared to that in Europe, the fear of complications of otitis media (such as meningitis, mastoiditis, and hearing loss), the role of worry over malpractice action, otitis media that is virus induced (for which antibiotics will not be effective), growing worldwide bacterial resistance to antibiotics, the effective management of parents whose children have ear infections, and the shifting to more conservative management of acute otitis media by restricting initial use of antimicrobials. One sidebar offers ten recommendations for the better management of acute otitis media (AOM), including the use of antibiotics but in a more conservative fashion. 10 references.

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Clinical Significance of Resistant Organisms in Otitis Media Source: Pediatric Infectious Disease Journal. 19(4): 378-382. April 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: This article explores the clinical significance of resistant organisms in otitis media (middle ear infection). The bacteriology of otitis media comprises three main pathogens: Streptococcus pneumoniae, nontypable Haemophilus influenzae, and Moraxella catarrhalis. Although the prevalence of resistant strains varies geographically and temporally, antimicrobial resistance is widespread and increasing. Among the risk factors for development of resistance in otitis media are antimicrobial use, young age, day care attendance, and prior hospitalization. The increasing rate of resistance to antibiotic drugs is associated with a decreased rate of successful eradication of

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pathogens from middle ear fluid, which is associated with clinical failure. A bacteriologic cure rate of 80 to 85 percent is observed for S. pneumoniae and nontypable H. influenzae when serum concentrations exceed the MIC for 40 to 50 percent of dosing interval. Comparative trials indicate that some of the beta lactams can achieve bacteriologic eradication in acute otitis media, although major differences in outcome exist among agents based on pathogen, beta lactamase status, and MIC values. The author concludes that overall the choice of antibiotics for treatment of otitis media should take into consideration their in vitro activity against the locally prevalent organisms, especially resistant organisms, and results obtained from studies in which bacteriologic outcome was used as the endpoint. 2 figures. 28 references. •

Acute Otitis Media: Making an Accurate Diagnosis Source: American Family Physician. 53(4): 1200-1206. March 1996. Summary: This article explores the procedure for making an accurate diagnosis of acute otitis media. An otoscope with a fresh bulb and a good power source, as well as a view of the tympanic membrane that is not obstructed by cerumen, are essential to making the diagnosis of acute otitis media. A bulging, cloudy, immobile tympanic membrane is highly associated with otitis media. Erythema of the eardrum alone, however, is often the result of viral infection, crying, or attempts to remove cerumen and should not be the sole basis for the diagnosis of acute otitis media. The authors stress that to avoid the common problem of overdiagnosing acute otitis media, the clinician should consider the predictive values of the various symptoms and physical examination findings associated with ear infections. 4 tables. 26 references. (AA-M).

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Otitis Media with Effusion in Young Children: Guideline Overview Source: Journal of the National Medical Association. 86(10): 731-732, 792-793. Summary: This article provides an overview of the Public Health Service clinical practice guideline on the diagnosis, treatment, and management of otitis media with effusion (OME) in young children. A multidisciplinary panel of private sector experts was convened to assist the contractor in developing the guideline. The panel's recommendations fall into two broad areas: the diagnosis of OME and evaluation of hearing and management of OME. In addition, the panel discussed several other issues of interest, including the relationship of OME to allergy and certain environmental factors, such as cigarette smoke. The target patient for the panel's recommendations is an otherwise healthy child, age 1 through 3 years, who has no craniofacial or neurologic abnormalities or sensory deficits. The article concludes with a description of the three forms in which readers can obtain the guideline: Clinical Practice Guideline; Quick Reference Guide; and Parent Guide.

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Risk Factors of Otitis Media with Effusion During Infancy Source: International Journal of Pediatric Otorhinolaryngology. 48(3): 239-249. May 25, 1999. Contact: Available from Elsevier Science. P.O. Box 945, New York, NY 10159-0945. (888) 437-4636. Fax (212) 633-3680. E-mail: [email protected]. Summary: This article reports on a study in which possible risk factors were associated with the prevalence of otitis media (middle ear infection) with effusion (OME) in a group of 250 infants (aged 0 to 2 years). In order to determine OME, otoscopy and tympanometry were performed at 3 monthly intervals beginning at term date (date

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when the baby was expected to be born). Eighteen epidemiology features were inventoried by the use of a questionnaire. The prevalence of OME was most strongly associated with age. Other factors significantly associated with the prevalence of OME were gestational age, birth weight, breastfeeding, day care attendance, number of siblings, season, and parent reported ear infection, hearing loss, mouth breathing, and common cold. No significance was found for gender, date of birth, passive smoking, family history of otitis media, parental socioeconomic status, and histories of snoring and consultation of a physician. The authors conclude that both intrinsic and extrinsic factors appear to play an important role in the prevalence of OME. Some of the risk factors may be age dependent (birth weight and prematurity) and others appeared to be time dependent (breastfeeding, day care attendance, and season). 30 •

Language, Speech Sound Production, and Cognition in Three-Year-Old Children in Relation to Otitis Media in Their First Three Years of Life Source: Pediatrics. 105(5): 1119-1130. May 2000. Contact: Available from American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. Website: www.pediatrics.org. Summary: This article reports on a study that tested relationships between children's cumulative duration of middle ear effusion (MEE) in their first 3 years of life and their scores on measures of language, speech sound production, and cognition at 3 years of age. The authors enrolled 6,350 healthy infants by 2 months of age who presented for primary care. The authors monitored the children's middle ear status throughout their first 3 years of life, monitored the validity of the otoscopic observations on an ongoing basis, and treated the children for otitis media (middle ear infection) according to specific guidelines. Children who met specified criteria (n = 241) were assigned to undergo tympanostomy tube placement either promptly or after a defined extended period if MEE remained present. In these 241 children, the authors assess language development, speech sound production, and cognition at 3 years of age, using both formal tests and conversational samples. Results showed weak to moderate, statistically significant negative correlations between children's cumulative durations of MEE in their first year of life, and their scores on formal tests of receptive vocabulary and verbal aspects of cognition at 3 years of age. However, the percent of variance in these scores explained by time with MEE in the first year of life beyond that explained by sociodemographic variables ranged only from 1.2 percent to 2.9 percent, and the negative correlations were concentrated in the subgroup of children whose families had private health insurance (rather than Medicaid). The authors found no significant correlations in the study population as a whole or in any subgroup between time with MEE during antecedent periods and children's scores on measures of spontaneous expressive language, speech sound production, or other measured aspects of cognition. In contrast, by wide margins, scores on all measures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged children. The authors conclude that either persistent early life MEE actually causes later small, circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified, confounding factors predispose children both to early life otitis media and to certain types of developmental impairment. 1 figure. 6 tables. 91 references.

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Practice Patterns Versus Practice Guidelines in Pediatric Otitis Media Source: Otolaryngology-Head and Neck Surgery. 124(5): 489-495. May 2001.

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Contact: Available from Harcourt Health Sciences, Subscription Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. (800) 654-2452. Fax (407) 363-9661. Website: www.harcourthealth.com. Summary: This article reports on a study undertaken to investigate the practice patterns of physicians and their adherence to an evidence based practice guideline (PG) on pediatric otitis media with effusion (OME, middle ear infection). The authors hypothesized that overall knowledge of the recommendations from the guidelines would be less than 75 percent, and that specialist physicians would have better knowledge of the recommendations than generalist physicians. The survey study included 1,167 otolaryngologists, pediatricians, and pediatric otolaryngologists. Each physician was sent a 6 item survey asking about their practice patterns and treatment preferences for young children with OME. The overall response rate was 48 percent. Only 8 (1.4 percent) of the 558 responding physicians answered all 6 items congruent with the PG. Overall, pediatricians, otolaryngologists, and pediatric otolaryngologists had similar total scores, but different scores on individual items. The authors were particularly concerned by the results on 2 items covering key treatment recommendations which were answered in agreement with the PG by fewer than half of the physicians. It is not clear from this study whether these discrepancies were due to poor dissemination or knowledge of the PG, or disagreement with its recommendations. 2 tables. 22 references. •

Chronic Otitis Media With Effusion in Infancy: How Frequent Is It? How Does It Develop? Source: Archives of Otolaryngology-Head and Neck Surgery. 121(4): 432-436. April 1995. Summary: This article reports on research undertaken to study the occurrence and development of chronic otitis media with effusion (OME) in infancy. Information was gathered on a random sample of 2512 children from a birth cohort with a 2-year followup. Chronic OME was determined as a minimum of 2 months of asymptomatic middle ear effusion revealed by tympanocentesis and specific operative findings. Results showed that the periodic prevalence rate of chronic OME up to the age of 24 months was 4.4 percent. The maximum risk was at age 16 months. The number of acute otitis media episodes among children who developed chronic OME was more than double that of normal healthy children before the onset of chronic inflammation and about five times as high during prolong mucous middle ear effusion. 1 figure. 3 tables. 32 references. (AA-M).

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Otitis Media and Disordered Phonologies: Some Concerns and Cautions Source: Topics in Language Disorders. 14(2): 72-83. February 1994. Summary: This article reviews the association between otitis media with effusion and phonological impairment. The author notes that many questions have gone unanswered, such as why large numbers of children who experience early persistent otitis media do not present phonological deficits, and what specific measures might facilitate therapy for those who do. The author first reviews problems faced by researchers and then summarizes established findings concerning otitis media and its effects on phonological acquisition. Professionals are warned neither to ignore nor exaggerate the possible influence of a history of otitis media on a child's phonological deficits. 20 references. (AA-M).

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Acute Otitis Media: Management and Surveillance in an Era of Pneumococcal Resistance-A Report from the Drug-Resistant Streptococcus Pneumoniae Therapeutic Working Group Source: Pediatric Infectious Disease Journal. 18(1): 1-9. January 1999. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 350, Hagerstown, MD 21740-0350. Website: www.lww.com. Summary: This article summarizes the report of a therapeutic working group that was convened to provide consensus recommendations for the management of acute otitis media (AOM) and the surveillance of drug resistant Streptococcus pneumoniae (DRSP). Five areas were addressed, considering published and unpublished data from the scientific literature and from the experts present. Oral amoxicillin should remain the first line antimicrobial agent for treating AOM. In view of the increasing prevalence of DRSP, the safety of amoxicillin at higher than standard dosages and evidence that higher dosages of amoxicillin can achieve effective middle ear fluid concentrations, an increase in the dosage used for empiric treatment from 40 to 45 mg per kg per day to 80 to 90 mg per kg per day is recommended. For patients with clinically defined treatment failure after 3 days of therapy, useful alternative agents include oral amoxicillin clavulanate, cefuroxime axetil and intramuscular ceftriaxone. Many of the 13 other FDA approved otitis media drugs lack good evidence for efficacy against DRSP. Currently local surveillance data for pneumococcal resistance that are relevant for the clinical management of AOM are not available from most areas in the U.S. Recommendations to improve surveillance include establishing criteria for setting susceptibility breakpoints for clinically appropriate antimicrobials to ensure relevance for treating AOM, testing middle ear fluid or nasal swab isolates in addition to sterile site isolates and testing of drugs that are useful in treating AOM. The authors stress that these recommendations are intended to provide a framework for appropriate clinical and public health responses to this problem. 4 tables. 59 references. (AA-M).

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Acute Otitis Media: Update on How and When to Give Antibiotics Source: Consultant. 36(4): 721-728. April 1996. Summary: This article updates readers on the use of antibiotic therapy for acute otitis media (AOM) in children. The authors note that the emergence and global spread of antibiotic-resistant bacteria have prompted a thoughtful re-evaluation of optimal diagnostic criteria and indications for treatment. Diagnosis is most certain when the tympanic membrane is discolored, bulging, and immobile. Once the diagnosis of AOM is established, antibiotic treatment is a reasonable, but not necessary, option. Amoxicillin remains the drug of first choice; trimethoprim-sulfamethoxazole is an appropriate second choice for apparent treatment failure due to beta-lactamase-producing bacteria. The authors stress that the goal in AOM is effective treatment while decreasing the impact of antbiotic therapy on the selection of resistant pathogens. This can be achieved through accurate diagnosis of AOM, coupled with judicious use of antibiotics and a decreased duration of therapy. 2 figures. 2 tables. 31 references. (AA-M).

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Ear Infections: Is the Treatment Part of the Problem? Source: Hearing Health. 9(2): 14-16. February-March 1993. Contact: Available from Voice International Publications, Inc. P.O. Drawer V, Ingleside, TX 78362-0500. Voice/TTY (361) 776-7240. Fax (361) 776-3278. Website: www.hearinghealthmag.com.

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Summary: This article, directed toward the general public, addresses the concern about the 'standard' management of otitis media with antibiotics. The article states that approximately one million tympanotomy tubes are placed in the ears of American children each year and perhaps an equal number of children are given prophylactic antibiotics in an effort to lessen the frequency of ear problems. The drawbacks of using antibiotics, in particular the development of fungal infections (especially those caused by the common yeast, Candida albicans), are discussed, and other ways of managing children with recurrent otitis media are suggested. •

Chronic Otitis Media with Effusion Source: Pediatrics in Review. 20(3): 85-93. March 1999. Contact: Available from American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (800) 433-9016 (members) or (888) 227-1773 (nonmembers). Fax (847) 434-8000. Website: www.aap.org. Summary: This continuing education article for pediatricians reviews chronic otitis media with effusion (OME). The authors break down the percent of cases of chronic OME that yield bacterial growth on culture and discuss which bacteria they yield. The authors then describe the effects of antibiotic treatment for acute OM on the long term resolution of middle ear effusion (MEE). The authors also list the risk factors that increase the duration of OME and the risk of chronic OME, as well as detail the percentage of children who experience hearing loss following chronic OME. The authors conclude by reviewing the care of the child who requires referral to an otolaryngologist for myringotomy with insertion of ventilation tubes. The authors caution that antibiotic treatment of acute otitis media and OME has only a minimal effect on the long term resolution of MEE. If the child has hearing impairment, referral to an otolaryngologist for myringotomy and tympanostomy tube insertion is a treatment option that is recommended after 4 months of effusion with hearing loss. Sequelae of chronic OME include deficient expressive language and poorer attention skills due to the temporary hearing loss associated with OME, high frequency sensorineural hearing loss, tympanic membrane atrophy, perforation, retraction, atelectasis, and cholesteatoma. 9 figures. 2 tables. 13 references.

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Management of Otitis Media: 2000 and Beyond Source: Pediatric Infectious Disease Journal. 19(4): 383-387. April 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: This review article provides an overview of the management of acute otitis media (AOM, middle ear infection) in which the author offers his assessment of future trends in diagnosis and therapy. Bacteria and viruses will continue to find ways to survive the activity of currently available antimicrobial drugs. Among the new antimicrobial drugs under consideration are ketolides, oxazolodinones, and quinolones. Guidelines stress limiting usage of antimicrobial agents to diseases that are likely caused by bacterial pathogens. Antiviral drugs are now available against influenza virus and respiratory syncytial virus infections. Tympanometry or acoustic reflectometry are adjunctive techniques for assisting in the diagnosis of middle ear effusion in children whose otoscopic examination is ambiguous. The author notes that parents influence decisions by pediatricians to use antimicrobial agents and should be informed about the appropriate usage of antibiotics. Educators and public health officials must find techniques to distinguish web sites that provide information of value from those that are

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not credible. Of paramount importance is the development of techniques to increase the accuracy of clinical and microbiologic diagnosis. Finally, there is a need for studies of appropriate scientific design that can assess the efficacy and safety of alternative therapies. 2 tables. 19 references. •

Medical and Surgical Management of Otitis Media Source: Current Opinion in Otolaryngology and Head and Neck Surgery. 8(6): 458-464. December 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: This review article summarizes the latest research on the diagnosis and medical and surgical management of otitis media. Acute otitis media (AOM), which is the most commonly diagnosed medical problem in children, is an acute inflammation of the middle ear cleft with systemic signs of inflammation. Several investigators studied the risk factors for otitis media during the year 2000. One researcher found that otitis media with effusion (OME) was strongly associated with age, early gestational age, low birth weight, enrollment in day car, number of siblings, and cold weather. Another researcher found a strong genetic basis for OME and AOM. Other investigators have reported on the value of tympanometry and reflectometry in the diagnosis of OME. Other areas of scientific inquiry during the year 2000 focused on the influence of allergy on otitis media, middle ear pathogens, and the role of middle ear inflation in the prevention of OME. Oral antibiotics continue to be heavily used in the United States, and AOM may be overdiagnosed. Several investigators reported work on S. pneumonia drug resistance and altered strategies for antibiotic use. In addition, a new conjugated heptavalent pneumococcal vaccine was evaluated during the year. Other research conducted during the year 2000 addressed the efficacy of tympanostomy tubes, the occurrence and prevention of tympanostomy tube complications, and the use of adenoidectomy and laser assisted myringotomy as treatments for OME. 1 table. 49 references.

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Prevalence of Various Respiratory Viruses in the Middle Ear During Acute Otitis Media Source: New England Journal of Medicine. 340(4): 260-264. January 28, 1999. Summary: Vaccines against respiratory viruses may be able to reduce the frequency of acute otitis media. Although the role of respiratory viruses in the pathogenesis of acute otitis media is well established, the relative importance of various viruses is unknown. This article reports on a study that determined the prevalence of various respiratory viruses in the middle ear fluid of 456 children (aged 2 months to 7 years) with acute otitis media (AOM). At enrollment and after two to five days of antibiotic therapy, specimens of middle ear fluid and nasal wash were obtained for viral and bacterial cultures and the detection of viral antibodies. A specific viral cause of the respiratory tract infections was identified in 186 of the 456 children (41 percent). Respiratory syncytial virus was the most common virus identified in middle ear fluid: it was detected in the middle ear fluid of 48 of the 65 children (74 percent) infected by this virus. Parainfluenza viruses (15 of 29 children, or 52 percent) and influenza viruses (10 of 24 children, or 42 percent) were detected in the middle ear fluid significantly more often than enteroviruses (3 of 27 children, or 11 percent) or adenoviruses (1 of 23 children, or 4 percent). The authors conclude that respiratory syncytial virus is the principal virus invading the middle ear during acute otitis media. An effective vaccine

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against upper respiratory tract infections caused by respiratory syncytial virus may reduce the incidence of AOM in children. 3 tables. 37 references. (AA-M). •

Viral and Bacterial Interaction in Acute Otitis Media Source: Pediatric Infectious Disease Journal. 19(5 Supplement): S24-S30. May 2000. Contact: Available from Lippincott Williams and Wilkins. 12107 Insurance Way, Hagerstown, MD 21740. (800) 637-3030. Fax (301) 824-7390. Website: www.lww.com. Summary: Viral infection of the upper respiratory tract induces Eustachian tube dysfunction and microbial invasion of the middle ear. These conditions lead to acute inflammatory changes and signs and symptoms of middle ear infection. By the time acute otitis media (AOM, middle ear infection) is diagnosed, viral infection of the upper respiratory tract may have been aborted, and the virus may never enter the middle ear. If the virus enters the middle ear along with bacteria or if the viral upper respiratory tract infection is still ongoing at the time of AOM diagnosis, evidence suggests that the virus may interact with the bacteria, leading to adverse outcomes of AOM. This review article discusses clinical evidence of viral and bacterial interaction that occurs by the time AOM has been developed, effects of the interaction on the clinical course of AOM and recovery, and potential mechanisms of the interaction. The author concludes that AOM, which is generally considered a bacterial disease, is more likely a bacterial complication of viral upper respiratory tract infection. More sensitive methods for detection of a wide variety of viruses in a uniform manner are needed to help clarify the relative significance of each virus type. 5 tables. 58 references.

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Novel Use of Xylitol Sugar in Preventing Acute Otitis Media Source: Pediatrics. 102(4): 879-884. October 1998. Contact: Available from American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (800) 433-9016 (members) or (888) 227-1773 (nonmembers). Fax (847) 434-8000. Website: www.aap.org. Summary: Xylitol, a commonly used sweetener, is effective in preventing dental caries. This article reports on a study that evaluated whether xylitol could be effective in preventing acute otitis media (AOM), as it inhibits the growth of pneumococci. In all, 857 healthy children recruited from day care centers were randomized to one of five treatment groups to receive control syrup (n = 165), xylitol syrup (n = 159), control chewing gum (n = 178), xylitol gum (n = 179) or xylitol lozenge (n = 176). The daily dose of xylitol varied from 8.4 g (chewing gum) to 10 g (syrup). The occurrence of AOM each time the child showed any symptoms of respiratory infection was the main outcome. Although at least one event of AOM was experienced by 68 (41 percent) of the 165 children who received control syrup, only 46 (29 percent) of the 159 children receiving xylitol syrup were affected, for a 30 percent decrease. Likewise, the occurrence of otitis decreased by 40 percent compared with control subjects in the children who received xylitol chewing gum and by 20 percent in the lozenge group. Thus, the occurrence of AOM during the follow up period was significantly lower in those who received xylitol syrup or gum, and these children required antimicrobials less often than did controls. Xylitol was well tolerated. 3 figures. 3 tables. 26 references. (AA-M).

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Federally Funded Research on Ear Infections The U.S. Government supports a variety of research studies relating to ear infections. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to ear infections. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore ear infections. The following is typical of the type of information found when searching the CRISP database for ear infections: •

Project Title: ADULTS W/ ATTENTION DEFICIT DISORDER: FAMILIAL & BEHAVIORAL DISORDERS Principal Investigator & Institution: Dawson, Deborah V.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: Young boys with Fragile X Syndrome were characterized on the basis of a range of physical characteristics. Results were compared with a group of developmentally delayed boys of similar age who were known to test negative for Fragile X. The results of this study underscored the difficulty of identifying Fragile X Syndrome on the basis of physical characteristics: although it confirmed a number of reported profiles, it also underscored the considerable overlap in the two populations. Findings of this study differed from certain other reports in the lack of significantly greater incidence of ear infections. A major result of these investigations was the identification of significantly enlarged testicular volume in young boys with Fragile X syndrome, and its characterization and relationship with age. Lachiewicz AM, Dawson DV, Spiridigliozzi GA. Physical characteristics of young boys with Fragile X syndrome Exploring the difficulty of making a clinical diagnosis in young males. Future work will focus on behavioral aspects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AFFINITY ENHANCEMENT OF A HUMANIZED ANTI-ICAM ANTIBODY Principal Investigator & Institution: Fang, Fang; Perlan Therapeutics, Inc. 6310 Nancy Ridge Dr, Ste 102 San Diego, Ca 921213209 Timing: Fiscal Year 2001; Project Start 15-AUG-2001; Project End 14-FEB-2002 Summary: (provided by applicant): The common cold is a benign disease that also causes ear infections in children and is a leading cause of "attacks" in asthmatic patients. Common cold infections have a great economic impact but are currently treated by OTC

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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remedies intended to alleviate symptoms. Human rhinoviruses cause 70 percent of colds and include >120 different serotypes. This large genetic diversity makes development of a vaccine near impossible. However, about 90 percent of rhinovirus serotypes bind to nasal epithelial cell surface receptor, ICAM- 1. We have developed prototype antiICAM-1 antibody fusion constructs that bind to ICAM-1 with high affinity and that prevent rhinovirus infection in cell culture assays. High affinity (low Koff) antibodies are essential for durable protection from infection. This proposal describes a novel method for in vitro affinity enhancement of the antibody through selective amino acid substitutions. The choice of residues to mutate is critical for efficiency and success. Amino acid residues are mutated individually and together to generate E. coli based libraries. Libraries are screened using an "off rate" screening method designed to select for specific, high affinity (low Koff) binding. Once the core antibody has been affinity enhanced, it will be used to generate fusion constructs for clinical evaluation. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETICS /BIOLOGY OF M. CATARRHALIS LOS IN OTITIS MEDIA Principal Investigator & Institution: Campagnari, Anthony A.; Professor; Medicine; State University of New York at Buffalo Suite 211 Ub Commons Amherst, Ny 14228 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Moraxella catarrhalis is a Gram-negative human pathogen, which predominantly causes middle ear infections and sinusitis in infants and children, and lower respiratory tract infections in adults. This organism is the third leading cause of otitis media and it is estimated that approximately 50% of children will become colonized by this bacterium in the first 6 months of life. Recurrent acute otitis media infections have also become prevalent resulting in potential hearing loss and subsequent developmental and learning problems as these children reach school age. Middle ear infections are very common and it is estimated that 80% of children under the age of 3 will experience at least one episode. There are also significant health care costs associated with treatment for otitis media and it has been determined that M. catarrhalis is responsible for approximately 3 to 4 million physician office visits annually. This estimate is considered conservative now that over 90% of M. catarrhalis clinical isolates produce b-lactamase. Together, these data have stimulated research efforts aimed at identifying specific virulence factors involved in colonization and infection. One prominent bacterial surface component implicated as a potential virulence factor, is the lipooligosaccharide (LOS). Structural studies show that M. catarrhalis LOS is similar to the LOS of other Gram-negative human pathogens, including Neisseris meningitidis, Neisseria gonorrhoeae and Haemophilus influenzae. More importantly, these common LOS structures shared by M. catarrhalis and these prominent human mucosal pathogens have been implicated as virulence factors. Although M. catarrhalis express these LOS epitopes, there have been minimal studies describing the role of LOS in pathogenesis. In addition, there is currently no information available regarding the assembly and expression of this major surface glycolipid. In this proposal we will perform a comprehensive analysis of the genetics and biology of M. catarrhalis LOS. These studies will be instrumental to our understanding of the role of LOS in the pathogenesis of otitis media and should provide insight into new strategies designed to prevent this disease. We will test our hypotheses by the following specific aims: (1) Isolate and characterize of the genes involved in the biosynthesis and assembly of M. catarrhalis LOS. (2)Perform biologic studies to define the role for M. catarrhalis LOS in otitis media.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFLAMMATORY MECHANISMS IN VIRAL OTITIS MEDIA Principal Investigator & Institution: Buchman, Craig A.; Associate Professor; Otolaryngology/Head & Neck Surgery; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, Nc 27599 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2005 Summary: Acute otitis media (AOM) and viral upper respiratory tract infections (URIs) represent the two most common diseases affecting the human population, and account for substantial patient morbidity and health care costs. Epidemiological and experimental studies suggest that URIs play a causal role in the pathogenesis of AOM. Specifically, viruses can invade the middle ear (ME) space and invoke an inflammatory response that culminates in ME effusion (fluid) formation and consequent symptoms (pain, hearing loss). The molecular events responsible for the inflammatory response of the human ME following viral exposure have not been characterized. Studies using viral inoculation of nasal and tracheobronchial tissues suggest that the initiating inflammatory events are epithelium-mediated through local cytokine production. Since the ME normally does not contain aggregates of leukocytes, it is likely that the initiating events in viral otitis media are epithelium-mediated as well. The long-term goal of the present study is to investigate the ME mucosal response(s) to viral exposure in an effort to better understand the initiating events in AOM. Such knowledge will help develop new therapies for this significant disease. The goals of this project are to: (1) perform influenza A viral challenge experiments in the laboratory's normal ME epithelial cell culture system and measure expression of the interleukin (IL,)-1alpha, IL-1beta, IL-6, IL8, IL-10 and tumor necrosis factor (TNF)-alpha genes using reverse transcriptasepolymerase chain reaction (RT-PCR), in situ hybridization, and enzyme-linked immunoabsorbent assays (ELISA); (2) evaluate the same cytokine responses in ME epithelial cells derived from "otitis-prone" individuals; and (3) evaluate the efficacy of several potentially inhibitory substances in these models. The results of these experiments will provide a better understanding of the initiating events in viral otitis media and, hopefully, will lead to the development of novel therapies for this disease. Successful completion of this award by the principal investigator (PI) will provide the added research training and career development for future large-scale studies as an independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEW TREATMENT FOR INFLAMMATION IN MIDDLE EAR INFECTIONS Principal Investigator & Institution: Kurtz, Stephen E.; Targeted Gene Delivery, Inc. 2611 Sw 3Rd Ave, Ste 200 Portland, or 97201 Timing: Fiscal Year 2003; Project Start 15-DEC-2002; Project End 14-JUN-2003 Summary: (provided by applicant): Otitis media with effusion (OME) is one of the most prevalent inflammatory diseases in the pediatric population, and is associated with pain and hearing loss. OME is characterized by release of inflammatory mediators and enzymes such as pro-inflammatory cytokines, cellular infiltration into the middle ear, and secretion of a mucin-rich effusion. In the majority of cases, inflammation and resulting fluid accumulation are initially triggered by stimulation of host immune cells with specific bacterial products, such as end toxin. These stimulatory products are found both on intact viable bacteria and bacterial debris that is present after bacterial death.

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Currently, antibiotics are used almost exclusively for treatment of otiUs media, however antibiotic therapy only kills the bacteria and does not specifically target the inflammation and accumulation of fluid in the middle ear that irresponsible for the pain and diminished hearing seen in OME. The goal of this proposal will be to test the feasibility of a novel therapy to minimize or resolve the inflammation and result in accumulation of middle ear fluid, and prevent the hearing loss in OME. Our strategy will be to block at the initiating stage the intracellular activation that results from the interaction of bacterial products with host immune cells within the middle ear leading to inflammation and the clinical complications of OME. This proposal will establish conditions for inhibiting the cellular activation and inflammation induced both by specific bacterial products and cell extracts from killed whole bacteria. Once these conditions have been defined in vitro (Specific aim #1), the in vivo effectiveness of this therapeutic approach to minimize inflammation will be examined by assessing middle ear pathology, middle ear fluid accumulation, and prevention of hearing loss in an in vivo model of OME induced by injection of viable bacteria (specific aim #2). We speculates that the most efficient management of OME will involve a combination of antibiotics and a treatment specific for bacterial-induced inflammation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: POINT OF CARE INSTRUMENT FOR VIRAL RESPIRATORY DIAGNOSIS Principal Investigator & Institution: Ives, Jeffrey T.; Scientist; Xtrana, Inc. 717 Yosemite Cir Denver, Co 80220 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2005 Summary: (provided by applicant): The common respiratory viruses (influenza, parainfluenza, respiratory syncytial virus or RSV, and rhinovirus) cause millions of cases of upper and lower respiratory tract disease every year. The spectrum of illness induced directly by the viruses is very broad, ranging from mild colds and simple ear infections to more serious and sometimes life-threatening diseases such as bronchiolitis, pneumonia, and asthma. In spite of the importance of diagnosing and treating these viral infections, current diagnostic methods of physical exam or rapid immunoassays or culture in reference laboratories do not provide the accuracy, sensitivity, or timely information that the primary care physician needs for treatment. Antiviral therapeutics are becoming increasingly viable, but they require accurate identification of the infectious virus(es). While sensitive, newer assays and instrumentation based on nucleic acid technologies are not cost effective or practical for point of care in a physician's office. To provide a cost effective, point of care system for diagnosing respiratory viruses, this application describes an integrated and unique device that will begin with a nasal wash sample and use nucleic acid-based technologies to accurately identify eight respiratory viruses: RSV A and B; parainfluenza 1, 2, and 3; influenza A and B; and rhinovirus. After loading the sample, proprietary steps of sample preparation, RNA extraction, multiplexed amplification, and detection by lateral flow strips will be automatically performed. These processing steps will be directed on a disposable, microfluidic card that both minimizes the reagent costs and provides an enclosed container for convenient, biosafe disposal. To develop this diagnostic device, a series of technical milestones will be accomplished. First, a novel method of multiplexed target amplification will be optimized on respiratory viral targets. Second, nasal wash samples will be directly prepared for multiplexed amplification by flow through extraction and unique solid phase analysis. Sample preparation and amplification will be managed by developing disposable, laminated microfluidics cards with channels, reagents, and

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valves. Using a protoype workstation, the described system will be tested with patient samples and spiked samples to verify the utility, specificity, sensitivity, and reproducibility of the system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ROLE OF VIRUS AND GENETIC SUSCEPTIBILITY IN OTITIS MEDIA Principal Investigator & Institution: Alper, Cuneyt M.; Associate Professor; Children's Hosp Pittsburgh/Upmc Hlth Sys of Upmc Health Systems Pittsburgh, Pa 15213 Timing: Fiscal Year 2002; Project Start 27-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): Otitis media (OM) is a common disease in infants and children. While each year between 3 and 5 billion dollars are spent in the United States on the management of this disease, few treatments are recognized as effective. The well-supported immediate cause of OM is a preceding or concurrent viral upper respiratory tract infection (vURI) and it has been suggested that most episodes of OM could be prevented by preventing vURIs or by early treatment of those infections prior. In recent years, effective vaccines and antivirals have been marketed that prevent or treat infection with some of the viruses that cause OM, and others are in development. However, the judicious introduction of these possible interventions for OM depends on a number of factors not known at present. These include, for each virus that can cause vURIs: the natural history of OM, the temporal pattern relating vURIs and OM presentations, the co-incidence of OM and vURI and the percent of vURI and OM episodes that are symptomatic, among others. Also, to avoid over-treatment of patients at little risk for OM, a definition of patient characteristics that predispose to OM is important. In the proposed study, we will acquire this information. Specifically, we will study young children in their home environment throughout the typical cold-flu months by daily symptom recording and assessment of middle ear status, weekly ear and nose examinations and monthly bacterial and virus assays; and, if they develop signs and symptoms of either a cold-like illness or OM, we will re-evaluate these children in the clinic for confirmatory diagnosis of OM, vURI and etiological virus. For all enrolled children, we will determine their genotype for the production of certain cytokines that were suggested to influence disease expression during a vURI and/or the development of OM. During vURIs, we will also determine the types of cytokines that are produced in the nose, and relate these to OM incidence. From this close follow up of children for OM and vURI, we will estimate the parameters needed to define the expected efficacy and efficiency of different strategies to prevent OM caused by vURI. The role of cytokine genotype and expression pattern in predisposing to the development of OM as a complication of vURI may delineate possible "at risk" groups for targeted intervention. These results will be used in the design of future studies that prevent OM by moderating vURI pathogenesis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STREPTOCOCCUS PNEUMONIAE ADHERENCE AND OTITIS MEDIA PATH Principal Investigator & Institution: Demaria, Thomas F.; Otolaryngology; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2001; Project Start 01-AUG-1996; Project End 31-JUL-2005 Summary: (Adapted from the Investigator's Abstract) Otitis media (middle ear inflammation) ranks first among the most common diagnoses requiring a physician's

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office visit and recent estimates indicate that virtually all children (99%) will experience a least one episode of otitis media (OM) by age 2. The disease progresses in many children to recurrent infections and chronic inflammation, often with complications and sequalae that include persistent hearing loss nd communication disorders. Streptococcus pneumoniae (Spn), is one of the foremost human pathogens and is the primary nasopharynx, the initial event in the induction of OM and the mechanisms which effect the transition for a colonized state to invasion of the middle ear and the induction of the disease state by Spn are not known. The long term objectives of this proposal are to delineate the pathogenic mechanisms involved in Spn adherence, colonization, and invasion of the middle ear and to develop a scientific rationale for the design of novel diagnostic and prevention strategies. The specific aims of this proposal are: 1) To continue to define the role of Spn neuraminidase in the pathogenesis of OM and to assess whether it is a protective antigen and a potential protein-based vaccine candidate, and whether neuraminidase inhibitors are effective in the prevention of Spn nasopharyngeal colonization of OM. 2) To assess the efficacy of lacto-N-neotetraose, a Spn carbohydrate receptor analog, as an anti-infective for nasopharyngeal colonization. 3) To continue to define the mechanisms whereby influenza A virus affects Spn adherence, colonization, and OM. These aims are designed to delineate the initial interaction, adherence, and colonization which represents the first in a series of steps that culminates in otitis media. These studies may suggest avenues for blocking interaction of Spn with host cells either by immunization or direct intervention blockade with isolated receptor moieties or bacterial adhesin components. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRUCTURAL STUDIES OF BACTERIAL HYALURONATE LYASE ENZYMEN Principal Investigator & Institution: Jedrzejas, Mark J.; Microbiology; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 08-MAY-2001 Summary: The objective of this research proposal is to develop a better understanding of the structural properties and mechanism of action of S. pneumoniae hyaluronate lyase enzyme. The long term objective is to better understand the mechanism of invasion of host tissue and the penetration of host defenses by S. pneumoniae and other Grampositive bacteria. Such understanding may lead to the development of new antibacterial therapeutic agents. S. pneumoniae is the most common cause of fatal pneumonia in the elderly, and it is one of the most common causes of middle ear infections and meningitis in children. The present vaccine consists of a mixture of 23 different capsular polysaccharides. While this vaccine is very effective in young adults, it is only about 60 percent effective in the elderly. In children less than 2 years of age the vaccine is ineffective and is not recommended due to the inability of this age group to mount an antibody response to the penumococcal polysaccharides. Antimicrobial drugs such as penicillin have diminished the risk of pneumococcal disease. However, in most parts of this country, up to 35 percent of pneumococcal strains are now resistant to penicillin and the frequency of multidrug resistant strains is steadily increasing. It has been recently suggested that certain pneumococcal proteins such as hyaluronate lyase, pneumolysin, and pneumococcal surface protein A (PspA) could be used as potential vaccine or drug targets for development of new cure. Hyaluronate lyase is a major surface protein of S. pneumoniae with possibly antigenetically variable properties that might be essential for full pneumococcal virulence. Thus, hyaluronate lyase might represent one of the best alternatives for a pneumococcal vaccine or drug target especially when combined with

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other pneumococcal virulence factors such as PspA or pneumolysin. We have expressed in E. coli, purified, and crystallized fully active forms of hyaluronate lyase enzyme from S. pneumoniae and Group B Streptococcus. The specific aims of the research proposed in this application are directed towards: a) the determinatin of the crystal structure of the hyaluronate lyase enzyme; b) thoroughly characterizing the properties and mapping the active site of this enzyme utilizing oligonucleotide mediated site directed mutagenesis. The results will enhance our knowledge about mechanisms involved in the action of the enzyme and in the pathogenesis of S. pneumoniae bacteria. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “ear infections” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for ear infections in the PubMed Central database: •

A New Rat Model of Otitis Media Caused by Streptococcus pneumoniae: Conditions and Application in Immunization Protocols. by van der Ven LT, van den Dobbelsteen GP, Nagarajah B, van Dijken H, Dortant PM, Vos JG, Roholl PJ.; 1999 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96998

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Adenovirus serotype 1 does not act synergistically with Moraxella (Branhamella) catarrhalis to induce otitis media in the chinchilla. by Bakaletz LO, Murwin DM, Billy JM.; 1995 Oct; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173592

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Amoxicillin treatment of experimental acute otitis media caused by Haemophilus influenzae with non-beta-lactamase-mediated resistance to beta-lactams: aspects of virulence and treatment. by Melhus A, Janson H, Westman E, Hermansson A, Forsgren A, Prellner K.; 1997 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=164048

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Bacteriologic Efficacies of Oral Azithromycin and Oral Cefaclor in Treatment of Acute Otitis Media in Infants and Young Children. by Dagan R, Leibovitz E, Fliss DM, Leiberman A, Jacobs MR, Craig W, Yagupsky P.; 2000 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89626

3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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Blinded Multiplex PCR Analyses of Middle Ear and Nasopharyngeal Fluids from Chinchilla Models of Single- and Mixed-Pathogen-Induced Otitis Media. by Bakaletz LO, White GJ, Post JC, Ehrlich GD.; 1998 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=121361

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Characterization of ear fluid isolates of Alloiococcus otitidis from patients with recurrent otitis media. by Bosley GS, Whitney AM, Pruckler JM, Moss CW, Daneshvar M, Sih T, Talkington DF.; 1995 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=228599

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Comparison of Alteration of Cell Surface Carbohydrates of the Chinchilla Tubotympanum and Colonial Opacity Phenotype of Streptococcus pneumoniae during Experimental Pneumococcal Otitis Media with or without an Antecedent Influenza A Virus Infection. by Tong HH, Grants I, Liu X, DeMaria TF.; 2002 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=128169

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Effect of Influenza A Virus Infection on Nasopharyngeal Colonization and Otitis Media Induced by Transparent or Opaque Phenotype Variants of Streptococcus pneumoniae in the Chinchilla Model. by Tong HH, Weiser JN, James MA, DeMaria TF.; 2001 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=97928

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Effect of recolonisation with "interfering" [alpha] streptococci on recurrences of acute and secretory otitis media in children: randomised placebo controlled trial. by Roos K, Hakansson EG, Holm S.; 2001 Jan 27; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26587

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Efficacy of clarithromycin treatment of acute otitis media caused by infection with penicillin-susceptible, -intermediate, and -resistant Streptococcus pneumoniae in the chinchilla. by Alper CM, Doyle WJ, Seroky JT, Bluestone CD.; 1996 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163435

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Efficacy of Linezolid in Experimental Otitis Media. by Pelton SI, Figueira M, Albut R, Stalker D.; 2000 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89742

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Efficacy of single-dose ceftriaxone in experimental otitis media induced by penicillinand cephalosporin-resistant Streptococcus pneumoniae. by Barry B, Muffat-Joly M, Bauchet J, Faurisson F, Gehanno P, Pocidalo JJ, Carbon C.; 1996 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=163458

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Eradication by Ceftriaxone of Streptococcus pneumoniae Isolates with Increased Resistance to Penicillin in Cases of Acute Otitis Media. by Gehanno P, Nguyen L, Barry B, Derriennic M, Pichon F, Goehrs JM, Berche P.; 1999 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=89013

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Experimental Acute Otitis Media Due to Nontypeable Haemophilus influenzae: Comparison of High and Low Azithromycin Doses with Placebo. by Babl FE, Pelton SI, Li Z.; 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127299

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Expression of Cytokine Genes during Pneumococcal and Nontypeable Haemophilus influenzae Acute Otitis Media in the Rat. by Melhus A, Ryan AF.; 2000 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101687

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Household Transmission of Streptococcus pneumoniae among Siblings with Acute Otitis Media. by Shimada J, Yamanaka N, Hotomi M, Suzumoto M, Sakai A, Ubukata K, Mitsuda T, Yokota S, Faden H.; 2002 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=130916

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Identification of Common Lipooligosaccharide Types in Isolates from Patients with Otitis Media by Monoclonal Antibodies against Nontypeable Haemophilus influenzae 9274. by Ueyama T, Gu XX, Tsai CM, Karpas AB, Lim DJ.; 1999 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=95667

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Identification of the Lipooligosaccharide Biosynthesis Gene lic2B as a Putative Virulence Factor in Strains of Nontypeable Haemophilus influenzae That Cause Otitis Media. by Pettigrew MM, Foxman B, Marrs CF, Gilsdorf JR.; 2002 Jul; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=128108

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Immunization with high-molecular-weight adhesion proteins of nontypeable Haemophilus influenzae modifies experimental otitis media in chinchillas. by Barenkamp SJ.; 1996 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=173911

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In Vivo Efficacies of Amoxicillin and Cefuroxime against Penicillin-Resistant Streptococcus pneumoniae in a Gerbil Model of Acute Otitis Media. by Cenjor C, Ponte C, Parra A, Nieto E, Garcia-Calvo G, Gimenez MJ, Aguilar L, Soriano F.; 1998 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105604

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Middle Ear Fluid Cytokine and Inflammatory Cell Kinetics in the Chinchilla Otitis Media Model. by Sato K, Liebeler CL, Quartey MK, Le CT, Giebink GS.; 1999 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96550

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Nasopharyngeal antibodies to pneumococcal pneumolysin in children with acute otitis media. by Virolainen A, Jero J, Kayhty H, Karma P, Eskola J, Leinonen M.; 1995 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=170225

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Optimal Dose of Amoxicillin in Treatment of Otitis Media Caused by a PenicillinResistant Pneumococcus Strain in the Gerbil Model. by Parra A, Ponte C, Cenjor C, Garcia-Calvo G, Gimenez MJ, Aguilar L, Soriano F.; 2002 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=127470

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Passive Transfer of Antiserum Specific for Immunogens Derived from a Nontypeable Haemophilus influenzae Adhesin and Lipoprotein D Prevents Otitis Media after Heterologous Challenge. by Kennedy BJ, Novotny LA, Jurcisek JA, Lobet Y, Bakaletz LO.; 2000 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=97485

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Pharmacokinetics and Efficacy of Linezolid in a Gerbil Model of Streptococcus pneumoniae-Induced Acute Otitis Media. by Humphrey WR, Shattuck MH, Zielinski RJ, Kuo MS, Biermacher JJ, Smith DP, Jensen JL, Schaadt RD, Zurenko GE, Richards IM.; 2003 Apr; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=152499

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Pragmatic randomised controlled trial of two prescribing strategies for childhood acute otitis media. by Little P, Gould C, Williamson I, Moore M, Warner G, Dunleavey J.; 2001 Feb 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=26576

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Prevalence of Antimicrobial-Resistant Pathogens in Middle Ear Fluid: Multinational Study of 917 Children with Acute Otitis Media. by Jacobs MR, Dagan R, Appelbaum PC, Burch DJ.; 1998 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=105503

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Primary care based randomised, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. by Damoiseaux RA, van Balen FA, Hoes AW, Verheij TJ, de Melker RA.; 2000 Feb 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27282

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Protection against Development of Otitis Media Induced by Nontypeable Haemophilus influenzae by Both Active and Passive Immunization in a Chinchilla Model of Virus-Bacterium Superinfection. by Bakaletz LO, Kennedy BJ, Novotny LA, Duquesne G, Cohen J, Lobet Y.; 1999 Jun; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=96578

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Rationale behind high-dose amoxicillin therapy for acute otitis media due to penicillin-nonsusceptible pneumococci: support from in vitro pharmacodynamic studies. by Lister PD, Pong A, Chartrand SA, Sanders CC.; 1997 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=164037

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Streptococcus pneumoniae Causes Experimental Meningitis following Intranasal and Otitis Media Infections via a Nonhematogenous Route. by Marra A, Brigham D.; 2001 Dec; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=98817

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Transcription of genes encoding iron and heme acquisition proteins of Haemophilus influenzae during acute otitis media. by Whitby PW, Sim KE, Morton DJ, Patel JA, Stull TL.; 1997 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstr act&artid=175673

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Two-Step PCR-Based Assay for Identification of Bacterial Etiology of Otitis Media with Effusion in Infected Lebanese Children. by Matar GM, Sidani N, Fayad M, Hadi U.; 1998 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=104796

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Variability of Outer Membrane Protein P1 and Its Evaluation as a Vaccine Candidate against Experimental Otitis Media due to Nontypeable Haemophilus influenzae: an Unambiguous, Multifaceted Approach. by Bolduc GR, Bouchet V, Jiang RZ, Geisselsoder J, Truong-Bolduc QC, Rice PA, Pelton SI, Goldstein R.; 2000 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=98360

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with ear infections, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “ear infections” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for ear infections (hyperlinks lead to article summaries): •

A bacteriological study of otitis media with effusion. Concurrent coagulase-negative staphylococcal infections in the middle ear. Author(s): Bunse T, Hildmann H, Zan W, Opferkuch W. Source: Arch Otorhinolaryngol. 1987; 243(6): 387-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3566622&dopt=Abstract

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A systematic review of the effectiveness of ofloxaxin otic solution for the treatment of suppurative otitis media. Author(s): Abes G, Espallardo N, Tong M, Subramaniam KN, Hermani B, Lasiminigrum L, Anggraeni R. Source: Orl; Journal for Oto-Rhino-Laryngology and Its Related Specialties. 2003 MarchApril; 65(2): 106-16. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12824733&dopt=Abstract

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Acinetobacter and similar organisms in ear infections. Author(s): Dadswell JV. Source: Journal of Medical Microbiology. 1976 August; 9(3): 345-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=957420&dopt=Abstract

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Are nasal steroid sprays effective for otitis media with effusion? Author(s): Chaffee JR, St Anna L. Source: The Journal of Family Practice. 2003 August; 52(8): 647-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899825&dopt=Abstract

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Are tympanostomy tubes indicated for recurrent acute otitis media? Author(s): Wilson SA, Mayo H, Fisher M. Source: The Journal of Family Practice. 2003 May; 52(5): 403-4, 406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12737775&dopt=Abstract

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Association between gastroesophageal reflux and sinusitis, otitis media, and laryngeal malignancy: a systematic review of the evidence. Author(s): Weaver EM. Source: The American Journal of Medicine. 2003 August 18; 115 Suppl 3A: 81S-89S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928081&dopt=Abstract

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Autoimmunity in the etiology of otitis media with effusion. Author(s): Kirglu M, Yildirim I, Aydogan B, Okur E, Tuncer U, Erken E. Source: American Journal of Otolaryngology. 2003 May-June; 24(3): 159-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761702&dopt=Abstract

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Bacteriocin-like inhibitory substance (BLIS) production by the normal flora of the nasopharynx: potential to protect against otitis media? Author(s): Walls T, Power D, Tagg J. Source: Journal of Medical Microbiology. 2003 September; 52(Pt 9): 829-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12909662&dopt=Abstract

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Bacteriologic and clinical efficacy of high dose amoxicillin for therapy of acute otitis media in children. Author(s): Piglansky L, Leibovitz E, Raiz S, Greenberg D, Press J, Leiberman A, Dagan R. Source: The Pediatric Infectious Disease Journal. 2003 May; 22(5): 405-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792379&dopt=Abstract

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Beliefs about and responses to childhood ear infections: a study of parents in eastern North Carolina. Author(s): Curry MD, Mathews HF, Daniel HJ 3rd, Johnson JC, Mansfield CJ. Source: Social Science & Medicine (1982). 2002 April; 54(8): 1153-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11993452&dopt=Abstract

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Black-white differences in health care utilization among US children with frequent ear infections. Author(s): Park CH, Kogan MD, Overpeck MD, Casselbrant ML. Source: Pediatrics. 2002 May; 109(5): E84-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11986490&dopt=Abstract

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Bordetella trematum sp. nov., isolated from wounds and ear infections in humans, and reassessment of Alcaligenes denitrificans Ruger and Tan 1983. Author(s): Vandamme P, Heyndrickx M, Vancanneyt M, Hoste B, De Vos P, Falsen E, Kersters K, Hinz KH. Source: International Journal of Systematic Bacteriology. 1996 October; 46(4): 849-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8863408&dopt=Abstract

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Can acute otitis media caused by Haemophilus influenzae be distinguished from that caused by Streptococcus pneumoniae? Author(s): Leibovitz E, Satran R, Piglansky L, Raiz S, Press J, Leiberman A, Dagan R. Source: The Pediatric Infectious Disease Journal. 2003 June; 22(6): 509-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799507&dopt=Abstract

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CHAMPUS recapture in the treatment of ear infections. Author(s): Zieno SA. Source: Military Medicine. 1993 April; 158(4): 273-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8479638&dopt=Abstract

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Characteristics of the type B tympanogram can predict the magnitude of the air-bone gap in otitis media with effusion. Author(s): Sichel JY, Priner Y, Weiss S, Levi H, Barshtein G, Eliashar R, Elidan J. Source: The Annals of Otology, Rhinology, and Laryngology. 2003 May; 112(5): 450-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784986&dopt=Abstract

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Child care arrangements and repeated ear infections in young children. Author(s): Hardy AM, Fowler MG. Source: American Journal of Public Health. 1993 September; 83(9): 1321-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8363010&dopt=Abstract

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Childhood otitis media and electrically elicited stapedius reflexes in adult cochlear implantees. Author(s): Todd NW, Ajayi E, Hasenstab MS, Webster DA, Boyd PJ. Source: Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2003 July; 24(4): 621-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12851555&dopt=Abstract

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Chronic otitis media with effusion sequelae in children treated with tubes. Author(s): Daly KA, Hunter LL, Lindgren BR, Margolis R, Giebink GS. Source: Archives of Otolaryngology--Head & Neck Surgery. 2003 May; 129(5): 517-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759263&dopt=Abstract

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Chronic suppurative otitis media in school pupils in Nigeria. Author(s): Ologe FE, Nwawolo CC. Source: East Afr Med J. 2003 March; 80(3): 130-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12762427&dopt=Abstract

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Ciprofloxacin in oral treatment of ear infections. Author(s): Van de Heyning PH, Pattyn SR, Valcke HD. Source: Pharm Weekbl Sci. 1986 February 21; 8(1): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2938071&dopt=Abstract

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Clinical considerations in the diagnosis of otitis media. Author(s): Klaudt MR, Steinbach WJ, Sectish TC. Source: Curr Allergy Asthma Rep. 2003 July; 3(4): 313-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791208&dopt=Abstract

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Clinical experiences with ofloxacin sequential therapy in chronic ear infections. Author(s): Heppt W, Lutz H. Source: European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (Eufos) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 1993; 250 Suppl 1: S19-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8476581&dopt=Abstract

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Cochlear implantation in children with otitis media. Author(s): Fayad JN, Tabaee A, Micheletto JN, Parisier SC. Source: The Laryngoscope. 2003 July; 113(7): 1224-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838023&dopt=Abstract

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Comparison of tone burst and tapping evocation of myogenic potentials in patients with chronic otitis media. Author(s): Yang TL, Young YH. Source: Ear and Hearing. 2003 June; 24(3): 191-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799539&dopt=Abstract

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Complications of acute middle ear infections. Author(s): Pfaltz CR, Griesemer C. Source: Ann Otol Rhinol Laryngol Suppl. 1984 July-August; 112: 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6431873&dopt=Abstract

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Day care, infant feeding, and ear infections. Author(s): Visness CM, Kennedy KI, Labbok M. Source: American Journal of Public Health. 1995 February; 85(2): 267-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7856792&dopt=Abstract

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Development and characterization of a pooled Haemophilus influenzae genomic library for the evaluation of gene expression changes associated with mucosal biofilm formation in otitis media. Author(s): Erdos G, Sayeed S, Antalis P, Hu FZ, Hayes J, Goodwin J, Dopico R, Post JC, Ehrlich GD. Source: International Journal of Pediatric Otorhinolaryngology. 2003 July; 67(7): 749-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791450&dopt=Abstract

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Distribution and heritability of recurrent ear infections. Author(s): Kvaerner KJ, Tambs K, Harris JR, Magnus P. Source: The Annals of Otology, Rhinology, and Laryngology. 1997 August; 106(8): 62432. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9270423&dopt=Abstract

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Does pacifier use cause ear infections in young children? Author(s): Hanafin S, Griffiths P. Source: British Journal of Community Nursing. 2002 April; 7(4): 206, 208-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11979200&dopt=Abstract

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Does this child have acute otitis media? Author(s): Rothman R, Owens T, Simel DL. Source: Jama : the Journal of the American Medical Association. 2003 September 24; 290(12): 1633-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506123&dopt=Abstract

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Ear infections and the Marlboro Man. Author(s): Smith JM. Source: Asha. 1992 September; 34(9): 5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1456994&dopt=Abstract

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Ear infections in autistic and normal children. Author(s): Konstantareas MM, Homatidis S. Source: Journal of Autism and Developmental Disorders. 1987 December; 17(4): 585-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3680158&dopt=Abstract

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Ear infections. Author(s): Reich JJ. Source: Emergency Medicine Clinics of North America. 1987 May; 5(2): 227-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3325272&dopt=Abstract

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Ear infections. Author(s): Buffin JT. Source: The Practitioner. 1979 December; 223(1338): 776-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=542446&dopt=Abstract

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Effect of conjugate pneumococcal vaccine followed by polysaccharide pneumococcal vaccine on recurrent acute otitis media: a randomised study. Author(s): Veenhoven R, Bogaert D, Uiterwaal C, Brouwer C, Kiezebrink H, Bruin J, IJzerman E, Hermans P, de Groot R, Zegers B, Kuis W, Rijkers G, Schilder A, Sanders E. Source: Lancet. 2003 June 28; 361(9376): 2189-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842372&dopt=Abstract

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Effect of gestational and passive smoke exposure on ear infections in children. Author(s): Lieu JE, Feinstein AR. Source: Archives of Pediatrics & Adolescent Medicine. 2002 February; 156(2): 147-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11814376&dopt=Abstract

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Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children: a randomized controlled trial. Author(s): Hoberman A, Greenberg DP, Paradise JL, Rockette HE, Lave JR, Kearney DH, Colborn DK, Kurs-Lasky M, Haralam MA, Byers CJ, Zoffel LM, Fabian IA, Bernard BS, Kerr JD. Source: Jama : the Journal of the American Medical Association. 2003 September 24; 290(12): 1608-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506120&dopt=Abstract

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Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial. Author(s): Couzos S, Lea T, Mueller R, Murray R, Culbong M. Source: The Medical Journal of Australia. 2003 August 18; 179(4): 185-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914507&dopt=Abstract

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Efficacy of single-dose azithromycin in treatment of acute otitis media in children after a baseline tympanocentesis. Author(s): Dunne MW, Khurana C, Mohs AA, Rodriguez A, Arrieta A, McLinn S, Krogstad JA, Blatter M, Schwartz R, Vargas SL, Emparanza P, Fernandez P, Gooch WM 3rd, Aspin M, Podgore J, Roine I, Blumer JL, Ehrlich GD, Chow J. Source: Antimicrobial Agents and Chemotherapy. 2003 August; 47(8): 2663-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12878537&dopt=Abstract

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Efficacy of topical ciprofloxacin in the treatment of ear infections in adults. Author(s): Garcia Rodriguez JA, Garcia Sanchez JE, Garcia Garcia MI, Garcia Sanchez E, Munoz Bellido JL, Ramos Macias A. Source: The Journal of Antimicrobial Chemotherapy. 1993 March; 31(3): 452-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8486586&dopt=Abstract

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Evaluation of spiramycin as a therapeutic agent for elimination of nasopharyngeal pathogens. Possible use of spiramycin for middle ear infections and for gonococcal and meningococcal nasopharyngeal carriage. Author(s): Kamme C, Kahlmeter G, Melander A. Source: Scandinavian Journal of Infectious Diseases. 1978; 10(2): 135-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=97775&dopt=Abstract

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Factors associated with poor outcome in children with acute otitis media. Author(s): Monobe H, Ishibashi T, Fujishiro Y, Shinogami M, Yano J. Source: Acta Oto-Laryngologica. 2003 June; 123(5): 564-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12875576&dopt=Abstract

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Frequent ear infections and child care. Author(s): Boyle CA. Source: Paediatric and Perinatal Epidemiology. 1999 October; 13(4): 473-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10563366&dopt=Abstract

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Frequent ear infections in association with child-care characteristics, based on the 1988 Child Health Supplement to the National Health Interview Survey. Author(s): Hildesheim ME, Hoffman HJ, Overpeck MD. Source: Paediatric and Perinatal Epidemiology. 1999 October; 13(4): 466-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10563365&dopt=Abstract

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Fungal infections of ear with special reference to chronic suppurative otitis media. Author(s): Talwar P, Chakrabarti A, Kaur P, Pahwa RK, Mittal A, Mehra YN. Source: Mycopathologia. 1988 October; 104(1): 47-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3216882&dopt=Abstract

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Gradenigo's syndrome--a rare complication of otitis media. Author(s): Jagadeesan P, Madeswaran K, Thiruppathy SP, Kalairajan D, Inbasekaran V. Source: J Indian Med Assoc. 2002 November; 100(11): 669-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12797641&dopt=Abstract

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Healthy People 2010 objective: reduce number and frequency of courses of antibiotics for ear infections in young children. Author(s): Jackson PL. Source: Pediatric Nursing. 2001 November-December; 27(6): 591-3, 605. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024532&dopt=Abstract

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Hearing loss due to mannosidosis and otitis media with effusion. A case report and review of audiological assessments in children with otitis media with effusion. Author(s): Ahmmed AU, O'Halloran SM, Roland NJ, Starkey M, Wraith JE. Source: The Journal of Laryngology and Otology. 2003 April; 117(4): 307-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12816222&dopt=Abstract

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Hearing loss induced by noise, ear infections, and head injuries: results from the Nord-Trondelag Hearing Loss Study. Author(s): Tambs K, Hoffman HJ, Borchgrevink HM, Holmen J, Samuelsen SO. Source: International Journal of Audiology. 2003 March; 42(2): 89-105. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641392&dopt=Abstract

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High rates of recombination in otitis media isolates of non-typeable Haemophilus influenzae. Author(s): Cody AJ, Field D, Feil EJ, Stringer S, Deadman ME, Tsolaki AG, Gratz B, Bouchet V, Goldstein R, Hood DW, Moxon ER. Source: Infection, Genetics and Evolution : Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases. 2003 May; 3(1): 57-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12797973&dopt=Abstract

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Host-derived sialic acid is incorporated into Haemophilus influenzae lipopolysaccharide and is a major virulence factor in experimental otitis media. Author(s): Bouchet V, Hood DW, Li J, Brisson JR, Randle GA, Martin A, Li Z, Goldstein R, Schweda EK, Pelton SI, Richards JC, Moxon ER. Source: Proceedings of the National Academy of Sciences of the United States of America. 2003 July 22; 100(15): 8898-903. Epub 2003 Jul 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855765&dopt=Abstract

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Increased antimicrobial resistance in organisms recovered from otitis media with effusion. Author(s): Brook I, Yocum P, Shah K, Feldman B, Epstein S. Source: The Journal of Laryngology and Otology. 2003 June; 117(6): 449-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12818052&dopt=Abstract

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JAMA patient page. Acute otitis media. Author(s): Parmet S, Lynm C, Glass RM. Source: Jama : the Journal of the American Medical Association. 2003 September 24; 290(12): 1666. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14506125&dopt=Abstract

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Labyrinthine fistula: a complication of chronic suppurative otitis media. Author(s): Grewal DS, Hathiram BT, Dwivedi A, Kumar L, Sheth K, Srivastava S. Source: The Journal of Laryngology and Otology. 2003 May; 117(5): 353-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12803784&dopt=Abstract

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Lasting auditory attention impairment after persistent middle ear infections: a dichotic listening study. Author(s): Asbjornsen A, Holmefjord A, Reisaeter S, Moller P, Klausen O, Prytz B, Boliek C, Obrzut JE. Source: Developmental Medicine and Child Neurology. 2000 July; 42(7): 481-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10972421&dopt=Abstract

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Lincomycin therapy in chronic middle ear infections. Author(s): Trakas JC, Lind HE. Source: Antimicrobial Agents Chemother. 1965; 5: 717-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5883488&dopt=Abstract

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Management of acute ear infections. Author(s): Walike JW. Source: Otolaryngologic Clinics of North America. 1979 May; 12(2): 439-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=460883&dopt=Abstract

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Management of acute otitis media. Author(s): Marcy SM. Source: The Pediatric Infectious Disease Journal. 2003 July; 22(7): 673-4; Author Reply 674. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867849&dopt=Abstract

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Managing childhood ear infections. Author(s): Holt GR, Gates GA. Source: Compr Ther. 1980 December; 6(12): 59-65. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7009037&dopt=Abstract

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Measurement of cefaclor and amoxicillin-clavulanic acid levels in middle-ear fluid in patients with acute otitis media. Author(s): Scaglione F, Caronzolo D, Pintucci JP, Fraschini F. Source: Antimicrobial Agents and Chemotherapy. 2003 September; 47(9): 2987-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12937009&dopt=Abstract

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Microbiology and management of chronic suppurative otitis media in children. Author(s): Brook I. Source: Journal of Tropical Pediatrics. 2003 August; 49(4): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12929878&dopt=Abstract

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Middle ear infections in pediatric patients: treatment with amoxicillin. Author(s): Aronovitx GH. Source: The Journal of Infectious Diseases. 1974 June; 129(0): Suppl: S185-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4152133&dopt=Abstract

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Modern management of acute otitis media. Author(s): Weber SM, Grundfast KM. Source: Pediatric Clinics of North America. 2003 April; 50(2): 399-411. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809330&dopt=Abstract

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Mycological and histological investigations in humans with middle ear infections. Author(s): Vennewald I, Schonlebe J, Klemm E. Source: Mycoses. 2003 February; 46(1-2): 12-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588477&dopt=Abstract

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Nasopharyngeal carriage of anaerobes during health and acute otitis media by two years of age. Author(s): Kononen E, Syrjanen R, Takala A, Jousimies-Somer H. Source: Diagnostic Microbiology and Infectious Disease. 2003 July; 46(3): 167-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867091&dopt=Abstract

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Natural history of untreated otitis media. Author(s): Rosenfeld RM, Kay D. Source: The Laryngoscope. 2003 October; 113(10): 1645-57. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14520089&dopt=Abstract

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New strategies for treating ear infections in children. Author(s): McMillan JA. Source: Am J Manag Care. 2002 October; 8(14 Suppl): S343-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408219&dopt=Abstract

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Nitrofurazone in the treatment of bacterial ear infections: re-evaluation after twenty years. Author(s): Douglass CC. Source: The Laryngoscope. 1970 March; 80(3): 400-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5436960&dopt=Abstract

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Ofloxacin otic solution: a review of its use in the management of ear infections. Author(s): Simpson KL, Markham A. Source: Drugs. 1999 September; 58(3): 509-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10493278&dopt=Abstract

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Opsonization and phagocytosis of bacteria during various middle ear infections. Author(s): Stenfors LE, Raisanen S. Source: International Journal of Pediatric Otorhinolaryngology. 1993 August; 27(2): 13745. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8258481&dopt=Abstract

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Osteopathic manipulation to prevent otitis media--does it work? Author(s): Pichichero ME. Source: Archives of Pediatrics & Adolescent Medicine. 2003 September; 157(9): 852-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963587&dopt=Abstract

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Otitis media and tympanostomy tube insertion during the first three years of life: developmental outcomes at the age of four years. Author(s): Paradise JL, Dollaghan CA, Campbell TF, Feldman HM, Bernard BS, Colborn DK, Rockette HE, Janosky JE, Pitcairn DL, Kurs-Lasky M, Sabo DL, Smith CG. Source: Pediatrics. 2003 August; 112(2): 265-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12897272&dopt=Abstract

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Otoacoustic emissions in the general adult population of Nord-Trondelag, Norway: II. Effects of noise, head injuries, and ear infections. Author(s): Engdahl B, Tambs K. Source: International Journal of Audiology. 2002 January; 41(1): 78-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467373&dopt=Abstract

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Otogenous tetanus: a sequelae of chronic ear infections. Author(s): Fischer GW, Sunakorn P, Duangman C. Source: Am J Dis Child. 1977 April; 131(4): 445-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=322475&dopt=Abstract

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Physical examination for otitis media. Author(s): Roddey OF Jr, Hoover HA, Earle R Jr. Source: The Pediatric Infectious Disease Journal. 2003 July; 22(7): 673. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867848&dopt=Abstract

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Piercing the cartilage and not the lobes leads to ear infections. Author(s): Das P. Source: The Lancet Infectious Diseases. 2002 December; 2(12): 715. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467683&dopt=Abstract

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Pneumococcal conjugate vaccine for acute otitis media--yes or no? Author(s): Peltola H, Schmitt J, Booy R. Source: Lancet. 2003 June 28; 361(9376): 2170-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12842365&dopt=Abstract

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Preliminary results with the use of AlloDerm in chronic otitis media. Author(s): Fayad JN, Baino T, Parisier SC. Source: The Laryngoscope. 2003 July; 113(7): 1228-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12838024&dopt=Abstract

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Prevention of otitis media caused by viral upper respiratory tract infection: vaccines, antivirals, and other approaches. Author(s): Doyle WJ, Alper CM. Source: Curr Allergy Asthma Rep. 2003 July; 3(4): 326-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791210&dopt=Abstract

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Problem ear infections: what to do when the patient just doesn't get better. Author(s): Keim RJ. Source: Med Times. 1978 February; 106(2): 68-73. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=634088&dopt=Abstract

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Pseudomonas ear infections. Author(s): Pien FD. Source: Archives of Otolaryngology--Head & Neck Surgery. 1996 August; 122(8): 898-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8703402&dopt=Abstract

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Recurrent ear infections in children. A logical, step-wise approach to this potentially devastating problem. Author(s): Turner J. Source: Clinical Pediatrics. 1968 August; 7(8): 446-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5668008&dopt=Abstract

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Recurrent middle-ear infections in infants: the protective role of maternal breast feeding. Author(s): Persico M, Podoshin L, Fradis M, Golan D, Wellisch G. Source: Ear, Nose, & Throat Journal. 1983 June; 62(6): 297-304. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6409579&dopt=Abstract

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Response-shift bias and parent-reported quality of life in children with otitis media. Author(s): Timmerman AA, Anteunis LJ, Meesters CM. Source: Archives of Otolaryngology--Head & Neck Surgery. 2003 September; 129(9): 987-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12975273&dopt=Abstract

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Review of randomized controlled trials on pneumococcal vaccination for prevention of otitis media. Author(s): Straetemans M, Sanders EA, Veenhoven RH, Schilder AG, Damoiseaux RA, Zielhuis GA. Source: The Pediatric Infectious Disease Journal. 2003 June; 22(6): 515-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12799508&dopt=Abstract

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Risk factors for the development of otitis media. Author(s): Dhooge IJ. Source: Curr Allergy Asthma Rep. 2003 July; 3(4): 321-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791209&dopt=Abstract

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Role of respiratory viruses in children with acute otitis media. Author(s): Monobe H, Ishibashi T, Nomura Y, Shinogami M, Yano J. Source: International Journal of Pediatric Otorhinolaryngology. 2003 July; 67(7): 801-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791457&dopt=Abstract

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Screening children in the first four years of life to undergo early treatment for otitis media with effusion. Author(s): Butler CC, van der Linden MK, MacMillan H, van der Wouden JC. Source: Cochrane Database Syst Rev. 2003; (2): Cd004163. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12804500&dopt=Abstract

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Strategies for decreasing multidrug antibiotic resistance: role of ototopical agents for treatment of middle ear infections. Author(s): Klein JO. Source: Am J Manag Care. 2002 October; 8(14 Suppl): S345-52. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408220&dopt=Abstract

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The entity known as chronic silent (subclinical) otitis media: a common lesion and a forgotten diagnosis. Author(s): Ferlito A, Paparella MM, Rinaldo A, Schachern PA, Cureoglu S. Source: Acta Oto-Laryngologica. 2003 August; 123(6): 749-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12953778&dopt=Abstract

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The laws of acute otitis media. Author(s): Harrison CJ. Source: Primary Care. 2003 March; 30(1): 109-35. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12825252&dopt=Abstract

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The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Author(s): Mills MV, Henley CE, Barnes LL, Carreiro JE, Degenhardt BF. Source: Archives of Pediatrics & Adolescent Medicine. 2003 September; 157(9): 861-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12963590&dopt=Abstract

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Topical ofloxacin for chronic suppurative otitis media and acute exacerbation of chronic otitis media: optimum duration of treatment. Author(s): Suzuki K, Nishimura T, Baba S, Yanagita N, Ishigami H. Source: Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2003 May; 24(3): 447-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12806297&dopt=Abstract

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Topical treatment of chronic suppurative otitis media in Aboriginal children. Author(s): Coates H. Source: Ear, Nose, & Throat Journal. 2003 August; 82(8 Suppl 2): 13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974052&dopt=Abstract

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Treatment of otitis media and ear infections. Author(s): Holborow C. Source: Trop Doct. 1986 January; 16(1): 32-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3765065&dopt=Abstract

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Treatment of otitis media with observation and a safety-net antibiotic prescription. Author(s): Siegel RM, Kiely M, Bien JP, Joseph EC, Davis JB, Mendel SG, Pestian JP, DeWitt TG. Source: Pediatrics. 2003 September; 112(3 Pt 1): 527-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949278&dopt=Abstract

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Trends in otitis media among children in the United States. Author(s): Auinger P, Lanphear BP, Kalkwarf HJ, Mansour ME. Source: Pediatrics. 2003 September; 112(3 Pt 1): 514-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12949276&dopt=Abstract

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Tuberculous otitis media with mastoiditis and central nervous system involvement. Author(s): Mongkolrattanothai K, Oram R, Redleaf M, Bova J, Englund JA. Source: The Pediatric Infectious Disease Journal. 2003 May; 22(5): 453-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792390&dopt=Abstract

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Typing of Pseudomonas aeruginosa ear infections related to outcome of treatment. Author(s): Englender M, Harell M, Guttman R, Segal S. Source: The Journal of Laryngology and Otology. 1990 September; 104(9): 678-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2121879&dopt=Abstract

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Viral otitis media. Author(s): Buchman CA, Brinson GM. Source: Curr Allergy Asthma Rep. 2003 July; 3(4): 335-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12791211&dopt=Abstract

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CHAPTER 2. NUTRITION AND EAR INFECTIONS Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and ear infections.

Finding Nutrition Studies on Ear Infections The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “ear infections” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7

Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following is a typical result when searching for recently indexed consumer information on ear infections: •

Allergy management of refractory serous otitis media. Source: Hurst, D S Otolaryngol-Head-Neck-Surg. 1990 June; 102(6): 664-9 0194-5998

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Analysis of protease activity in human otitis media. Author(s): Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, USA. Source: Avidano, M A Cotter, C S Stringer, S P Schultz, G S Otolaryngol-Head-NeckSurg. 1998 October; 119(4): 346-51 0194-5998

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Characterization of ear fluid isolates of Alloiococcus otitidis from patients with recurrent otitis media. Author(s): Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Source: Bosley, G S Whitney, A M Pruckler, J M Moss, C W Daneshvar, M Sih, T Talkington, D F J-Clin-Microbiol. 1995 November; 33(11): 2876-80 0095-1137

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Effects of 21-aminosteroid U-74389G on acute otitis media in a guinea pig model. Author(s): Columbia University, New York, New York, USA. Source: Haddad, J Egusa, K Takoudes, T G Otolaryngol-Head-Neck-Surg. 1998 January; 118(1): 44-8 0194-5998

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Epidemiology of otitis media onset by six months of age. Author(s): Otitis Media Research Center, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA. Source: Daly, K A Brown, J E Lindgren, B R Meland, M H Le, C T Giebink, G S Pediatrics. 1999 June; 103(6 Pt 1): 1158-66 0031-4005

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Expression of acute otitis media after receptor blockade of platelet activating factor, thromboxane, and leukotrienes in the chinchilla. Author(s): Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA. Source: Diven, W F Burckart, G J Alper, C M Jaffe, R Evans, R W Doyle, W J Ann-OtolRhinol-Laryngol. 1998 March; 107(3): 199-206 0003-4894

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Influenza virus and rhinovirus-related otitis media: potential for antiviral intervention. Author(s): Department of Internal Medicine, University of Virginia School of Medicine, Box 800473, Charlottesville, VA 22908, USA. [email protected] Source: Hayden, F G Vaccine. 2000 December 8; 19 Suppl 1: S66-70 0264-410X

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Moraxella (Branhamella) catarrhalis-induced experimental otitis media in the chinchilla. Author(s): Department of Otolaryngology, Ohio State University College of Medicine, Columbus. Source: Chung, M H Enrique, R Lim, D J De Maria, T F Acta-Otolaryngol. 1994 July; 114(4): 415-22 0001-6489

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Nebulized surfactant for experimentally induced otitis media with effusion. Author(s): Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. Source: Nemechek, A J Pahlavan, N Cote, D N Otolaryngol-Head-Neck-Surg. 1997 November; 117(5): 475-9 0194-5998

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Participation of Ras and extracellular regulated kinase in the hyperplastic response of middle-ear mucosa during bacterial otitis media. Author(s): Department of Head and Neck Surgery, University of California, San Diego, School of Medicine, La Jolla, California, USA. Source: Palacios, S D Pak, K Kayali, A G Rivkin, A Z Aletsee, C Melhus, A Webster, N J Ryan, A F J-Infect-Dis. 2002 December 15; 186(12): 1761-9 0022-1899

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Role of leukotriene B4 and interleukin-8 in acute bacterial and viral otitis media. Author(s): Department of Pediatrics, University of Texas Medical Branch at Galveston 77555-0371, USA. Source: Chonmaitree, T Patel, J A Sim, T Garofalo, R Uchida, T Sim, T Howie, V M Owen, M J Ann-Otol-Rhinol-Laryngol. 1996 December; 105(12): 968-74 0003-4894

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Treatment of chronic suppurative otitis media with topical ciprofloxacin. Author(s): Department of Pediatric Otolaryngology, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pennsylvania 15213, USA. Source: Dohar, J E Alper, C M Rose, E A Doyle, W J Casselbrant, M L Kenna, M A Bluestone, C D Ann-Otol-Rhinol-Laryngol. 1998 October; 107(10 Pt 1): 865-71 0003-4894

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Tuberculous otitis media -- a diagnostic dilemma. Author(s): Department of Otolaryngology, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK. Source: Bhalla, R K Jones, T M Rothburn, M M Swift, A C Auris-Nasus-Larynx. 2001 August; 28(3): 241-3 0385-8146

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Xylitol in preventing acute otitis media. Author(s): Department of Paediatrics, University of Oulu, FIN-90220 Oulu, Finland. [email protected] Source: Uhari, M Tapiainen, T Kontiokari, T Vaccine. 2000 December 8; 19 Suppl 1: S1447 0264-410X

The following information is typical of that found when using the “Full IBIDS Database” to search for “ear infections” (or a synonym): •

Allergy management of refractory serous otitis media. Source: Hurst, D S Otolaryngol-Head-Neck-Surg. 1990 June; 102(6): 664-9 0194-5998

•

Analysis of protease activity in human otitis media. Author(s): Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Gainesville, USA. Source: Avidano, M A Cotter, C S Stringer, S P Schultz, G S Otolaryngol-Head-NeckSurg. 1998 October; 119(4): 346-51 0194-5998

•

Characterization of ear fluid isolates of Alloiococcus otitidis from patients with recurrent otitis media. Author(s): Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Source: Bosley, G S Whitney, A M Pruckler, J M Moss, C W Daneshvar, M Sih, T Talkington, D F J-Clin-Microbiol. 1995 November; 33(11): 2876-80 0095-1137

•

Effects of 21-aminosteroid U-74389G on acute otitis media in a guinea pig model. Author(s): Columbia University, New York, New York, USA. Source: Haddad, J Egusa, K Takoudes, T G Otolaryngol-Head-Neck-Surg. 1998 January; 118(1): 44-8 0194-5998

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•

Epidemiology of otitis media onset by six months of age. Author(s): Otitis Media Research Center, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA. Source: Daly, K A Brown, J E Lindgren, B R Meland, M H Le, C T Giebink, G S Pediatrics. 1999 June; 103(6 Pt 1): 1158-66 0031-4005

•

Expression of acute otitis media after receptor blockade of platelet activating factor, thromboxane, and leukotrienes in the chinchilla. Author(s): Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA. Source: Diven, W F Burckart, G J Alper, C M Jaffe, R Evans, R W Doyle, W J Ann-OtolRhinol-Laryngol. 1998 March; 107(3): 199-206 0003-4894

•

Influenza virus and rhinovirus-related otitis media: potential for antiviral intervention. Author(s): Department of Internal Medicine, University of Virginia School of Medicine, Box 800473, Charlottesville, VA 22908, USA. [email protected] Source: Hayden, F G Vaccine. 2000 December 8; 19 Suppl 1: S66-70 0264-410X

•

Moraxella (Branhamella) catarrhalis-induced experimental otitis media in the chinchilla. Author(s): Department of Otolaryngology, Ohio State University College of Medicine, Columbus. Source: Chung, M H Enrique, R Lim, D J De Maria, T F Acta-Otolaryngol. 1994 July; 114(4): 415-22 0001-6489

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Nebulized surfactant for experimentally induced otitis media with effusion. Author(s): Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. Source: Nemechek, A J Pahlavan, N Cote, D N Otolaryngol-Head-Neck-Surg. 1997 November; 117(5): 475-9 0194-5998

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Participation of Ras and extracellular regulated kinase in the hyperplastic response of middle-ear mucosa during bacterial otitis media. Author(s): Department of Head and Neck Surgery, University of California, San Diego, School of Medicine, La Jolla, California, USA. Source: Palacios, S D Pak, K Kayali, A G Rivkin, A Z Aletsee, C Melhus, A Webster, N J Ryan, A F J-Infect-Dis. 2002 December 15; 186(12): 1761-9 0022-1899

•

Role of leukotriene B4 and interleukin-8 in acute bacterial and viral otitis media. Author(s): Department of Pediatrics, University of Texas Medical Branch at Galveston 77555-0371, USA. Source: Chonmaitree, T Patel, J A Sim, T Garofalo, R Uchida, T Sim, T Howie, V M Owen, M J Ann-Otol-Rhinol-Laryngol. 1996 December; 105(12): 968-74 0003-4894

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Treatment of chronic suppurative otitis media with topical ciprofloxacin. Author(s): Department of Pediatric Otolaryngology, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pennsylvania 15213, USA. Source: Dohar, J E Alper, C M Rose, E A Doyle, W J Casselbrant, M L Kenna, M A Bluestone, C D Ann-Otol-Rhinol-Laryngol. 1998 October; 107(10 Pt 1): 865-71 0003-4894

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Tuberculous otitis media -- a diagnostic dilemma. Author(s): Department of Otolaryngology, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK. Source: Bhalla, R K Jones, T M Rothburn, M M Swift, A C Auris-Nasus-Larynx. 2001 August; 28(3): 241-3 0385-8146

Nutrition

•

51

Xylitol in preventing acute otitis media. Author(s): Department of Paediatrics, University of Oulu, FIN-90220 Oulu, Finland. [email protected] Source: Uhari, M Tapiainen, T Kontiokari, T Vaccine. 2000 December 8; 19 Suppl 1: S1447 0264-410X

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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The following is a specific Web list relating to ear infections; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Vitamins Vitamin a Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com

•

Minerals Betaine Hydrochloride Source: Prima Communications, Inc.www.personalhealthzone.com Zinc Source: Healthnotes, Inc.; www.healthnotes.com

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Food and Diet Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Garlic Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,786,00.html Sugar Alcohols Source: Healthnotes, Inc.; www.healthnotes.com

53

CHAPTER 3. INFECTIONS

ALTERNATIVE

MEDICINE

AND

EAR

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to ear infections. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to ear infections and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “ear infections” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to ear infections: •

A case-control study on the risk factors of hepatitis C virus infection among Koreans. Author(s): Kim YS, Ahn YO, Kim DW. Source: Journal of Korean Medical Science. 1996 February; 11(1): 38-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8703369&dopt=Abstract

•

A study of deafness in West Africa. Author(s): Holborow C, Martinson F, Anger N. Source: International Journal of Pediatric Otorhinolaryngology. 1982 June; 4(2): 107-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7129783&dopt=Abstract

•

A study of tea tree oil ototoxicity. Author(s): Zhang SY, Robertson D.

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Source: Audiology & Neuro-Otology. 2000 March-April; 5(2): 64-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10720822&dopt=Abstract •

Acoustic otoscopy in the diagnosis of otitis media. Author(s): Jehle D, Cottington E. Source: Annals of Emergency Medicine. 1989 April; 18(4): 396-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2650590&dopt=Abstract

•

Acute acoustic nerve palsy associated with vincristine therapy. Author(s): Mahajan SL, Ikeda Y, Myers TJ, Baldini MG. Source: Cancer. 1981 May 15; 47(10): 2404-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7272895&dopt=Abstract

•

Acute respiratory infections in children: a study of knowledge and practices of mothers in rural Haryana. Author(s): Saini NK, Gaur DR, Saini V, Lal S. Source: J Commun Dis. 1992 June; 24(2): 75-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1344174&dopt=Abstract

•

An ethnographic study of acute respiratory infections in four local government areas of Nigeria. Author(s): Oyejide CO, Oke EA. Source: Afr J Med Med Sci. 1995 March; 24(1): 85-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7495206&dopt=Abstract

•

Are water and tympanotomy tubes compatible? Author(s): Jaffe BF. Source: The Laryngoscope. 1981 April; 91(4): 563-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7218998&dopt=Abstract

•

Children with special health care needs program: urban/rural comparisons. Author(s): Saywell RM Jr, Zollinger TW, Schafer ME, Schmit TM, Ladd JK. Source: The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association. 1993 Fall; 9(4): 314-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10171770&dopt=Abstract

•

Chiropractic care of a patient with temporomandibular disorder and atlas subluxation. Author(s): Alcantara J, Plaugher G, Klemp DD, Salem C.

Alternative Medicine 55

Source: Journal of Manipulative and Physiological Therapeutics. 2002 January; 25(1): 6370. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11898020&dopt=Abstract •

Chiropractic correction of congenital muscular torticollis. Author(s): Toto BJ. Source: Journal of Manipulative and Physiological Therapeutics. 1993 October; 16(8): 556-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8263436&dopt=Abstract

•

Combination chemotherapy with cisplatin, carboplatin, and etoposide in advanced malignancy: a phase I trial. Author(s): Rajkumar SV, Frytak S, Rubin J, Camoriano JK, Fitch TR. Source: American Journal of Clinical Oncology : the Official Publication of the American Radium Society. 1997 October; 20(5): 500-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9345336&dopt=Abstract

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Development of tympanosclerosis: can predicting factors be identified? Author(s): Forseni M, Eriksson A, Bagger-Sjoback D, Nilsson J, Hultcrantz M. Source: The American Journal of Otology. 1997 May; 18(3): 298-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9149821&dopt=Abstract

•

Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors. Author(s): Froehle RM. Source: Journal of Manipulative and Physiological Therapeutics. 1996 March-April; 19(3): 169-77. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8728460&dopt=Abstract

•

Effect of acupuncture on young pigs with induced enteropathogenic Escherichia coli diarrhea. Author(s): Hwang YC, Jenkins EM. Source: Am J Vet Res. 1988 September; 49(9): 1641-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3066247&dopt=Abstract

•

Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections. Author(s): de Lange de Klerk ES, Blommers J, Kuik DJ, Bezemer PD, Feenstra L. Source: Bmj (Clinical Research Ed.). 1994 November 19; 309(6965): 1329-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7866080&dopt=Abstract

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Efficacy of minocycline and EDTA lock solution in preventing catheter-related bacteremia, septic phlebitis, and endocarditis in rabbits. Author(s): Raad I, Hachem R, Tcholakian RK, Sherertz R. Source: Antimicrobial Agents and Chemotherapy. 2002 February; 46(2): 327-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11796338&dopt=Abstract

•

Efficacy of pyrethroid-impregnated ear tags for prophylaxis of tick-borne diseases of cattle. Author(s): Taylor SM, Kenny J, Mallon TR, Elliott CT, McMurray C, Blanchflower J. Source: The Veterinary Record. 1984 May 5; 114(18): 454-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6730269&dopt=Abstract

•

ELISA to determine immunoreactive Pseudomonas aeruginosa elastase in chronic suppurative otitis media. Author(s): Jin CS, Hamaguchi Y, Sakakura Y. Source: Int Arch Allergy Appl Immunol. 1991; 96(3): 193-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1804790&dopt=Abstract

•

Epidemiological factors associated with neonatal tetanus mortality: observations from a cluster survey in Nigeria. Author(s): Eregie CO. Source: East Afr Med J. 1993 July; 70(7): 434-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8293702&dopt=Abstract

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Ganciclovir prophylaxis for cochlear pathophysiology during experimental guinea pig cytomegalovirus labyrinthitis. Author(s): Woolf NK, Ochi JW, Silva EJ, Sharp PA, Harris JP, Richman DD. Source: Antimicrobial Agents and Chemotherapy. 1988 June; 32(6): 865-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2843084&dopt=Abstract

•

Home medication and microbiological profile in chronic otitis media in some Nigerian children. Author(s): Utsalo SJ, Onoyom-Ita V, Ifeanyi-Chukwu M, Akpan JO. Source: Cent Afr J Med. 1990 November; 36(11): 278-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2092881&dopt=Abstract

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Management of acute otitis media in an era of increasing antibiotic resistance. Author(s): Klein JO. Source: International Journal of Pediatric Otorhinolaryngology. 1999 October 5; 49 Suppl 1: S15-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10577768&dopt=Abstract

Alternative Medicine 57

•

Management of otitis media: 2000 and beyond. Author(s): Klein JO. Source: The Pediatric Infectious Disease Journal. 2000 April; 19(4): 383-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10783040&dopt=Abstract

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Modern management of acute otitis media. Author(s): Weber SM, Grundfast KM. Source: Pediatric Clinics of North America. 2003 April; 50(2): 399-411. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12809330&dopt=Abstract

•

Otitis media in Greenland. Studies on historical, epidemiological, microbiological, and immunological aspects. Author(s): Homoe P. Source: Int J Circumpolar Health. 2001; 60 Suppl 2: 1-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11725622&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

•

AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to ear infections; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Allergies and Sensitivities Source: Healthnotes, Inc.; www.healthnotes.com Cellulitis Source: Integrative Medicine Communications; www.drkoop.com Common Cold Source: Integrative Medicine Communications; www.drkoop.com Ear Infection Source: Integrative Medicine Communications; www.drkoop.com Infantile Colic Source: Integrative Medicine Communications; www.drkoop.com Infection Source: Healthnotes, Inc.; www.healthnotes.com Measles Source: Integrative Medicine Communications; www.drkoop.com Meningitis Source: Integrative Medicine Communications; www.drkoop.com Otitis Media Source: Integrative Medicine Communications; www.drkoop.com Recurrent Ear Infections Source: Healthnotes, Inc.; www.healthnotes.com Roseola Source: Integrative Medicine Communications; www.drkoop.com Skin Infection Source: Integrative Medicine Communications; www.drkoop.com

•

Alternative Therapy Chiropractic Source: Integrative Medicine Communications; www.drkoop.com Craniosacral Therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,685,00.html

Alternative Medicine 59

Homeopathy Source: Integrative Medicine Communications; www.drkoop.com Osteopathy Source: Integrative Medicine Communications; www.drkoop.com •

Chinese Medicine Baifan Alternative names: Alum; Baifan (Bai Fan); Alumen Source: Chinese Materia Medica

•

Homeopathy Aconitum Napellus Source: Healthnotes, Inc.; www.healthnotes.com Belladonna Source: Healthnotes, Inc.; www.healthnotes.com Chamomilla Source: Healthnotes, Inc.; www.healthnotes.com Ferrum Phosphoricum Source: Healthnotes, Inc.; www.healthnotes.com Hepar Sulphuris Calcareum Source: Healthnotes, Inc.; www.healthnotes.com Magnesia Phosphorica Source: Healthnotes, Inc.; www.healthnotes.com Mercurius Solubilis Source: Healthnotes, Inc.; www.healthnotes.com Pulsatilla Source: Healthnotes, Inc.; www.healthnotes.com

•

Herbs and Supplements Echinacea Alternative names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida Source: Healthnotes, Inc.; www.healthnotes.com Linden Alternative names: Tilia spp. Source: Healthnotes, Inc.; www.healthnotes.com

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Mullein Alternative names: Verbascum thapsus Source: Healthnotes, Inc.; www.healthnotes.com Mullein Source: Prima Communications, Inc.www.personalhealthzone.com Ofloxacin Source: Healthnotes, Inc.; www.healthnotes.com St. John’s Wort Alternative names: Hypericum perforatum Source: Healthnotes, Inc.; www.healthnotes.com Topical Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON EAR INFECTIONS Overview In this chapter, we will give you a bibliography on recent dissertations relating to ear infections. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “ear infections” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on ear infections, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Ear Infections ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to ear infections. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Otitis Media among Puerto Ricans and Blacks: Ethnicity, Epidemiology, and Family Health Cultures by Allen, Lisa Winokur, Phd from The University of Connecticut, 1988, 322 pages http://wwwlib.umi.com/dissertations/fullcit/8822907

•

Tympanometry in Diagnosis and Follow-up of Otitis Media in Children Less Than Two Years of Age by Palmu, Arto Antti Ilmari; Md from Tampereen Yliopisto (finland), 2002, 146 pages http://wwwlib.umi.com/dissertations/fullcit/f709809

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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

63

CHAPTER 5. CLINICAL TRIALS AND EAR INFECTIONS Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning ear infections.

Recent Trials on Ear Infections The following is a list of recent trials dedicated to ear infections.8 Further information on a trial is available at the Web site indicated. •

A Randomized Controlled Trial of the Use of Craniosacral Osteopathic Manipulative Treatment and of Botanical Treatment in Recurrent otitis media in Children. Condition(s): Otitis Media Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: A randomized, blinded, controlled trial will be performed to determine the efficacy of herbal therapy and craniosacral manipulation for the prevention of acute otitis media in children with recurrent otitis media. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00010465

•

Adenoidectomy for Otitis media in 2-3 Year Old Children Condition(s): Otitis Media with Effusion Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Deafness and Other Communication Disorders (NIDCD)

8

These are listed at www.ClinicalTrials.gov.

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Ear Infections

Purpose - Excerpt: The purpose of this study is to evaluate the efficacy of three different surgical treatments (1. Bilateral myringotomy and tube insertion (M&T); 2. Adenoidectomy and bilateral myringotomy (A&T); 3. Adenoidectomy with myringotomy and tympanostomy tube insertion (A-M&T)) in reducing subsequent episodes of middle ear disease and hearing loss caused by the fluid in the middle ear in children aged 24-47 months. The fluid in the middle ear is of at least three months' duration and unresponsive to standardized, recent antimicrobial treatment. The children are assigned to one of the three surgical treatments. After surgery, they are followed with examinations monthly and at the time of intercurrent infections for three years. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00016497 •

Levofloxacin In The Treatment Of Children With Recurrent And/or Persistent Acute Otitis Media Condition(s): Otitis Media Study Status: This study is currently recruiting patients. Sponsor(s): Johnson & Johnson Pharmaceutical Research and Development, L.L.C. Purpose - Excerpt: The purpose of this study is to demonstrate non-inferiority of levofloxacin compared with amoxicillin/clavulanate on the clinical response at the end of therapy in infants and children who have recurrent and/or persistent acute otitis media. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00051753

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “ear infections” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials:

Clinical Trials 65

•

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

•

For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON EAR INFECTIONS Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “ear infections” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on ear infections, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Ear Infections By performing a patent search focusing on ear infections, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on ear infections: •

Administration of oxazolidinones for transdermal delivery Inventor(s): Ford; Charles W. (Portage, MI), Watts; Jeffrey L. (Portage, MI) Assignee(s): Pharmacia & Upjohn Company (Kalamazoo, MI) Patent Number: 6,613,349 Date filed: May 26, 1999 Abstract: Disclosed is a method of treating a non-topical infection selected from the group consisting of ear infections, skin and soft tissue infections, acne, infected wounds, bacteremia, in a useful warm blooded mammal who is in need of such treatment which comprises topical administration of a pharmaceutical formulation containing a transdermally effective amount of an Oxazolidinone. Excerpt(s): The present invention is a method of treating topical application of known pharmaceutically useful Oxazolidinone antibacterials to treat non-topical infections. U.S. Pat. Nos. 5,164,510, 5,231,188, 5,565,571, 5,652,238, 5,688,792, 5,698,574 and 5,627,181 all disclose various oxazolidinone antibiotics which are well known to those skilled in the art. U.S. Pat. No. 5,688,792 discloses various oxazolidinone antibiotics which can be administered orally, parenterally or topically. The topical application being by gel or cream vehicle. Web site: http://www.delphion.com/details?pn=US06613349__

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Apparatus for treating recurrent ear infections Inventor(s): Pender; Daniel J. (325 E. Park Ave. - Suite 1, Long Beach, NY 11561) Assignee(s): none reported Patent Number: 4,712,537 Date filed: August 13, 1986 Abstract: A method and apparatus for treating ear infections in which a straight linear path is established from an external position to a specific target site on the eardrum. Thereafter a laser beam is caused to be emitted along the established path to impinge upon the eardrum to create a hole at the target site. Immediately thereafter, a hollow, tubular drainage missile is caused to be projected along the same established path into the hole formed at the target site to seat therein. The missile maintains the hole open for the drainage of the middle ear for so long as the physician deems necessary. Excerpt(s): The present invention relates to a method and apparatus for treating persistant ear infections. Recent advancements in the treatment of many physical dysfunctions and illnesses have employed laser technology, i.e. the use of high intensity light to incise, cauterize or otherwise treat internal tissues and organs. The use of laser technology has become quite common for the treatment of eye, knee and bladder conditions and recently there has been a suggestion to use this technology in the treatment of recurring ear effusions and infections, where large bodies of fluid collect in the middle ear forming a host for the growth of bacteria and an impediment to hearing. An article, appearing in "LASERS: Lightwave of the Future", edited by Allan Mauer, Arco Publishing Inc., 1982 page 11, reported an experiment by Dr. Richard Goode,

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Associate Professor of Surgery at Stamford University, in which a laser beam was employed to pierce a patient's eardrum permitting the draining of the fluid from the middle ear. This technology was reported as being inherently less painful, quicker and more easily healable than the prior techniques which were based upon knife or needle surgery. The techniques reported by Dr. Goode have not, however, been widely adopted since several still unsolved problems exist. An initial problem lies in the absence of suitable equipment and the means necessary for aiming and delivering the laser beam to the exact spot on the eardrum to provide the most effective drainage hole, while a second, equally significant problem lies in the maintenance of the hole formed, by the laser beam, open for a sufficiently long time to permit complete drainage of the underlying fluid collection. The use of conventional drainage tubes requires general anesthesia and manual insertion in the case of children, and such is usually preferred in a hospital operating room. Web site: http://www.delphion.com/details?pn=US04712537__ •

Chewable softgel oral hygiene product Inventor(s): Montes; Rebecca (Los Angeles, CA), Steele; Donald R. (Los Angeles, CA) Assignee(s): Soft Gel Technologies, Inc. (Los Angeles, CA) Patent Number: 5,948,388 Date filed: June 12, 1998 Abstract: A chewable softgel formulation to deliver water soluble vitamins and supplements to improve dissolution time and availability. The formulation contains components design for the elimination and prevention of dental caries, bad breath, gingivitis and also inner ear infections. Excerpt(s): A chewable softgel formulation to deliver water soluble vitamins and supplements to improve dissolution time and availability. The formulation contains components specifically designed for oral hygiene, including breath freshening, dental caries prevention, gingivitis prevention, and also inner ear infection prevention. The formulation includes a powerful active ingredient which exhibits impressive antimutagenic activity. Applephenon, an apple extract an essential component of the encapsulated softgel formulation also functions as a breath neutralizing agent. It is also beneficial in the prevention of dental caries by preventing bacterial cells from adhering to tooth surfaces. Various chewable formulations have been utilized in the past to inhibit plaque, neutralize bad breath and limit sugar quantity. None of the formulations are chewable softgel formulations which encapsulate a powerful ingredient applephenon, to combat various dental maladies. Web site: http://www.delphion.com/details?pn=US05948388__

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Compositions for inhibiting dental caries and/or middle ear infections and uses thereof Inventor(s): Aaltonen; Antti Sakari (Marttilantie 2as.6, FIN-03850 Pusula, FI), Suhonen; Jouko (663 Garth Ct., Yorktown Heights, NY 10598) Assignee(s): none reported Patent Number: 6,143,330 Date filed: August 24, 1998 Abstract: Compositions for treating or preventing dental caries and/or middle ear infections. These compositions comprise antibodies to dental caries and/or antibodies to bacteria causing middles ear infections and/or an agent preventing the adhesion, accumulation or reporduction of the pathogens of tooth or middle ear. The preferred agent is xylitol. Methods for using these compositions are also included. Excerpt(s): This invention relates to an immune milk preparation for the prevention of middle ear infections (otitis media) in children. The preparation contains antibodies produced against bacteria which cause middle ear infections and, if desired, also dental caries inhibiting agents. So called immune milk can be produced by vaccinating a pregnant cow against certain pathogens whereby the cow organism forms antibodies to these diseases, which antibodies are transferred to the colostrum. The remedying effects of immune milk have been known for a long time. Already since the beginning of the century immunized goat or cow milk has been tested in the treatment of various bacterial and viral diseases. The most important of the more recent studies are concentrated on the diseases dependent on the microbes of the gastrointestinal tract, i.a. rheumatoid arthritis, dental caries, gingivitis, diarrheas, dysentery, gastritis and cryptosporidiosis. A dental caries inhibiting product of immunized cow's milk, which contains specific antibodies to killed Streptococcus mutans cells, is known (U.S. Pat. No. 4,324,782). In the United States usual immune milk is produced by maintaining the antibody level with boosters. The amount of antibodies is rather small, and the effect is based on daily administration. In Taiwan immune milk is sold as a health drink. In Australia powder containing antibodies to rotavirus has been mixed into i.a. infant formulas (Murtomaa-Niskala, 1994). Whole milk products also contain non-specific antibacterial factors which may have effect of microbial flora (Takahashi et al., 1992). In Finland immune milk has been prepared against i.a. Helicobacter pylori infection (Oona et al., 1994), and antibodies to Streptococcus mutans and Streptococcus sobrinus, obtained from the colostrum of an immunized bovine (Loimaranta et al., 1996), have been studied at the Dental Department of the University of Turku (Prof. Jorma Tenovuo, personal communication). This immune milk has been produced at the Centre of Agricultural Research in Jokioinen. Web site: http://www.delphion.com/details?pn=US06143330__

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Incandescent lamp structure for applying therapeutic heat Inventor(s): Beddoe; Alexander F. (32851 Mill Creek Dr., Fort Bragg, CA 95437), Beddoe; Martha A. (32851 Mill Creek Dr., Fort Bragg, CA 95437) Assignee(s): none reported Patent Number: 4,658,823 Date filed: April 15, 1986

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Abstract: A therapeutic device to give the controlled application of heat to the live human ear and its structures thereof for the treatment of pain and congestion due to injury, inflammation, or infection. The lamp consists of an adjustable handle (10) attached to a mounting base (20) that holds a ceramic light bulb socket (36) which can hold approximately a 15 to 25 watt incandescent appliance light bulb as the heat source. The heat produced by the light bulb is controlled and directed to the point of application by a lamp housing (16) with an open end for placing over the ear. The lamp housing also has as a part of its structure an adjustable vent ring (24) with vent holes (26) and an upper limit sealed thermostat (32). The adjustable venting system along with the thermostat create a combination that allows for a simple, accurate, safe, and economical way of adding a new dimension for using light and heat in assisting in the treatment of earaches and ear infections, making it a mother's best friend. Also can be used in other applications where heat without undue pressure can be used to manage specific, but localized, inflammatory conditions. Excerpt(s): This invention pertains to incandescent light, especially to a therapeutic incandescent light device that produces a focused and controlled source of light and heat to assist in the prevention and elimination of congestion due to injury, inflammation, or infection of the external, middle, or inner human ear and structures thereof. Because people are continuing to have an ever increasing awareness of personal responsibility in matters pertaining to their wellness, health consumers are continuing to seek methods and devices which they can use to help themselves and their families overcome and prevent health problems. Heretofore, incandescent light has become such a common place item in our domestic as well our work environment for illumination purposes little thought has been exercised to use it other than for various forms of producing visible light and applications thereof. Web site: http://www.delphion.com/details?pn=US04658823__ •

Method of treating otitis media with uridine triphosphates and related compounds Inventor(s): Drutz; David J. (Houston, TX), Jacobus; Karla M. (Cary, NC), Rideout; Janet L. (Raleigh, NC) Assignee(s): Inspire Pharmaceuticals, Inc. (Durham, NC) Patent Number: 6,423,694 Date filed: February 21, 1996 Abstract: A method of promoting drainage of congested middle ear fluid in a subject in need of such treatment is disclosed. The method comprises administering to the middle ear of the subject a uridine triphosphate such as uridine 5'-triphosphate (UTP), an analog of UTP, or any other analog, in an amount effective to promote drainage of congested middle ear fluid by hydrating mucous secretions in the middle ear or by stimulating ciliary beat frequency in the middle ear or eustachian tube. The method is useful for treating patients afflicted with otitis media and other middle ear diseases, otitis externa, and inner ear diseases including Meniere's Disease. Pharmaceutical formulations and methods of making the same are also disclosed. Methods of administering the same would include any liquid suspension (including nasal drops or spray), oral, inhaled by nebulization, topical, injected or suppository form. Excerpt(s): This invention relates to a method of removing or preventing the accumulation of retained mucous secretions from the middle ear of a patient by administering certain uridine, adenosine, or cytidine triphosphates. Otitis media (OM) is

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a viral or bacterial infection of the middle ear primarily, but not exclusively, afflicting children under three years of age. It is characterized by the presence of congested fluid in the middle ear and is usually precipitated by an infection in the respiratory tract which spreads into the middle ear via the nasopharnyx and eustachian tube. The incidence of OM is increasing--annual physician's office visits for OM have increased 150% from 1975 through 1990 (L. McCraig and J. Hughes, JAMA 273(3), 214-19 (1995)). This is most likely due to increased use of large-group day care facilities, where children are exposed to more respiratory pathogens. Approximately 25-40 million office visits are made each year for diagnosis and treatment of OM, and by age three, approximately 75% of children will have had at least one episode of acute OM (with the maximum incidence in children 6-24 months of age) (J. Klein, Clin Infect Dis 19, 823-33 (1994)). Anatomically, the eustachian tubes in infants are shorter, wider, and lie more horizontally than in older children and adults, facilitating the spread of pathogens from the nasopharnyx to the middle ear (L. Schwartz and R. Brown, Arch Intern Med 152, 2301-04 (1992)). The infection evokes an inflammatory response in the mucosal tissue of the eustachian tube and middle ear, resulting in fluid effusion in the middle ear. The resulting fluid is viscous and pus-filled, making normal mucociliary movement of the fluid difficult, and inflammation of the eustachian tube at its narrowest point, the isthmus, effectively blocks drainage of the fluid into the nasopharnyx (J. Klein, supra (1994)). Middle ear congestion can be expected to cause significant pain, dizziness, and hearing impairment in the patient; the average hearing loss from the fluid accumulation is 25 decibels. This is of particular concern in very young children because impairment of hearing could delay or seriously impede aspects of normal cognitive development which are dependent upon exposure to language and social interaction (D. Teele, et al. J. Infect Dis 1621, 685-94 (1990)). Other potential (but uncommon) sequelae of OM include mastoiditis, meningitis, extradural abscess, subdural empyema, brain abscess, and lateral sinus thrombosis. About 80-90% of OM effusions eventually resolve spontaneously following antibiotic therapy; the process may take as long as three months. However, congestion in the middle ear may persist for weeks or even months beyond sterilization of this fluid with antibiotics due to a continued hypersecretory state of the mucous-producing cells. (S. Wintermeyer and M. Nahata, Annals of Pharmocotherapy 28, 1089-99 (1994)). The cause of this persistent hypersecretory state is not well understood but may relate to unrelieved underlying eustacian tube obstruction. As a further impediment to treatment, the effectiveness of antibiotic therapy is decreasing on account of growing bacterial resistance to antibiotics (M. Poole, Pediatr Infect Dis J. 14(4), 523-26 (1995)). If middle ear congestion persists for more than three months, surgery is commonly performed to insert a typanostomy tube to ventilate the middle ear of the patient (K. Grundfast, Arch Otolaryngol Head Neck Surg, 120, 797-98 (1994)). Tympanostomy surgery is now the second most frequent surgical procedure in children (after circumcision) (J. Klein, supra (1994)). The tube allows drainage of the fluid out of the ear and eventual resolution of the disease in a vast majority of chronic cases. However, the surgery is costly (>$2,000), and requires administering general anesthesia, a particular concern in infant patients. Furthermore, potential (but uncommon) sequelae of the surgery include persistent otorrhea, permanent perforation or scarring of the tympanic membrane, and cholesteatoma (a cyst-like sac filled with keratin debris that can occlude the middle ear and erode surrounding structures) (J. Klein, supra (1995)). Web site: http://www.delphion.com/details?pn=US06423694__

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Method of treatment Inventor(s): Lezdey; Darren (Indian Rock Beach, FL), Lezdey; John (Voorhees, NJ) Assignee(s): J & D Sciences, Inc. (Safety Harbor, FL) Patent Number: 6,174,859 Date filed: April 6, 1999 Abstract: The present invention provides a method and composition for treating eye and ear infections from parasites and eye and ear infections, characterized by the presence of pseudomonas and increased kallikrein and kinin activity. The compositions contain a protease inhibitor selected from the group consisting of alpha 1-antitrypsin, secretory leucocyte protease inhibitor and antiplasmin inhibitor, a steroidal antiphlogistic compound, and a non-steroidal antiphlogistic compound and optionally hyaluronic acid. Excerpt(s): The present invention relates to a method of treating eye and ear infections resulting from parasites and/or infections characterized by the presence of pseudomonas, increased kallikrein and kinin activity. More particularly, there is provided compositions containing a protease inhibitor selected from the group consisting of alpha 1-antitrypsin (AAT), secretory leucocyte protease inhibitor (SLPI) and anti-plasmin inhibitor. Arachidic acid is liberated in damaged, wounded, or inflamed tissues from phospholipids of cytoplasmatic membranes by the action of phospholipase enzyme and may be then metabolized by the cyclooxygenase cycle (by lipoxygenase enzyme) to prostanoids and eicosanoids. Antiphlogistics of both the steroid and nonsteroid nature, antibiotics, and sulfonamides are often used for therapeutic purposes. The antibiotics which specifically suppress pathogenic microbes and are often used in ophthalmology, are tetracycline, chloramphenicol, bacitracin, and neomycin. Therapeutics which prevent the development of inflammation (antiphlogistics) are both steroid and nonsteroid. The steroid antiphlogistics (e.g., dexamethasone block phospholipase. The anti-inflammatory drugs of nonsteroid nature (e.g., indomethacin, flurbiprofen, pirprofen) block cyclooxygenase and others. The blockage of these enzymes is important, because the products formed in metabolic cycles have a strong chemotactic effect (they cause accumulation of leukocytes in the sites of origin), (e.g., some leucotrienes) and increase the vascular permeability. This contributes to an excess development of the inflammation. Inflammations, (both of infectious and noninfectious origin) are very dangerous for the anterior and posterior segments of the eye. Thus, scars formed in the cornea during the final stage of the healing process cause the loss of an exceptional function of this tissue, i.e. transparency. The loss of transparency of optical media of the eye (cornea, lens) then leads to a reduction or even loss of sight. A disadvantage of locally applied antiphlogistics is the relatively low efficiency, retarded healing, and contribution to the development of infection. The local effect of antibiotics is limited. Web site: http://www.delphion.com/details?pn=US06174859__

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Methods and compositions for treating sinusitis, otitis media and other related disorders using antihistamines Inventor(s): Johnson; Nancy R. (Westfield, NJ) Assignee(s): Schering Corporation (Kenilworth, NJ) Patent Number: 6,297,227 Date filed: September 9, 1999 Abstract: The present invention discloses antibiotic-excluded compositions and methods to treat non-infective sinusitis and otitis media. The compositions comprise a therapeutically effective amount of a corticosteroid, and the methods comprise administering a pharmaceutical composition comprising a therapeutically effective amount of a corticosteroid. Preferred corticosteroids are mometasone furoate and mometasone furoate monohydrate. Excerpt(s): The present invention generally relates to methods of treating sinusitis and otitis media (including otitis media with effusion and persistent middle ear effusion) involving the administration of a therapeutically effective amount of a corticosteroid. It specifically relates to such treatment involving the administration of a therapeutically effective amount of mometasone furoate. The subject matter of this patent application is related to that disclosed in pending U.S. patent applications, Ser. No. 09/391,795 filed of even date herewith, Ser. No. 08/376,506, filed Jan. 23, 1995, and Ser. No. 07/984,573, filed Apr. 29, 1998. Sinusitis is the most frequently reported chronic disease in the United States, affecting more than 14% of the population. Sinusitis is an inflammation of the mucosa of the paranasal sinuses. Generally, there is an allergic cause to sinusitis. Otitis media, like sinusitis, is also generally considered to have an allergic cause. These are also characterized by retention of thickened respiratory secretions; however, the inflammation is manifest in the ear rather than in the sinuses. A discussion of sinusitis and otitis media can be found in Conn's Current Therapy, 235 (1997); Diseases of the Sinuses--A Comprehensive Textbook of Diagnosis and Treatment, ed. M. E. Gershwin et al, Human Press, Totowa, N.J., pages 151-157 (1996); and Allergy--Principles and Practice, Volume II, ed. E. Middleton, Jr. et al, Mosby-Year Book, Inc., New York, pages 1027-1033 (1998). Also, a review of sinusitis and related facts is given by Z. Pelikan, "The Role of Allergy in Sinus Disease", Clinical Reviews in Allergy and Immunology, 16, 55156 (1998). Sinusitis and otitis media are often typically treated as infectious diseases. The treatment typically includes administration of an antibiotic along with a corticosteroid and an antihistamine, or a nasal decongestant. such as described in, for example, J. Braun et al, Allergy, 52 (6) 650-655 (1997). There are, however, occasions, when the sinusitis or otitis media is not necessarily accompanied by an infection. This is particularly true when the disease is associated with allergic rhinitis. At those times, administration of an antibiotic may not be needed. Physicians, however, do not generally administer corticosteroids for these indications without accompanying antibiotic. Web site: http://www.delphion.com/details?pn=US06297227__

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Otitis media vaccine Inventor(s): Bakaletz; Lauren O. (Columbus, OH), Kolattukudy; Pappachan E. (Columbus, OH), Sirakova; Tatiana (Columbus, OH) Assignee(s): The Ohio State University Research Foundation (Columbus, OH) Patent Number: 6,562,349 Date filed: November 29, 1999 Abstract: It has been discovered that a vaccine comprised of fimbrin, a filamentous protein derived from the bacterial surface appendages of non-typable Haemophilus influenzae is useful in studying, preventing or reducing the severity of, otitis media. The gene sequence of the DNA coding for fimbrin and the amino acid sequence of fimbrin have also been determined. Vectors containing DNA coding for fimbrin have also been developed, and transformants have been prepared which contain such vectors and which express such DNA and provide a source of pure fimbrin. Excerpt(s): Otitis media is an infection of the middle ear that occurs primarily in children. Left untreated, the disease can result in hearing loss, and developmental delays. It is estimated that otitis media accounted for 31 million of the 130 million office visits for respiratory diseases in the period from 1987-87. Recent data indicate that suppurative and unspecified otitis media rank first in the list of the 30 most common diagnoses requiring a physician's office visit for patients up to age 24. Over one billion dollars per year is spent on treatment of this disease and the related loss of income for working parents is estimated to be between $300 and $600 million. Approximately 83% of all children by three years of age will have had at least one episode of acute otitis media. Non-typable strains of Haemophilus influenzae account for 25-30% of all cases of otitis media, 53% of recurrent otitis media, and are the primary pathogens isolated from 62% of cases of chronic otitis media with effusion. Although non-typable Haemophilus influenzae (NTHi) are primary pathogens in otitis media, neither the pathogenic mechanisms nor the host immunological response has been fully defined for this disease. It would be desirable to have a vaccine to confer immunity to non-typable Haemophilus influenzae or to reduce the severity of otitis media caused by Haemophilus influenzae. Web site: http://www.delphion.com/details?pn=US06562349__

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Plush toy with ear system for displaying normal and abnormal eardrums Inventor(s): Burgio; Paul A. (4279 Brigadoon, Shoreview, MN 55126), Nelms, Jr.; C. Randall (15 Ridge Rd., N. Oaks, St. Paul, MN 55127) Assignee(s): none reported Patent Number: 4,944,681 Date filed: January 11, 1989 Abstract: An ear examination simulator unit for use by parents, children and health care professionals to recognize ear disorders in children includes an ear structure simulator module that is mounted within a head portion of a furry racoon or the like animal facsimile. The ear structure simulator module includes a tube body having orifices defined in ends thereof for receiving an otoscope or other examination tool. Mounted within the tube portion is a semi-translucent membrane and a photographic slide depicting an eardrum in normal or various diseased states. A source of illumination

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provides light which is distributed by the membrane in order to provide back lighting of the images on the photograpic slide. In addition, the membrane may be textured and colored so as to simulate a human eardrum in its healthy state. The plush toy provides comfort to the child during painful bouts of ear infections and during ear surgery. Excerpt(s): The present invention relates to ear examination simulators which may be used by parents, educators or the like to develop the skills to use an otoscope and the skill to recognize normal and diseased eardrums. More particularly, the present invention relates to an ear examination simulator unit which may be mounted within the head of a plush toy such as a teddy bear so that it may readily be used as a teaching tool for parents and children alike. Teaching devices have been used in medical schools and other advanced educational environments to teach the anatomical details of the human ear. An example of such a device is described in U.S. Pat. No. 2,778,125 to Hantman. The Hantman device simulates the various physical features of the interior of the human ear, ear canal and eardrum. Unfortunately, though, it fails to provide any images for students to view of an ear in various states of disease. In addition, these types of teaching tools are fairly expensive, which makes them prohibitive for use by school nurses or parents in diagnosing ear disorders of children. It is clear that there has existed a long and unfilled need in the prior art for an ear examination simulator unit for use in practicing ear examinations which is not prohibitively expensive, is capable of showing an ear in various diseased states and may conveniently be used by parents, health care professionals and children to diagnose ear disorders. Web site: http://www.delphion.com/details?pn=US04944681__ •

Pogostemon cablin extract for inhibiting H. influenzae adhesion and treating otitis media or sore throat Inventor(s): Hwang; Shie-Ming (Columbus, OH), Tsai; Hsiu-Hsien (Chang-Huah, TW) Assignee(s): Sage R&D, a partnership (Columbus, OH) Patent Number: 5,776,462 Date filed: December 10, 1996 Abstract: The attachment of H. influenzae to human cells such as oropharyngeal cells, is inhibited by aqueous extracts of the plants known as Pogostemon cablin and Agastache rugosa. The composition obtained from the aqueous extraction of the plants Pogostemon cablin, Agastache rugosa or mixtures thereof is also effective in preventing or treating Otitis media and sore throat. The plant extract may be contained in a liquid enteral product such as an infant formula or may be incorporated into lozenges, candies, chewing gums and the like. The plant extract may also be administered as a throat spray or nasally using drops or a spray. A process for the production of a medicinal product is also disclosed. Excerpt(s): This invention relates to the inhibition of Haemophilus influenzae (hereinafter "H. Influenzae") attachment to human cells, more specifically the nasopharynx system, and thereby provide for the prevention and treatment of Otitis media and sore throat in humans. In this invention an aqueous extract from the plant Pogostemon cablin or the plant Agastache rugosa is disclosed to treat and to effectively relieve humans from H. Influenzae infections, Otitis media and sore throat. The extracts of the plants have shown good anti-H. Influenzae activity in human trials and a neonatal rat model. H. Influenzae is a bacteria known to cause Otitis media and sore throat in humans. Modern medical science is constantly searching for new and more powerful

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agents to prevent, treat or retard bacterial and viral infections and cure the diseases they cause. Bacterial and viral infections of humans and domestic animals cost billions of dollars annually. Vast sums of money are spent each year by pharmaceutical companies to identify, characterize and produce new antibiotics and anti-virals to combat the emerging drug resistant strains which have become a serious problem. Reliable prophylactic treatments for disease prevention are also of major interest. Otitis media is the second most common cause for outpatient visits by the pediatric population of the United States, following upper respiratory tract infections. Antibiotic and surgical approaches have been used for treatment. Non-typable H. Influenzae is associated with many cases of Otitis media and is considered the leading causative agent of chronic Otitis media with effusion. Web site: http://www.delphion.com/details?pn=US05776462__ •

Therapeutic use of DMDM Hydantoin Inventor(s): Andermann; Guy (2, Rond Point de l'Esplanade, F 67000 Strasbourg, FR) Assignee(s): none reported Patent Number: 5,036,095 Date filed: November 14, 1989 Abstract: This invention is for the use of DMDM Hydantoin as a pharmaceutical compound for the treatment of malconditions of mammalian and human skin and membranes. In particular, DMDM Hydantoin may be used to treat dermatological conditions such as acne, burns, and lacerations. DMDM Hydantoin may also be used as an aqueous spray, mouthwash and may be used to treat eye and ear infections as well as to treat mastitis in cattle. Excerpt(s): This invention relates generally to the field of pharmaceutical preparations and more particularly to pharmaceutical preparations employing DMDM Hydantoin as an active ingredient. As stated above, DMDM Hydantoin has found application as a preservative in a wide variety of non-therapeutic products, and literature has been published in that respect both alone and in combination with other preservatives. To this date, there has been no suggestion that DMDM could be useful beyond the field of human and animal diseases. The general purpose of the present invention relates to the therapeutic use of DMDM Hydantoin as a pharmaceutical composition in association with carriers for topical application to mammalian skin and other membranes for use in the treatment in diseases thereof. In particular, DMDM Hydantoin has been found to be useful for the non-antibiotic chemotherapeutic treatment of humans and other mammals for which prophylactic and curative purposes, where the use of antibiotics would be undesirable. Web site: http://www.delphion.com/details?pn=US05036095__

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Treatment of otitis media by sublingual administration of DNA Inventor(s): Allen; Michael (Sacramento, CA), McMichael; John (Delanson, NY) Assignee(s): Milkhaus Laboratory (Delanson, NY) Patent Number: 5,948,768 Date filed: July 28, 1998

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Abstract: Methods for treating symptoms of otitis media in a patient, are presented. Methods comprise administering an effective amount of DNA to a subject in a manner so as not to effect gene transfer. Excerpt(s): The present invention relates to methods for treatment of otitis media. The present invention relates generally to methods for treatment of pulmonary diseases and diseases associated with upper respiratory tract infection. Such diseases, including cystic fibrosis, emphysema, chronic bronchitis, sinusitis, and the common cold, have in common bronchial or sinus congestion, production of large amounts of sputum, and the possibility of secondary bacterial infection requiring antibiotic therapy. Acute otitis media is a bacterial or viral infection in the middle ear which is usually secondary to upper respiratory tract infections and is most common in children. Microorganisms may migrate from the nasopharynx to the middle ear over the surface of the eustachian tube's mucous membrane or by propagating in the lamina propria of the mucous membrane as a spreading cellulitis or thrombophlebitis. Pain and hearing loss are the most common presenting complaints although fever, nausea, vomiting and diarrhea may occur in young children. Therapy for acute otitis media includes analgesics, decongestants and antibiotics. In addition, topical vasoconstrictors may be administered into the nasal cavity to improve eustachian tube function. Further, systemic sympathomimetic amines such as ephedrine sulfate may also be administered. Web site: http://www.delphion.com/details?pn=US05948768__ •

Use of indigestible oligosaccharides to reduce the incidence of otitis media in humans Inventor(s): Dohnalek; Margaret Ione Halpin (Worthington, OH), Hilty; Milo Duane (Lewis Center, OH), Ostrom; Karin Margaret (Reynoldsburg, OH) Assignee(s): Abbott Laboratories (Abbott Park, IL) Patent Number: 5,849,324 Date filed: June 12, 1996 Abstract: A method is provided for reducing the incidence of otitis media in infants and young children by enterally administering indigestible fructooligosaccharides. More specifically, the present invention relates to a method for reducing the incidence of otitis media comprising administering to humans an indigestible fructooligosaccharide selected from the group consisting of 1-kestose, nystose and 1-.sup.F -B-fructofuranosyl nystose. The indigestible fructooligosaccharides can be produced through enzymatic synthesis, chemical techniques or isolated from plant materials and are administered in the form of a nutritional product, candy, tablets, chewing gums, lozenges, milk products, yogurts and the like. In a preferred embodiment of this invention, the fructooligosaccharides have a DP of 2 to 20 and still more preferably are the fructooligosaccharides FG.sub.2, GF.sub.3, and GF.sub.4. Excerpt(s): This application claims benefit of U.S. Provisional Application No. 60/001,000 filed Jul. 10, 1995. The present invention relates to a method for reducing the incidence of otitis media by enterally administering to humans an indigestible oligosaccharide. Prevention of otitis media in young children is a significant public health problem that has not been solved. Methods of prevention presently available are limited to practices that reduce transmission of infectious agents to susceptible individuals. Such methods include provision of clean water, hand washing, and good personal hygiene. The development of effective vaccines to prevent otitis media has

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been limited because of the large number of potential pathogens that can cause this disease and because young children, who are at greatest risk, often fail to develop effective immunity. Individuals treated with antibiotics for otitis media and other infectious diseases may become colonized with antibiotic-resistant bacteria and may not respond to antibiotic treatment. Web site: http://www.delphion.com/details?pn=US05849324__

Patent Applications on Ear Infections As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to ear infections: •

Composition and method for treating the over-production of mucin in diseases such as otitis media using an inhibitor of MUC5AC Inventor(s): Basbaum, Carol; (San Francisco, CA), Kim, Young S.; (Hillsborough, CA), Li, Jian-Dong; (Glendale, CA), Lim, David; (Pasadena, CA), Shuto, Tsuyoshi; (Kumamoto, JP), Wang, Beinan; (Glendale, CA), Xu, Haidong; (Glendale, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 2040 Main Street; Fourteenth Floor; Irvine; CA; 91614; US Patent Application Number: 20020151491 Date filed: November 27, 2001 Abstract: Disclosed herein is a method for the identification of a treatment for overproduction of mucin during otitis media (OM) and chronic obstructive pulmonary disease (COPD). The method uses a MUC5AC plasmid to identify novel cytoplasmic proteins of Nontypeable Haemophilus influenzae, a common mediator of OM and COPD, which up-regulate human MUC5AC mucin transcription via a positive p38 MAP kinase pathway and a negative PI 3-Kinase-Akt pathway. These proteins can be used to identify or design inhibitors of the p38 MAP kinase pathway and activators of the PI 3kinase Akt pathway. Excerpt(s): The present invention provides for methods of identifying compounds for treating medical conditions related to the inappropriate overproduction of mucin in the middle ear and respiratory system, as well as compounds and methods for treating such conditions. More specifically, the present invention identifies methods of treating mucin overproduction with P38 MAP kinase inhibitors or PI 3 kinase activators. The overproduction of mucin is associated with diseases such as Otitis media (OM), the most common childhood infection and also the leading cause of conductive hearing loss in children, and chronic obstructive pulmonary disease (COPD), a lower respiratory tract infection and the fourth leading cause of death in the United States. While it has been shown that overproduction of mucin, the major protein of mucus in the middle ear, plays an important role in the development of conductive hearing loss, little is known about the causes of and molecular mechanisms underlying mucin overproduction. Moreover, inappropriate antibiotic treatment of OM contributes to the worldwide emergence of multidrug-resistant strains of bacterial pathogens. Thus, due to

10

This has been a common practice outside the United States prior to December 2000.

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the prevalence, long-term sequelae and the cost to our society, there is an urgent need for the development of novel therapeutic strategies. Nontypeable Haemophilus influenzae (NTHi) is an important human pathogen in both children and adults. In children, it causes otitis media (OM), the most common childhood infection and the leading cause of conductive hearing loss in the United States. In adults, it causes lower respiratory tract infections in the setting of chronic obstructive pulmonary disease (COPD). The molecular mechanisms underlying the pathogenesis of NTHi-induced infections remain undefined. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Composition and method for treatment of otitis media Inventor(s): Mautone, Alan J.; (Morristown, NJ) Correspondence: Richard L. Strauss, ESQ.; 2492 Oceanside Road; Oceanside; NY; 11572; US Patent Application Number: 20020064503 Date filed: December 4, 2001 Abstract: A process, composition and method for increasing and enhancing mammalian eustachian tube lumen patency and pressure equalization performance is disclosed wherein an aerosolized mixture of lipid crystals comprised of a mixture of one or more lipids surfactants and one or more spreading agents selected from the group consisting of sterols, lipids, fatty acids, cholesteryl esters, phospholipids, carbohydrates, and proteins, in powder form, and one or more propellants, in which the lipid surfactants and spreading agents are not soluble, are administered through a mammalian airway orifice. Upon administration, the propellant(s) are evaporated from the mixture and the lipid crystals are deposited within a subject mammalian eustachian tube whereupon said lipid crystals come into contact with lumen surfaces of the tube forming an amorphous spread film thereupon substantially decreasing the opening pressure of the lumen. In a second preferred embodiment, a therapeutically active agent effective in the treatment of otitis media is added to the mixture of lipid crystals and upon administration of said aerosol mixture, the amorphous spread film formed thereby carries said therapeutically active agent through the eustachian tube to the tissues of the middle ear. In an alternate preferred embodiment, the afore-mentioned reduction of surface tension and delivery of therapeutically active agents is provided by a mixture of lipid crystals comprised of surfactant(s), therapeutically active agents and a propellant in which such other components are not soluble. Excerpt(s): This application is a continuation-in-part of U.S. patent application No. 09/639,682 filed on Aug. 16, 2000, which said application is a continuation of U.S. patent application No. 09/450,884 filed Nov. 28, 1999 and issued as U.S. Pat. No. 6,156,294 on Dec. 5, 2001. The present invention relates to the field of pharmacological compositions and methods of utilizing such compositions in order to improve the flow of both naturally occurring fluids and pharmacologic agents through the mammalian eustachian tube. Otitis media is a pathological condition common to mammalian species and most common to children. During episodes of otitis media, fluid accumulates in the middle ear or, as it is also known, the tympanic cavity. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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•

Composition for inhibition of H. influenzae and treatment of otitis media and sore throat Inventor(s): Hwang, Shie-Ming; (Columbus, OH) Correspondence: Donald O. Nickey; 8765 Colvin Drive; Plain City; OH; 43064; US Patent Application Number: 20020106416 Date filed: January 30, 2002 Abstract: The attachment of H. influenzae to human cells such as oropharyngeal cells, is inhibited by aqueous extracts of the plants known as Pogostemon cablin and Agastache rugosa. The composition obtained from the aqueous extraction of the plants Pogostemon cablin, Agastache rugosa or mixtures thereof is also effective in preventing or treating Otitis media and sore throat. The plant extract may be contained in a liquid enteral product such as an infant formula or may be incorporated into lozenges, candies, chewing gums and the like. The plant extract may also be administered as a throat spray or nasally using drops or a spray. A process for the production of a medicinal product is also disclosed. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/344,445 filed Feb. 13, 1998, now U.S. Pat. No. ______; which is a Divisional of U.S. patent application Ser. No. 08/761,321 filed Dec. 10, 1996, now U.S. Pat. No. 5,776,462. This invention relates to a composition for the inhibition of Haemophilus influenzae (hereinafter "H. Influenzae") attachment to human cells, more specifically the nasopharynx system, and thereby provide for the prevention and treatment of Otitis media and sore throat in humans. In this invention, a composition from an aqueous extract from the plant Pogostemon cablin or the plant Agastache rugosa has been isolated to treat and to effectively relieve humans from H. Influenzae infections, Otitis media and sore throat. The compositions have shown good anti-H. Influenzae activity in human trials and a neonatal rat model. H. Influenzae is a bacteria known to cause Otitis media and sore throat in humans. Modern medical science is constantly searching for new and more powerful agents to prevent, treat or retard bacterial and viral infections and cure the diseases they cause. Bacterial and viral infections of humans and domestic animals cost billions of dollars annually. Vast sums of money are spent each year by pharmaceutical companies to identify, characterize and produce new antibiotics and anti-virals to combat the emerging drug resistant strains which have become a serious problem. Reliable prophylactic treatments for disease prevention are also of major interest. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Cromolyn for eye and ear infections Inventor(s): Kronis, K. Anne; (Tampa, FL), Lezdey, Darren; (Indian Rock Beach, FL), Lezdey, John; (Indian Rock Beach, FL) Correspondence: John Lezdey & Associates; Suite A; 1409 N. FT. Harrison; Clearwater; FL; 33755; US Patent Application Number: 20020091100 Date filed: January 5, 2001 Abstract: The present invention provides a method and composition for treating eye and ear inflammation and eye and ear infections. The compositions contain a cromolyn

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compound alone or in combination with a corticosteroid. A steroidal antiphlogistic compound, a non-steroidal antiphlogistic compound and optionally hyaluronic acid may be added. Excerpt(s): The present invention relates to a method of treating eye and ear infections including those resulting from parasites and/or infections characterized by the presence of inflammation, increased kallikrein and kinin activity. More particularly, there is provided compositions containing a cromolyn compound alone or in combination with a corticosteroid. Aracadonic acid is liberated in damaged, wounded, or inflamed tissues from phospholipids of cytoplasmatic membranes by the action of phospholipase enzyme and may be then metabolized by the cyclooxygenase cycle (by lipoxygenase enzyme) to prostanoids and eicosanoids. Antiphlogistics of both the steroid and nonsteroid nature, antibiotics, and sulfonamides are often used for therapeutic purposes. The antibiotics which specifically suppress pathogenic microbes and are often used in ophthalmology, are tetracycline, chloramphenicol, bacitracin, and neomycin. Therapeutics which prevent the development of inflammation (antiphlogistics) are both steroid and nonsteroid. The steroid antiphlogistics (e.g., dexamethasone block phospholipase). The anti-inflammatory drugs of nonsteroid nature (e.g., indomethacin, flurbiprofen, pirprofen) block cyclooxygenase and others. The blockage of these enzymes is important, because the products formed in metabolic cycles have a strong chemotactic effect (they cause accumulation of leukocytes in the sites of origin), (e.g., some leucotrienes) and increase the vascular permeability. This contributes to an excess development of the inflammation. Inflammations (both of infectious and noninfectious origin) are very dangerous for the anterior and posterior segments of the eye. Thus, scars formed in the cornea during the final stage of the healing process cause the loss of an exceptional function of this tissue, i.e. transparency. The loss of transparency of optical media of the eye (cornea, lens) then leads to a reduction or even loss of sight. A disadvantage of locally applied antiphlogistics is the relatively low efficiency, retarded healing, and contribution to the development of infection. The local effect of antibiotics is limited. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Method of treating middle ear infections Inventor(s): Conroy, Peter J.; (Fort Worth, TX), Wall, G. Michael; (Fort Worth, TX) Correspondence: Alcon Research, LTD.; Patrick M. Ryan(q-148); R&d Counsel; 6201 South Freeway; Fort Worth; TX; 76134-2099; US Patent Application Number: 20030139382 Date filed: September 13, 2002 Abstract: Aqueous suspension formulations containing dexamethasone and ciprofloxacin are disclosed for the treatment of middle ear infections in human patients having an open tympanic membrane. Excerpt(s): This application claims priority to U.S. Provisional Application, Serial No. 60/323,951, filed Sep. 21, 2001. This invention relates to the use of formulations of ciprofloxacin and dexamethasone to treat otic infections. Specifically, the invention relates to the topical use of such a fixed combination to treat middle ear infections in humans. External ear infections, known as acute otitis externa ("AOE"), are currently treated with oral antibiotics, topical single-entity antibiotics, or topical antibiotic/steroid combination products. An example of an oral antibiotic product used to treat AOE is

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AUGMENTIN.RTM. (amoxicillin and clavulanic acid). An example of a single-entity antibiotic product approved for topical use in treating AOE is FLOXIN.RTM. (ofloxacin). Examples of combination products approved for this use include CORTISPORIN.RTM. (hydrocortisone, neomyciri sulfate, and polymyxin b sulfate) and CIPRO.RTM.HC (ciprofloxacin and hydrocortisone). A product called SOFRADEX (gramicidin, framycetin and hydrocortisone) is available in some European countries and in Australia. External ear infections typically involve bacteria of the following types: Pseudomonas aeruginosa, Staphylococcus aureus. Staphylococcus sp. and Coryneforms. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

TOPICAL ADMINISTRATION OF OXAZOLIDINONES FOR TRANSDERMAL DELIVERY Inventor(s): FORD, CHARLES W.; (PORTAGE, MI), WATTS, JEFFREY L.; (PORTAGE, MI) Correspondence: John H. Engelmann; Pharmacia & Upjohn Company; 301 Henrietta Street; 0228-32-law; Kalamazoo; MI; 49007; US Patent Application Number: 20020009483 Date filed: May 26, 1999 Abstract: Disclosed is a method of treating a non-topical infection selected from the group consisting of ear infections, skin and soft tissue infections, acne, infected wounds, bacteremia, in a useful warm blooded mammal who is in need of such treatment which comprises topical administration of a pharmaceutical formulation containing a transdermally effective amount of an OXAZOLIDINONE. Excerpt(s): This application claims the benefit of US provisional application Ser. No. 60/088,283 filed Jun. 5, 1998, under 35 USC.sctn.119(e)(i). The present invention is a method of treating topical application of known pharmaceutically useful oxazolidinone antibacterials to treat non-topical infections. U.S. Pat. Nos. 5,164,510, 5,231,188, 5,565,571, 5,652,238, 5,688,792, 5,698,574 and 5,627,181 all disclose various oxazolidinone antibiotics which are well known to those skilled in the art. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Treating infections by administration of oxazolidinones Inventor(s): Ford, Charles W.; (Portage, MI), Watts, Jeffrey L.; (Kalamazoo, MI) Correspondence: Pharmacia & Upjohn; 301 Henrietta ST; 0228-32-law; Kalamazoo; MI; 49007; US Patent Application Number: 20030096850 Date filed: October 8, 2002 Abstract: Disclosed is a method of treating ear infections, soft-tissue infections, acne, or cellulitis in a mammal in need thereof comprising administration of Oxazolidinone in a pharmaceutical formulation or composition to the skin of the mammal at a site proximal to the site of the infection to deliver a pharmaceutically-effective amount of Oxazolidinone to the infection to have a concentration of the Oxazolidinone at the site of

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infection of about 0.5 to about 4.mu.g/ml, provided that the application for administration is not directly to the site of the infection. Excerpt(s): This application claims the benefit of U.S. provisional application Serial No. 60/328,665 filed on Oct. 11, 2001, under 35 USC 119(e)(i), which is incorporated herein by reference in its entirety. The present invention is a method of treating gram-positive infections by applying an Oxazolidinone to the skin of a mammal in need thereof to obtain a concentration of about 0.5 to about 4.mu.g/ml of the Oxazolidinone for about 40 to about 60% of the duration of dosage interval at the site of infection that is a site other than the site of application. Said method is particularly useful for treating infections including any one or more of the following: ear infections, soft-tissue infections, acne, or cellulites. The following US patents disclose various oxazolidinone antibiotics which are well known to those skilled in the art: U.S. Pat. Nos. 5,698,574; 5,688,792; 5,652,238; 5,627,181; 5,565,571; 5,231,188; and 5,164,510. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Use of antimicrobial proteins and peptides for the treatment of otitis media and paranasal sinusitis Inventor(s): Andalibi, Ali; (Studio City, CA), Ganz, Tomas; (Los Angeles, CA), Lee, HaaYung; (La Crescenta, CA), Li, Jian-Dong; (Glendale, CA), Lim, David J.; (Pasadena, CA), Webster, Paul; (Pasadena, CA) Correspondence: Knobbe Martens Olson & Bear Llp; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020141986 Date filed: November 27, 2001 Abstract: Disclosed herein is a composition and a method for the treatment of otitis media and paranasal sinusitis using human defensins, lysozyme and/or lactoferrin as a new class of non-antibiotic antimicrobials. From studies of otitis media and paranasal sinusitis, it was observed that certain innate immune modulators were important in the bodies response to the infection. Therefore, these innate immune modulators, lysozyme, lactoferrin, and defensins were tested for use as a non-antibiotic treatment for infection, particularly infections such as otitis media and sinusitis. Excerpt(s): This application claims priority of the U.S. Provisional Application 60/253,492, filed Nov. 28, 2000, herein incorporated by reference in it entirety. The invention relates generally to the use of human beta defensins, lysozyme, and lactoferrin as a new class of non-antibiotic antimicrobials. More specifically, the invention relates to the use of these antimicrobials for the treatment of otitis media and paranasal sinusitis. The rapid worldwide increase in antibiotic resistance among pathogens has given rise to an urgent need to develop new and innovative non-antibiotic approaches to prevent and manage disease. Otitis media and sinusitis are two very common infections which are difficult to treat for a number of reasons, including antibiotic resistance. Otitis media (OM) is the most prevalent infectious disease affecting young children, and the major cause of conductive hearing loss among this group. OM is also the leading indication for antibiotic therapy. OM results in 31 million annual visits to physicians' offices and is estimated to have a yearly cost exceeding $5 billion. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with ear infections, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “ear infections” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on ear infections. You can also use this procedure to view pending patent applications concerning ear infections. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON EAR INFECTIONS Overview This chapter provides bibliographic book references relating to ear infections. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on ear infections include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “ear infections” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on ear infections: •

Parent's Guide to Middle Ear Infection Source: Stanhope, N.J.: Hear You Are, Inc. 1994. 138 p. Contact: Available from Hear You Are Inc. 4 Musconetcong Avenue, Stanhope, NJ 07874. (201) 347-7662. PRICE: $24.95 plus shipping and handling. ISBN: 0962232629. Summary: This book is designed to answer parents' questions about ear infections in understandable terms. The author discusses the anatomy and physiology of the ear as well as ways to help the child with ear infections cope both at home and socially. Seven chapters cover topics including the anatomy of the ear; sound transmission; symptoms of ear infections; classification, diagnosis, prevalence, and etiology of otitis media; risk factors; hearing and its effect upon child development; medical treatment options, including drug therapy and surgery; professional therapy, including the role of the audiologist, audiology, and speech language pathology assistance; helping the child at home; and learning aids. Throughout the book, the author focuses on practical,

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everyday information to help parents whose children have problems with otitis media. The book concludes with a glossary, a bibliography, and a subject index. 63 references.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “ear infections” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “ear infections” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “ear infections” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Guide to Middle Ear Infection by Tim Peters; ISBN: 1879874113; http://www.amazon.com/exec/obidos/ASIN/1879874113/icongroupinterna

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A Parent's Guide to Middle Ear Infections by Dorinne S. Davis, E. Patricia Birsner (Editor) (1994); ISBN: 0962232629; http://www.amazon.com/exec/obidos/ASIN/0962232629/icongroupinterna

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Acute and Secretory Otitis Media; ISBN: 9062990231; http://www.amazon.com/exec/obidos/ASIN/9062990231/icongroupinterna

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Breaking the Antibiotic Habit: A Parent's Guide to Coughs, Colds, Ear Infections, and Sore Throats by Paul A. Offit (Author), et al; ISBN: 0471319821; http://www.amazon.com/exec/obidos/ASIN/0471319821/icongroupinterna

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Childhood Ear Infections: A Parent's Guide to Alternative Treatments by Michael A. Schmidt (Author) (2003); ISBN: 1556434421; http://www.amazon.com/exec/obidos/ASIN/1556434421/icongroupinterna

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Childhood Ear Infections: What Every Parent and Doctor Should Know About Prevention, Home Care, and Alternative Treatment by Michael A. Schmidt, Lendon H. Smith; ISBN: 1556430892; http://www.amazon.com/exec/obidos/ASIN/1556430892/icongroupinterna

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Clare Has An Ear Infection (Doctor Toby Books) by Andrew Pattison, Virginia Barrett (Illustrator); ISBN: 0947062327; http://www.amazon.com/exec/obidos/ASIN/0947062327/icongroupinterna

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Conquering Otitis Media by Charles D. Bluestone, et al; ISBN: 1896998054; http://www.amazon.com/exec/obidos/ASIN/1896998054/icongroupinterna

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Diseases Explained: Otitis Media Wall Chart by Lexi-Comp; ISBN: 193059819X; http://www.amazon.com/exec/obidos/ASIN/193059819X/icongroupinterna

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Ear infections and language development how ear infections and middle ear fluid might affect your child's language development : what you can do to help (SuDoc ED 1.310/2:443571) by Joanne Erwick Roberts; ISBN: B000115828; http://www.amazon.com/exec/obidos/ASIN/B000115828/icongroupinterna

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Ear infections facts for parents about otitis media (SuDoc HE 20.3652:EA 7) by U.S. Dept of Health and Human Services; ISBN: B000115YC2; http://www.amazon.com/exec/obidos/ASIN/B000115YC2/icongroupinterna

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Ear Infections in Your Child by Kenneth, M.D. Grundfast, Cynthia J. Carney (Contributor); ISBN: 0446389315; http://www.amazon.com/exec/obidos/ASIN/0446389315/icongroupinterna

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Ear, Nose, and Throat Disorders Sourcebook: Basic Information About Disorders of the Ears, Nose, Sinus Cavities, Pharynx, and Larynx Including Ear Infections, Tinnitus, Vestibular Disorders (Health Reference Series, Vol 37) by Linda M. Shin (Editor), et al (1998); ISBN: 0780802063; http://www.amazon.com/exec/obidos/ASIN/0780802063/icongroupinterna

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Ears : an owner's manual : coping with ear infections : how to use an otoscope by Rod Moser; ISBN: 0964231409; http://www.amazon.com/exec/obidos/ASIN/0964231409/icongroupinterna

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Healing Childhood Ear Infections: Prevention, Home Care, and Alternative Treatment by Michael A. Schmidt, Doris Rapp; ISBN: 155643216X; http://www.amazon.com/exec/obidos/ASIN/155643216X/icongroupinterna

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How to Stop Ear Infections.: Before They Start [LARGE PRINT] by Richard Herklots, Lynn Herklots (Illustrator) (1998); ISBN: 0962076031; http://www.amazon.com/exec/obidos/ASIN/0962076031/icongroupinterna

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Language Learning and Otitis Media; ISBN: 0890793247; http://www.amazon.com/exec/obidos/ASIN/0890793247/icongroupinterna

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My Ear Hurts: A Complete Guide to Understanding and Treating Your Child's Ear Infections by Ellen M. Friedman, et al (2001); ISBN: 0684873001; http://www.amazon.com/exec/obidos/ASIN/0684873001/icongroupinterna

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Office visits for otitis media : United States, 1975-90 (SuDoc HE 20.6209/3:214) by Susan M. Schappert; ISBN: B00010CO6M; http://www.amazon.com/exec/obidos/ASIN/B00010CO6M/icongroupinterna

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Otitis media : facts for parents (SuDoc HE 20.3652:OT 4) by U.S. Dept of Health and Human Services; ISBN: B000113X20; http://www.amazon.com/exec/obidos/ASIN/B000113X20/icongroupinterna

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Otitis Media and Sinusitis by Russell W. Steele; ISBN: 1581110383; http://www.amazon.com/exec/obidos/ASIN/1581110383/icongroupinterna

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Otitis Media Coping With the Effects in the Classroom by D. Davis; ISBN: 0962232602; http://www.amazon.com/exec/obidos/ASIN/0962232602/icongroupinterna

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Otitis Media Effusion in Children by David Chalmers (Author); ISBN: 0901260770; http://www.amazon.com/exec/obidos/ASIN/0901260770/icongroupinterna

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Otitis Media in Children: A Controversial Issue by Jean-Philippe Guyot (Editor) (1999); ISBN: 3805568355; http://www.amazon.com/exec/obidos/ASIN/3805568355/icongroupinterna

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Otitis media in early childhood and its relationship to later speech and language (SuDoc ED 1.310/2:312801) by U.S. Dept of Education; ISBN: B00010FLQM; http://www.amazon.com/exec/obidos/ASIN/B00010FLQM/icongroupinterna

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Otitis Media Today by M. Tos (Editor), et al; ISBN: 9062991653; http://www.amazon.com/exec/obidos/ASIN/9062991653/icongroupinterna

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Otitis Media with Effusion in Children by David Chalmers (Author), et al (1991); ISBN: 0521412242; http://www.amazon.com/exec/obidos/ASIN/0521412242/icongroupinterna

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Otitis Media With Effusion in Children (1991); ISBN: 0632024674; http://www.amazon.com/exec/obidos/ASIN/0632024674/icongroupinterna

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Otitis media with effusion in children (SuDoc HE 20.6520/4:12) by U.S. Dept of Health and Human Services; ISBN: B00010Q0OE; http://www.amazon.com/exec/obidos/ASIN/B00010Q0OE/icongroupinterna

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Otitis media; proceedings; ISBN: 0398022941; http://www.amazon.com/exec/obidos/ASIN/0398022941/icongroupinterna

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Recent Advances in Otitis Media by Goro Mogi, et al; ISBN: 9062991017; http://www.amazon.com/exec/obidos/ASIN/9062991017/icongroupinterna

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Recent Advances in Otitis Media With Effusion: Proceedings of the Third International Symposium, May 17-20, 1983 Fort Lauderdale, Florida by David J. Lim, et al; ISBN: 0801630088; http://www.amazon.com/exec/obidos/ASIN/0801630088/icongroupinterna

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Screening Children's Hearing: A Review of the Literature and Implications of Otitis Media by Mark Haggard, Eamonn Hughes; ISBN: 0113212100; http://www.amazon.com/exec/obidos/ASIN/0113212100/icongroupinterna

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Targeted Therapies in Otitis Media and Otitis Externa by Charles D., MD Bluestone, et al (2003); ISBN: 1550092553; http://www.amazon.com/exec/obidos/ASIN/1550092553/icongroupinterna

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The Natural Health Guide to Beating the Supergerms: and Other Infections, Including Colds, Flus, Ear Infections and Even HIV by Richard P. Huemer MD, et al (1997); ISBN: 0671537644; http://www.amazon.com/exec/obidos/ASIN/0671537644/icongroupinterna

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The Parent's Complete Guide to Ear Infections by Alan R. Greene (1997); ISBN: 1882606299; http://www.amazon.com/exec/obidos/ASIN/1882606299/icongroupinterna

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The Relationship Between Inflammation and Structural Changes in the Airways of the Lower and Upper Respiratory Tract: Studies in Patients With Asthma, Sjogren's Syndrome, Rhinitis and Children With Otitis Media With Effusion (Comprehensive Summaries of Uppsala Dissertations, 932) by Kawa Amin (2000); ISBN: 9155447279; http://www.amazon.com/exec/obidos/ASIN/9155447279/icongroupinterna

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Understanding Ear Infections by Peter Allen (1993); ISBN: 0962232610; http://www.amazon.com/exec/obidos/ASIN/0962232610/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “ear infections” (or synonyms) into the search box, and select “books

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only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Ear infections in your child Author: Grundfast, Kenneth.; Year: 1987; Hollywood, Fla.: F. Fell Publishers, 1987; ISBN: 0811907228 http://www.amazon.com/exec/obidos/ASIN/0811907228/icongroupinterna

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Ear infections in your child: the comprehensive parental guide to causes and treatments Author: Grundfast, Kenneth.; Year: 1986; Hollywood, FL: Compact Books, 1986; ISBN: 0936320222 http://www.amazon.com/exec/obidos/ASIN/0936320222/icongroupinterna

Chapters on Ear Infections In order to find chapters that specifically relate to ear infections, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and ear infections using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “ear infections” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on ear infections: •

Complications of Chronic Otitis Media Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 433-445. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Chronic otitis media (COM) is a common otologic (ear) condition characterized by a condition of chronic infection and otorrhea (drainage from the ear) through a tympanic membrane (eardrum) perforation. This chapter on the complications of COM is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. In this chapter, the author discusses extracranial and extratemporal complications of COM, intratemporal complications, and intracranial complications of the disease. The author notes that host-related factors, such as impaired resistance to disease or unfavorable anatomy, and microbiologic factors, such as bacterial invasiveness or degree of antimicrobial resistance, are intertwined in the pathophysiology of complications of COM. 7 figures. 64 references.

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Chronic Otitis Media and Cholesteatoma Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 409-431. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: Chronic otitis media (COM) is an unresolved inflammatory process of the middle ear and mastoid. The disease nearly always is associated with tympanic membrane (eardrum) perforation and may be active when infection and otorrhea (drainage from the ear) are present or quiet when they are absent. Cholesteatoma is a tumor like lesion of the temporal bone, causing an ingrowth of skin which invades the middle ear and the mastoid spaces. This chapter on COM and cholesteatoma is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. In the section on COM, the authors discuss definition, etiology, bacteriology, pathology, sensorineural hearing loss, history and physical findings, audiologic examination, vestibular examination, radiographic evaluation, medical treatment, tuberculous otomastoiditis, nontuberculous mycobacteria and COM, and Wegener's granulomatosis. In the section on cholesteatoma, the authors cover definition, pathology and pathogenesis of acquired cholesteatoma, growth patterns of cholesteatoma, epitympanic cholesteatomas, posterior mesotympanic cholesteatomas, history and physical findings of acquired cholesteatoma, audiologic examination, radiographic evaluation, the medical management of cholesteatomas, cholesteatomas in children, and congenital cholesteatoma. T39 figures. 123 references.

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Relationship of Otitis Media to Speech Processing and Language Development Source: in Katz, J.; Stecker, N.; Henderson, D. Central Auditory Processing: A Transdisciplinary View. St. Louis, MO: Mosby-Year Book, Inc. 1992. p. 187-197. Contact: Available from Mosby-Year Book, Inc. 11830 Westline Industrial Drive, P.O. Box 46908, St. Louis, MO 63146. (800) 426-4545; Fax (800) 535-9935; E-mail: [email protected].; http://www.mosby.com. PRICE: $43.95 plus shipping and handling. ISBN: 1556643721. Summary: This book chapter focuses on the relationship between fluctuating peripheral hearing loss caused by persistent otitis media (middle ear infection) and the development of speech processing. The author briefly reviews some of the research results that led to the current controversy over the role of frequent ear infections in the development of speech and language in children. The author concludes that, while the hearing loss associated with otitis media can be measured consistently, the related language effects cannot be so quantified. Otitis media appears to lead to differences in language development of different kinds during different periods of development. A consistent finding is that otitis media leads to across the board delays in language development between two and three years of age. Not enough children with early persistent otitis media suffer sufficient language delay for statistical significance. Those who do suffer delay may do so for a number of environmental reasons as well as otitis media. The author notes that the developmental language difficulties related to otitis media may be more complicated than present language evaluation can elucidate. 1 figure. 4 tables. 22 references. (AA-M).

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Acute Suppurative Otitis Media and Mastoiditis Source: in Canalis, R.F. and Lambert, P.R., eds. Ear: Comprehensive Otology. Philadelphia, PA: Lippincott Williams and Wilkins. 2000. p. 397-408. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030. Fax (301) 223-2300. Website: www.lww.com. PRICE: $179.00 plus shipping and handling. ISBN: 078171558X. Summary: This chapter is from a textbook that offers complete coverage of the field of clinical otology (study of the ear). The book is oriented to serve both the otolaryngology resident as a practical learning tool and the practicing otolaryngologist as an updated reference source of clinical and basic information. This chapter focuses on the clinical and pathologic features of acute bacterial infections of the middle ear cleft (acute otitis media) and mastoid process. In the first section, on acute otitis media, the authors discuss a definition, epidemiology, etiology, bacteriology, pathology, symptoms, physical findings, laboratory tests, hearing tests, clinical course, medical treatment, surgery (myringotomy, i.e., drainage tubes), follow up care, and complications. In the section on acute mastoiditis, the authors discuss a definition, incidence, bacteriology, pathology, symptoms, physical findings, laboratory tests, auditory tests, radiographic evaluation, medical management, and surgical management. The authors also discuss acute bullous myringitis (which involves the lateral middle ear boundary), the technique of simple mastoidectomy, and temporal bone fungal infection. 13 figures. 33 references.

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Otitis Media and Associated Complications Source: in Jafek, B.W.; Stark, A.K., eds. ENT Secrets: Questions You Will Be Asked On Rounds, In the Clinic, In the OR, On Exams. Philadelphia, PA: Hanley and Belfus. 1996. p. 39-43. Contact: Available from Hanley and Belfus. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (800) 962-1892 or (215) 546-7293; Fax (215) 790-9330; http://www.hanleyandbelfus.com. PRICE: $35.95 plus shipping and handling. ISBN: 1560531592. Summary: This chapter on otitis media and associated complications is from a book that utilizes a question and answer format to review details of the specialty of otorhinolaryngology (ear, nose and throat, or ENT). Topics covered include the terminology used to describe ear infections, the functions of the eustachian tube, the organisms most commonly found in otitis media, the organisms found in mastoiditis, the diagnosis of otitis media is diagnosed, the indications for tympanometry in the diagnosis of otitis media, hearing loss related to otitis media with effusion (OME), the problems of otitis media recurring in younger children, the medical management of acute otitis media, the medical management of chronic OME, the environmental risk factors for OME, tympanocentesis, myringotomy, the surgical options for treating otitis media, the patient selection considerations for surgery, the complications of tympanostomy tube insertion, the indications for adenoidectomy, the intratemporal complications of untreated otitis media, the intracranial complications of untreated otitis media, the significance of unilateral otitis media in an adult, and the use of steroid therapy in the treatment of OME. 8 references.

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Middle-Ear Disease (Otitis Media) Source: in Blackman, J.A. Medical Aspects of Developmental Disabilities in Children, Birth to Three. Frederick, MD: Aspen Publishers, Inc. 1997. p. 189-193.

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Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21704. (800) 638-8437; Fax (301) 417-7650. PRICE: $40.00 plus shipping and handling. ISBN: 0834207591. Summary: This chapter, from a early childhood textbook on the medical aspects of developmental disabilities in young children (birth to age three), outlines concerns related to middle ear disease (otitis media). Otitis media is an inflammatory disease of the middle ear, common in children under six years of age. The author defines two types of otitis media: acute otitis media, characterized by a red, bulging, immobile eardrum, ear pain, and bacteria and pus in the middle ear; and serous otitis media (or otitis media with effusion, OME), a more chronic condition that includes fluid in the middle ear space, which can result in varying degrees of hearing loss. Topics covered include incidence, etiology (cause), detection, course, accompanying health problems, medical management, and implications for early intervention. The most prudent course at the present time is to treat acute infections with appropriate antibiotics, to follow the status of the middle ear with pneumatic otoscopy or impedance tympanometry, and to consider various treatments for recurrent acute infections and persistent serous fluid in the middle ear. The author concludes that, because of the age group served and the types of disabilities encountered, ear infections are common in children participating in early education and therapeutic programs. Teachers and therapists must understand the nature of otitis media and appreciate its impact on health and developmental function. •

Ear Infections Source: in Andersen, R.D., et al. Infections in Children: A Sourcebook for Educators and Child Care Providers. 2nd ed. Gaithersburg, MD: Aspen Publishers, Inc. 1994. p. 91-104. Contact: Available from Aspen Publishers, Inc. 200 Orchard Drive, Gaithersburg, MD 20878. (800) 638-8437; Fax (301) 417-7650. PRICE: $39.00 plus shipping and handling. ISBN: 0834203871. Summary: This chapter, from a sourcebook on infections in children, discusses ear infections. The first section discusses acute otitis media; causes; signs and symptoms; diagnosis; management; and complications such as hearing loss, perforation of the eardrum, eardrum scarring, cholesteatoma, mastoiditis, labyrinthitis, systemic complications, learning impairment, and adverse reactions to antibiotic therapy; and recommendations. The second section of the book covers otitis media with effusion (OME), including its causes, signs and symptoms, diagnosis, management, complications, and recommendations. The final section discusses external otitis, including its causes, symptoms and diagnosis, management, and recommendations. 5 figures. 9 references.

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CHAPTER 8. MULTIMEDIA ON EAR INFECTIONS Overview In this chapter, we show you how to keep current on multimedia sources of information on ear infections. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on ear infections is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “ear infections” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “ear infections” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on ear infections: •

Ear Infections: Too Serious to Ignore Source: Princeton, NJ: Films for the Humanities and Sciences. 1996. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400; Fax (609) 275-3767; E-mail: [email protected]; http://www.films.com. PRICE: $99.00 plus shipping and handling. Stock Number BFA6425. Summary: By the age of three, about two thirds of children will be diagnosed with otitis media (infection of the middle ear). Middle ear infections are one of the most common childhood diseases and their frequency is on the rise. This program, narrated by Dr. Jerome Klein, professor of pediatrics at Boston University School of Medicine, explains why the prevalence of middle ear infections is increasing, and provides specific advice about what can be done to prevent children from being infected. The program has five sections: the risk factors for otitis media, particularly those environmental factors (like smoking, and child care options) that can be controlled; anticipated clinical course,

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including symptoms, diagnosis, and treatment issues; use of antimicrobial agents (antibiotics); middle ear effusion and accompanying problems with hearing loss; and prevention strategies, including vaccination, chemotherapy (antibiotic prophylaxis), and health education.

Bibliography: Multimedia on Ear Infections The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in ear infections (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on ear infections: •

Ear infections [videorecording]: too serious to ignore Source: a presentation of Films for the Humanities & Sciences; ITV, Information Television Network; Year: 1996; Format: Videorecording; [United States]: The Network, c1996

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Middle ear infections in children [videorecording] Source: Faculty of Health Sciences, McMaster University. [et al.]; Year: 1974; Format: Videorecording; Hamilton, Ont.: The University: [for sale by its Faculty of Health Sciences], 1974

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Pneumococcus and ear infections in children [videorecording] Source: a presentation of Films for the Humanities & Sciences; Year: 1996; Format: Videorecording; [United States]: Information Television Network, c1996

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The homeopathic treatment of people with ear infections [sound recording] Source: National Center for Homeopathy 1992; Year: 1992; Format: Sound recording; [United States: The Center?, 1992?]

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Understanding ear infections [videorecording]: a video guide for parents. Year: 2002; Format: Videorecording; Boynton Beach, FL: Distributed by Universal Health Communications, c2002

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CHAPTER 9. PERIODICALS AND NEWS ON EAR INFECTIONS Overview In this chapter, we suggest a number of news sources and present various periodicals that cover ear infections.

News Services and Press Releases One of the simplest ways of tracking press releases on ear infections is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “ear infections” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to ear infections. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “ear infections” (or synonyms). The following was recently listed in this archive for ear infections: •

Common cold drug may prolong ear infections Source: Reuters Health eLine Date: October 01, 2003

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Flu vaccine doesn't stop ear infections in kids Source: Reuters Health eLine Date: September 24, 2003

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Fewer ear infections for babies who sleep on backs Source: Reuters Health eLine Date: May 12, 2003

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Otitis media-related hearing loss not linked with decrease in academic skills Source: Reuters Medical News Date: October 11, 2002

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Ear infections do not affect child's learning Source: Reuters Health eLine Date: October 07, 2002

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Children's cavities, ear infection may be linked Source: Reuters Health eLine Date: March 28, 2002

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Group day care may increase risk of ear infections Source: Reuters Health eLine Date: December 24, 2001

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FDA okays Pfizer's Zithromax as one-dose treatment for pediatric otitis media Source: Reuters Industry Breifing Date: December 17, 2001

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CORRECTION: Pfizer earns endorsement for single-dose treatment of ear infections Source: Reuters Industry Breifing Date: November 09, 2001

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CORRECTION: Drug endorsed for 3-day ear infection treatment Source: Reuters Health eLine Date: November 09, 2001

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Pfizer earns endorsement for single-dose treatment of ear infections Source: Reuters Industry Breifing Date: November 07, 2001

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Drug endorsed for 3-day ear infection treatment Source: Reuters Health eLine Date: November 07, 2001

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Ear infection linked to childhood obesity Source: Reuters Health eLine Date: October 22, 2001

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FDA clears Glaxo's extra strength Augmentin for serious ear infections Source: Reuters Industry Breifing Date: June 25, 2001

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Child ear infections not linked to bad behavior Source: Reuters Health eLine Date: May 09, 2001

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Wyeth-Ayerst's Prevnar could prevent 1.2 million ear infections annually in US Source: Reuters Industry Breifing Date: February 08, 2001

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Vaccine shields kids from some ear infections Source: Reuters Health eLine Date: February 07, 2001

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FDA panel backs Glaxo's Augmentin ES for drug-resistant middle ear infections Source: Reuters Industry Breifing Date: January 30, 2001

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'Good' bacteria prevent repeat ear infections Source: Reuters Health eLine Date: January 26, 2001

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Oscar Wilde's death attributed to ear infection, not syphillis Source: Reuters Health eLine Date: November 24, 2000

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Ear infections may not cause academic problems Source: Reuters Health eLine Date: October 03, 2000

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SmithKline's high-dose Augmentin effective against resistant bacterial ear infections Source: Reuters Industry Breifing Date: September 20, 2000

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Restricting pacifier use may lower ear infection rates Source: Reuters Health eLine Date: September 05, 2000

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Many ear infections clear up without antibiotics Source: Reuters Health eLine Date: August 10, 2000

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Newborn's antibodies predict ear infection risk Source: Reuters Health eLine Date: May 19, 2000

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Ear infections linked to impaired speech Source: Reuters Health eLine Date: May 02, 2000

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Routine use of steroids for treatment of otitis media called into question Source: Reuters Medical News Date: March 03, 2000

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Ascent Pediatrics gets FDA approval for ear infection drug Source: Reuters Health eLine Date: January 28, 2000

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Neose terminates development of pediatric ear infection drug Source: Reuters Medical News Date: December 21, 1999

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Genes play role in child ear infections Source: Reuters Health eLine Date: December 07, 1999

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Laser-assisted myringotomy effective treatment for otitis media Source: Reuters Medical News Date: October 11, 1999

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Removing tonsils, adenoids won't help ear infections Source: Reuters Health eLine Date: September 07, 1999

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Simple measure can avoid swimmer's ear Source: Reuters Health eLine Date: August 23, 1999

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Smoking in pregnancy ups baby's ear infection risk Source: Reuters Health eLine Date: August 03, 1999

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Amoxicillin/clavulanate superior to azithromycin in treatment of acute otitis media Source: Reuters Medical News Date: May 06, 1999

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Day care raises child cold, ear infection risk Source: Reuters Health eLine Date: April 05, 1999

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Timing of surgery for otitis media with effusion does not affect speech Source: Reuters Medical News Date: March 22, 1999

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Viruses may contribute to ear infection Source: Reuters Health eLine Date: January 27, 1999

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CDC issues ear infection "battle plan" Source: Reuters Health eLine Date: January 20, 1999

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Laser promising for kids' ear infections Source: Reuters Health eLine Date: September 18, 1998

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Viruses may cause ear infection Source: Reuters Health eLine Date: August 04, 1998

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Link between otitis media, home environment and learning problems reported Source: Reuters Medical News Date: August 04, 1998

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Ear infections linked to caregiving Source: Reuters Health eLine Date: August 03, 1998

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Short antibiotic course treats ear infection Source: Reuters Health eLine Date: June 02, 1998

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Bacteria Test For Ear Infection Source: Reuters Health eLine Date: January 27, 1998

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Ear Infection Antibiotics Overprescribed Source: Reuters Health eLine Date: November 25, 1997

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “ear infections” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “ear infections” (or synonyms). If you know the name of a company that is relevant to ear infections, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “ear infections” (or synonyms).

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly

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to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “ear infections” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on ear infections: •

You Can Prevent Swimmer's Ear Source: Otoscope. 9(4): 3, 5. Spring 1994. Contact: Available from Ear Foundation. 2000 Church Street, Box 111, Nashville, TN 37236. (800) 545-HEAR; (615) 329-7809; TTY (615) 329-7849. PRICE: Subscription is $25.00. Reprints are available for $25.00/200 copies. Summary: This brief newsletter article provides readers with suggestions on how to prevent the infections known as swimmer's ear. The article recommends the use of rubbing alcohol, vinegar-alcohol mixtures, or over-the-counter preparations to help dry out the ear after swimming. The article also describes swimmer's ear infections, risk factors, and symptoms.

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Inner Ear Infections Source: Otoscope. 9(3): 1-3. Winter 1994. Contact: Available from Ear Foundation. 2000 Church Street, Box 111, Nashville, TN 37236. (800) 545-HEAR; (615) 329-7809; TTY (615) 329-7849. PRICE: Reprints are available for $25.00/200 copies. Summary: This newsletter article describes the physiology involved in inner ear infections. After a brief description of the evolutionary development of hearing and ear structure, the author discusses the defenses of the inner ear; how those defenses may be overcome; the anatomy of the ear; middle ear infections; complications of inner ear infection, including hearing loss, loss of balance function, and meningitis; chronic infections of the middle ear; cholesteatomas; and infections transmitted through the bloodstream to the inner ear. The author emphasizes the importance of preventive efforts and the medical and surgical management of causative ear infections.

Academic Periodicals covering Ear Infections Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to ear infections. In addition to these sources, you can search for articles covering ear infections that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for ear infections. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with ear infections. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to ear infections: Antipyrine and Benzocaine •

Otic - U.S. Brands: Allergen; Antiben; Auralgan; Aurodex; Auroto; Dolotic; Otocalm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202066.html

Azithromycin •

Systemic - U.S. Brands: Zithromax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202642.html

Erythromycin and Sulfisoxazole •

Systemic - U.S. Brands: Eryzole; Pediazole http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202224.html

Loracarbef •

Systemic - U.S. Brands: Lorabid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202680.html

Measles Virus Vaccine Live •

Systemic - U.S. Brands: Attenuvax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202338.html

Phenylephrine •

Nasal - U.S. Brands: Doktors; Duration; Rhinall http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202460.html

Pneumococcal Conjugate Vaccine •

Systemic - U.S. Brands: Prevnar http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500121.html

Sulfonamides and Trimethoprim •

Systemic - U.S. Brands: Bactrim; Bactrim DS; Bactrim I.V.; Bactrim Pediatric; Cofatrim Forte; Cotrim; Cotrim DS; Cotrim Pediatric; Septra; Septra DS; Septra Grape Suspension; Septra I.V.; Septra Suspension; Sulfatrim; Sulfatrim Pediatric; Sulfatrim S/S; Sulfatrim Suspension; S http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202781.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

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Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

109

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “ear infections” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 4722 55 930 45 3 5755

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “ear infections” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

20 Adapted 21

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on ear infections can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to ear infections. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to ear infections. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “ear infections”:

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•

Other guides Children's Health http://www.nlm.nih.gov/medlineplus/childrenshealth.html Ear Disorders http://www.nlm.nih.gov/medlineplus/eardisorders.html Ear Infections http://www.nlm.nih.gov/medlineplus/earinfections.html Hearing Disorders & Deafness http://www.nlm.nih.gov/medlineplus/hearingdisordersdeafness.html Infant and Toddler Health http://www.nlm.nih.gov/medlineplus/infantandtoddlerhealth.html

Within the health topic page dedicated to ear infections, the following was listed: •

General/Overviews Acute Otitis Media (Ear Infection) Source: Nemours Foundation http://kidshealth.org/parent/infections/bacterial_viral/otitis_media.html JAMA Patient Page: Acute Otitis Media Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZIDXIZZKD& sub_cat=554 Otitis Media http://www.nlm.nih.gov/medlineplus/tutorials/otitismedialoader.html

•

Diagnosis/Symptoms Ear Problems: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/507.html

•

Treatment Ear Infections and Ear Tube Surgery Source: Nemours Foundation http://kidshealth.org/parent/medical/ears/ear_infections.html

•

Alternative Therap Chiropractic Approach to the Ear Source: American Chiropractic Association http://www.amerchiro.org/media/tips/ear_chiropractic.shtml

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Specific Conditions/Aspects “Swimmer's Ear” (Otitis Externa) Source: National Center for Infectious Diseases, Division of Parasitic Diseases http://www.cdc.gov/healthyswimming/swimmers_ear.htm Cholesteatoma Source: American Academy of Otolaryngology--Head and Neck Surgery http://www.entnet.org/healthinfo/ears/cholesteatoma.cfm Fluid in the Middle Ear (Otitis Media with Effusion) http://www.cdc.gov/antibioticresistance/files/ome.pdf Perforated Eardrum Source: American Academy of Otolaryngology--Head and Neck Surgery http://www.entnet.org/healthinfo/ears/perforation.cfm

•

Children Causes of Hearing Loss in Children Source: American Speech-Language-Hearing Association http://www.asha.org/public/hearing/disorders/causes.htm Children's Middle Ear Infections Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/takecharge/healthdecisionguides/childrensmiddleea rinjury/index.cfm Ear Infection Quiz Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=QZ00026 Swimmer's Ear Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/aches/swimmers_ear.html Taking Care of Your Ears Source: Nemours Foundation http://kidshealth.org/kid/stay_healthy/body/ear_care.html What Is an Ear Infection? Source: Nemours Foundation http://kidshealth.org/kid/ill_injure/sick/ear_infection.html

•

From the National Institutes of Health Otitis Media (Ear Infection) Source: National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/health/hearing/otitism.asp

•

Organizations American Academy of Otolaryngology--Head and Neck Surgery http://www.entnet.org/ National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/

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•

Pictures/Diagram Atlas of the Body: The Ear Source: American Medical Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZYXNW46JC &sub_cat=198

•

Research Bacteria-Rich 'Biofilm' May Give Rise to Chronic Otitis Media Source: National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/news/releases/02/4_03_02.asp Many Parents Willing to Wait on Antibiotic Prescriptions for Ear Infections Source: Nemours Foundation http://kidshealth.org/research/antibiotic_rx.html Reduced: Unnecessary Antibiotics for Children Source: National Institute on Deafness and Other Communication Disorders http://www.nidcd.nih.gov/news/releases/02/6_25_02.asp Study Confirms Safety of Placing Infants to Sleep on Their Backs Source: National Institute of Child Health and Human Development, National Institute on Deafness and Other Communication Disorders http://www.nih.gov/news/pr/may2003/nichd-12.htm

•

Teenager External Otitis (Swimmer's Ear) Source: Nemours Foundation http://kidshealth.org/teen/infections/bacterial_viral/swimmers_ear.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on ear infections. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Chronic Otitis Media (Middle Ear Infection) and Hearing Loss Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery. 2003.

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Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. TTY: (703) 519-1585. Web site: www.entnet.org/kidsent. PRICE: Available free online. Summary: Chronic ear infections, if left untreated, can cause temporary or permanent hearing loss in a child. This fact sheet describes what otitis media is as well as how otitis media affects a child's hearing. The two types of hearing loss, the appropriate time for having a child's hearing tested, and other possible causes of temporary hearing loss are also described. •

Ear Infections and Language Development Source: Rockville, MD: American Speech-Language-Hearing Association (ASHA). 2000. [12 p.]. Contact: Available from American Speech-Language-Hearing Association (ASHA). Action Center, 10801 Rockville Pike, Rockville, MD 20852. (800) 638-8255. E-mail: [email protected]. Website: www.asha.org. PRICE: Single copy free. Also available from United States Department of Education. ED Pubs, P.O. Box 1398, Jessup, MD 20794-1398. (877) 4ED-PUBS. Website: www.ed.gov/pubs/edpubs/html. PRICE: Single copy free. Summary: Otitis media, an inflammation of the middle ear (behind the eardrum), is one of the most common illnesses of childhood. This brochure offers parents information about ear infections and language development, focusing on how ear infections and middle ear fluid might negatively affect a child's language development. The brochure describes the different types of otitis media (with and without effusion, or fluid), the symptoms and signs of otitis media, treatment options, how otitis media can affect hearing, how to recognize if a child has a hearing loss, how language learning can be affected by otitis media, who to contact about a child's speech or language development, how to help a child with persistent middle ear fluid by promoting good health and a beneficial listening environment, how to promote language learning, and how to promote early literacy learning. One detailed chart lists milestones of language development in each of seven age categories, from birth to 5 years. The brochure is illustrated with full color photographs of children, and concludes with a list of additional information resources. 6 figures. 1 table. 7 references.

•

About Ear Infections and Other Ear Problems Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1995. 16 p. Contact: Available from Channing L. Bete Company, Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733; Fax (800) 499-6464; http://www.channing.bete.com. PRICE: $1.25 each for 1-24 copies; bulk rates available. Item Number 39255A-12-95. Summary: This booklet familiarizes parents with ear infections and other ear problems common in children. The booklet emphasizes that most children will experience an ear infection (acute otitis media, or middle ear infection) and the pain and discomfort that accompanies these infections. The booklet encourages parents to educate themselves about ear infections, to recognize and avoid risk factors, and to make informed choices about treatment options. Other topics include the anatomy of the ear; the causes, symptoms, diagnosis and treatment of acute otitis media (ear infection), and otitis media with effusion (OME); what to do if hearing loss is suspected; the placement of tubes in the eardrums; treatment for the pain and discomfort of ear infections; complications;

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and risk factors including secondhand smoke, spending time with other children who may be ill, feeding practices (breastfeeding versus bottlefeeding), and contact with allergens. The booklet concludes with answers to common questions in the areas of swimmer's ear, the impact of a child's age on the incidence of ear infections, and how ear tubes are usually placed. The booklet includes many cartoon-like line drawings illustrating children and adults in a variety of everyday settings. •

Swimmer's Ear Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery. 2001. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery. One Prince St., Alexandria, VA 22314-3357. (703) 836-4444. TTY: (703) 519-1585. Web site: www.entnet.org. PRICE: Available free online; print brochure is $30.00 for 100 for non-members, plus shipping and handling. Discounted for members. Summary: This brochure describes the causes, signs and symptoms, treatment, and prevention of swimmer's ear, an infection of the outer ear structures caused by water trapped in the ear canal.

•

Discussion of Chronic Ear Infections Source: Los Angeles, CA: House Ear Institute. 1993. 25 p. Contact: Available from House Ear Institute. 2100 West Third Street, Fifth Floor, Los Angeles, CA 90057. Voice (800) 552-HEAR; (213) 483-4431; TTY (213) 484-2642; Fax (213) 483-8789. PRICE: $1.00 per booklet. Order Number BR-1. Summary: This brochure discusses chronic otitis media (infection of the middle ear). The booklet begins with a discussion of the anatomy and function of the normal ear, and then describes types of hearing impairment. Additional topics include the diseased middle ear; care of the ear; medical treatment; surgical treatment; myringoplasty; tympanoplasty; types of mastoid surgery; tympanoplasty with mastoidectomy; modified radical mastoidectomy; mastoid obliteration operation; what to expect following surgery; the risks and complications of surgery, including ear infection; loss of hearing; dizziness; facial paralysis; hematoma; and complications related to mastoidectomy. The booklet concludes with recommendations for patients who decide against surgery. 1 figure.

•

Ear Infections and Children: Guidelines for Parents Source: Elk Grove, IL: American Academy of Pediatrics (AAP). 1996. 6 p. Contact: Available from American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (800) 433-9016 (members) or (888) 227-1773 (nonmembers). Fax (847) 434-8000. Website: www.aap.org. PRICE: Single copy free; bulk rates available. Item Number HE0193. Summary: This brochure for parents, from the American Academy of Pediatrics, presents guidelines covering the symptoms, treatments, and possible complications of acute otitis media in children. The brochure notes that ear infections usually clear up without causing any lasting problems. However, if infections occur often or are not treated, they can lead to hearing loss or other damage. The brochure begins with a discussion of the anatomy of the ear and a listing of risk factors for ear infections in children. The brochure notes common symptoms, including pain, fever, ear drainage,

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and difficulty hearing. Later sections outline treatment for ear infections and possible complications. The brochure then describes treatments for repeated or chronic ear infections, including preventive treatment and surgically inserted tubes (myringostomy). One sidebar addresses ear infections and hearing loss and the importance of early identification of hearing loss. 1 figure. •

Doctor, Why Does My Child's Ear Ache?. Insights Into Otitis Media and Treatments Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. (AAO-HNS). 2001. 4 p. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314. (703) 836-4444. Fax ( Website: www.entnet.org. PRICE: $20.00 for 100 (members); $25.00 for 100 (non-members). Summary: This brochure helps parents understand otitis media (middle ear infection, a common cause of earache) and its treatments. Written in a question and answer format, the brochure defines otitis media, discusses its severity and why it should be treated, describes how the ear works to maintain hearing and balance, notes the symptoms of otitis media, reviews the causes of the condition, and explains what will happen at the doctor's office. The brochure concludes with a discussion of the use of medications to treat otitis media, and reviews the indications for ventilation tubes (myringostomy) in children. The brochure emphasizes the negative impact that ear infections can have on the child's hearing. Even a temporary or mild hearing loss may impair learning capacity and can delay speech development. The back page of the brochure offers a brief description of the medical specialty of otolaryngology-head and neck surgery. 3 figures.

•

Earache and Otitis Media Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. (AAO-HNS). 1993. [4 p.]. Contact: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. (AAO-HNS). One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. Fax (703) 683-5100. Website: www.entnet.org. PRICE: Single copy free (send self-addressed, stamped envelope); $20.00 per 100 for members; $25.00 per 100 for non-members. Item Number 4763180. Summary: This brochure provides basic information about earaches and otitis media (middle ear infection). The brochure notes that otitis media can be serious because of accompanying hearing loss which can impact on a child's language development. In order to avoid these complications, the brochure encourages parents to get any ear problems treatment as soon as possible. Other topics include the middle ear and how it functions, the causes of otitis media, the symptoms of otitis media, the doctor's examination for an ear infection, the use and importance of medication to treat ear infections, and the additional treatments that may be necessary, including the use of ventilation tubes (myringostomy). The brochure concludes with a brief description of the specialty of otolaryngology-head and neck surgery. 1 figure.

•

Treating Middle Ear Infections to Protect Your Child's Health and Hearing Source: San Bruno, CA: Staywell Company. 2003. 16 p. Contact: Available from Staywell Company. Order Department, 100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. PRICE: $1.50 each; bulk discounts available. Order Number 1635.

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Summary: This educational brochure, written in non-technical language, provides parents with information about middle ear infections in children. The brochure discusses treatment options, including medical care, antibiotics, and surgical care. The brochure addresses the anatomy of the middle ear and its role in hearing, how ear infections are diagnosed, and identifying hearing loss. The brochure provides information on surgical options, including deciding about and preparing for surgery, the typanostomy procedure, postoperative concerns, and care for a child with tubes in place. The brochure concludes with guidelines for preventing future ear infections. The brochure is illustrated with full-color drawings of children, parents, and health care providers from a range of ethnic groups. •

Ear Infection and the Use of Hearing Protection Source: Indianapolis, IN: Aearo Company. 1996. [4 p.]. Contact: Available from Aearo Company. 5457 West 79th Street, Indianapolis, IN 46268. (317) 692-6666. Fax (317) 692-6772. Website: www.aearo.com/html/industrial/earlog.htm. PRICE: Single copy free. Summary: This fact sheet discusses ear infection and the use of hearing protection. The author notes that documented instances in which hearing protection devices (HPDs) have been shown to create aural hygiene problems or are the causative agent for infections of the ear canal are rarely described in the literature. However, this does not prevent concerns from being raised regarding the potential role of HPDs in ear infection. The author addresses such concerns by examining ear canal anatomy, discussing the etiology and prevalence of external ear infection, and providing recommendations to minimize potential problems that can arise within occupational hearing conservation programs (HCPs). The fact sheet is available in English, German, Portuguese and Swedish versions. 1 figure. 1 table. 26 references. (AA-M).

•

Does Your Child Have an Ear Infection? Source: JAMA. Journal of the American Medical Association. 282(22): 2186. December 8, 1999. Summary: This fact sheet is designed as a patient education handout, to give to parents of children with suspected ear infections. The author emphasizes that recognizing the symptoms and detecting ear infections early are important to ensure that the condition does not lead to more serious complications, such as hearing loss or other damage. The fact sheet briefly refers to a recent study (published in the same issue of JAMA) that demonstrated that heredity appears to play a large role in middle ear effusion (fluid collecting in the middle ear). The fact sheet lists risk factors for getting middle ear infections (otitis media), including bottle feeding rather than breastfeeding, exposure to secondhand smoke, and attending a group child care facility. The fact sheet also lists signs of ear infection in children, defines otitis media, and summarizes recommended treatment strategies. The fact sheet concludes with the contact information for the National Institute on Deafness and Other Communication Disorders, the Agency for Health Care Policy and Research, and the American Academy of Pediatrics. One drawing shows a cut away of the human ear. 1 figure. 3 references.

•

Otitis Media Source: Bethesda, MD: National Institute on Deafness and Other Communication Disorders (NIDCD). March 1997. [5 p.].

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Contact: Available from National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse. 1 Communication Avenue, Bethesda, MD 20892-3456. Voice (800) 241-1044. TTY (800) 241-1055. Fax (301) 907-8830. E-mail: [email protected]. Website: www.nidcd.nih.gov. PRICE: Single copy free. NIH Publication Number 97-4216. Summary: This fact sheet presents information about otitis media, an infection or inflammation of the middle ear. This inflammation often begins when infections that cause sore throats, colds, or other respiratory or breathing problems spread to the middle ear. The fact sheet, written in question and answer format, first describes the basic anatomy of the ear and the physiology of hearing. Other topics covered include the causes of otitis media, why children are more affected by this problem than are adults, the symptoms of otitis media, the complications that can be caused by the condition, prevention strategies, how otitis media is diagnosed, treatment options, and current research activities in this area. Although the hearing loss caused by otitis media is usually temporary, untreated otitis media may lead to permanent hearing impairment. In addition, persistent fluids in the middle ear and chronic otitis media can reduce a child's hearing at a time that is critical for speech and language development. The fact sheet concludes with the contact information for four related resource organizations. •

Survey Highlights of Mothers' Knowledge of Ear Infections and Middle Ear Fluid in Young Children Source: AAO-HNS Bulletin. American Academy of Otolaryngology-Head and Neck Surgery Bulletin. 18(2): 33-34. February 1999. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314. (703) 836-4444. E-mai [email protected]. Website: www.entnet.org. Summary: This fact sheet reports the results of a survey that determined the understanding and concern of mothers of young children regarding children's ear infections and middle ear fluid. Questions were posed to 1,000 mothers of children ages six months through six years. The results of the survey are highlighted on two pages that can be copied and distributed to patients. The introductory material (for the health care provider) emphasizes that concerned parents should look beyond the infection itself to the middle ear fluid that accompanies it. It is this fluid that is the actual cause of temporary or permanent hearing losses, motor skill problems, and speech and learning delays. The survey results are reported in a bulleted fashion, covering general information, awareness of middle ear fluid, knowledge of preventive measures, and monitoring of middle ear fluid. The fact sheet includes a sidebar describing an educational pamphlet available from the American Academy of Otolaryngology Head and Neck Surgery; the pamphlet provides information about otitis media and treatments.

•

Ear Infections Information Packet Source: Bethesda, MD: National Institute on Deafness and Other Communication Disorders (NIDCD). September 1996. 64 p. Contact: Available from National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse. 1 Communication Avenue, Bethesda, MD 20892-3456. Voice (800) 241-1044. TTY (800) 241-1055. Fax (301) 907-8830. E-mail: [email protected]. Website: www.nidcd.nih.gov. PRICE: Single copy free.

124 Ear Infections

Summary: This information packet provides materials on ear infections. The packet includes a glossary of terms; fact sheets on the physiology of hearing; a description of otitis media, otosclerosis, and other middle-ear disorders; fact sheets on otitis media and otitis externa; an article on earache and ear tubes; a position statement from the American Academy of Audiology on audiologic guidelines for the diagnosis and treatment of otitis media in children; and an article for health care providers on otitis externa and bullous myringitis. The packet concludes with an annotated list of organizational sources of information on deafness, hearing and hearing disorders, and a brief search of materials from the Combined Health Information Database (CHID). •

Middle Ear Fluid: Serous Otitis Media Source: San Bruno, CA: Staywell Company. 2000. 2 p. Contact: Available from Staywell Company. Order Department, 100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. PRICE: Single copy free; $0.40 each for multiple copies; bulk discounts available. Order Number 1101. Summary: This patient education brochure describes the problem of serous otitis media (middle ear fluid) in both children and adults. After a description of the problem, the brochure covers Eustachian tube function; Eustachian tube anatomy in children and in adults; treatment options, including the surgical technique of tympanotomy; and postoperative care. The brochure stresses that treatment of serous otitis media is designed to restore ventilation to the middle ear. Medications and allergy management may open the Eustachian tube and reduce fluid secretion; when needed, a tympanotomy, with or without tube insertion, can be used to allow air to flow into the middle ear cavity. 2 figures. (AA-M).

•

When Your Child Has an Ear Infection Source: Patient Care. 29(16): 57. October 15, 1995. Summary: This patient education handout on ear infections (otitis media) in children is designed to be duplicated and distributed to parents by health care providers. The handout provides suggestions on home remedies for pain relief, knowing when to consult a health care provider, and recommendations for preventing future ear infections. One illustration diagrams the anatomy of the ear and discusses the causes of the pain associated with infections. 1 figure. The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “ear infections” (or synonyms). The following was recently posted: •

Acute otitis media: management and surveillance in an era of pneumococcal resistance Source: Centers for Disease Control and Prevention - Federal Government Agency [U.S.]; 1999; 11 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1705&nbr=931&am p;string=otitis+AND+media

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Diagnosis and treatment of otitis media in children Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1995 May (revised 2002 Dec); 28 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3667&nbr=2893&a mp;string=ear+AND+infections

•

Evidence based clinical practice guideline for medical management of otitis media in children 2 months to 6 years of age Source: Cincinnati Children's Hospital Medical Center - Hospital/Medical Center; 1999 http://www.guideline.gov/summary/summary.aspx?doc_id=1972&nbr=1198&a mp;string=ear+AND+infections

•

Otitis media Source: University of Michigan Health System - Academic Institution; 1997 November (revised 2002 May); 12 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3371&nbr=2597&a mp;string=ear+AND+infections

•

Screening for otitis media with effusion. Recommendation statement from the Canadian Task Force on Preventive Health Care Source: Canadian Task Force on Preventive Health Care - National Government Agency [Non-U.S.]; 2001 October; 2 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3071&nbr=2297&a mp;string=otitis+AND+media Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Ear Infections: Facts for Parents About Otitis Media Summary: Written especially for parents, this fact sheet describes the different types of otitis media and its causes, symptoms, and treatment. Source: National Institute on Deafness and Other Communication Disorders Information Clearinghouse http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6666

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•

Promotions for Kids' Dietary Supplements Leave Sour Taste Summary: A warning for parents and the general public about dietary supplements promoted as preventives or cures for a variety of childhood ailments, ranging from colds and ear infections to serious conditions Source: Federal Trade Commission http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6092 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to ear infections. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to ear infections. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with ear infections. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about ear infections. For more information, see

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the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “ear infections” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “ear infections”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “ear infections” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “ear infections” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on ear infections: •

Basic Guidelines for Ear Infections Otitis media - acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000638.htm Otitis media - chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000619.htm Otitis media with effusion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/007010.htm

•

Signs & Symptoms for Ear Infections Deafness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003044.htm Diarrhea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm

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Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Drainage from the ear Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003042.htm Ear discomfort Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm Ear pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm Ear pain or discomfort Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm Earache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003046.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Headache Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003024.htm Hearing loss Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003044.htm Joint pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Loss of hearing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003044.htm Nasal congestion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003049.htm Nasal discharge Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003051.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Neck pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm Swelling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003103.htm Throat, sore Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003053.htm

Online Glossaries 137

Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm •

Diagnostics and Tests for Ear Infections CT scan of the head Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003786.htm Mastoid X-rays Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003802.htm

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Surgery and Procedures for Ear Infections Myringotomy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003015.htm

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Background Topics for Ear Infections Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Analgesic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Inspection Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002388.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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EAR INFECTIONS DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Acremonium: A mitosporic fungal genus with many reported ascomycetous teleomorphs. Cephalosporin antibiotics are derived from this genus. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adjuvant Therapy: Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, or hormone therapy. [NIH]

Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerosol: A solution of a drug which can be atomized into a fine mist for inhalation therapy. [EU]

Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium

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cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Allergens: Antigen-type substances (hypersensitivity, immediate). [NIH]

that

produce

immediate

hypersensitivity

Allergic Rhinitis: Inflammation of the nasal mucous membrane associated with hay fever; fits may be provoked by substances in the working environment. [NIH] Alpha 1-Antitrypsin: Plasma glycoprotein member of the serpin superfamily which inhibits trypsin, neutrophil elastase, and other proteolytic enzymes. Commonly referred to as alpha 1-proteinase inhibitor (A1PI), it exists in over 30 different biochemical variant forms known collectively as the PI (protease inhibitor) system. Hereditary A1PI deficiency is associated with pulmonary emphysema. [NIH] Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH] Alpha-helix: One of the secondary element of protein. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acid Substitution: The naturally occurring or experimentally induced replacement of one or more amino acids in a protein with another. If a functionally equivalent amino acid is substituted, the protein may retain wild-type activity. Substitution may also diminish or eliminate protein function. Experimentally induced substitution is often used to study enzyme activities and binding site properties. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amniotic Fluid: Amniotic cavity fluid which is produced by the amnion and fetal lungs and kidneys. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH]

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Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broadspectrum antibiotic. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Annealing: The spontaneous alignment of two single DNA strands to form a double helix. [NIH]

Antecedent: Existing or occurring before in time or order often with consequential effects. [EU]

Antiallergic: Counteracting allergy or allergic conditions. [EU] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibiotic Prophylaxis: Use of antibiotics before, during, or after a diagnostic, therapeutic, or surgical procedure to prevent infectious complications. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antihistamine: A drug that counteracts the action of histamine. The antihistamines are of two types. The conventional ones, as those used in allergies, block the H1 histamine

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receptors, whereas the others block the H2 receptors. Called also antihistaminic. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antineoplastic: Inhibiting or preventing the development of neoplasms, checking the maturation and proliferation of malignant cells. [EU] Antiphlogistic: An agent that counteracts inflammation and fever. [EU] Antiplasmin: A member of the serpin superfamily found in human plasma that inhibits the lysis of fibrin clots which are induced by plasminogen activator. It is a glycoprotein, molecular weight approximately 70,000 that migrates in the alpha 2 region in immunoelectrophoresis. It is the principal plasmin inactivator in blood, rapidly forming a very stable complex with plasmin. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Aqueous: Having to do with water. [NIH] Arachidonate 12-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 12-hydroperoxyarachidonate (12-HPETE) which is itself rapidly converted by a peroxidase to 12-hydroxy-5,8,10,14-eicosatetraenoate (12-HETE). The 12-hydroperoxides are preferentially formed in platelets. EC 1.13.11.31. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atelectasis: Incomplete expansion of the lung. [NIH] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuated: Strain with weakened or reduced virulence. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Audiologist: Study of hearing including treatment of persons with hearing defects. [NIH]

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Audiology: The study of hearing and hearing impairment. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Aural: Pertaining to or perceived by the ear, as an aural stimulus. [EU] Autacoids: A chemically diverse group of substances produced by various tissues in the body that cause slow contraction of smooth muscle; they have other intense but varied pharmacologic activities. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bacteremia: The presence of viable bacteria circulating in the blood. Fever, chills, tachycardia, and tachypnea are common acute manifestations of bacteremia. The majority of cases are seen in already hospitalized patients, most of whom have underlying diseases or procedures which render their bloodstreams susceptible to invasion. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Infections: Infections by bacteria, general or unspecified. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bacteriostatic: 1. Inhibiting the growth or multiplication of bacteria. 2. An agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Beta-Thromboglobulin: A platelet-specific protein which is released when platelets aggregate. Elevated plasma levels have been reported after deep venous thrombosis, preeclampsia, myocardial infarction with mural thrombosis, and myeloproliferative disorders. Measurement of beta-thromboglobulin in biological fluids by radioimmunoassay is used for the diagnosis and assessment of progress of thromboembolic disorders. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving

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chemical reactions in living organisms. [EU] Biosynthesis: The building up of a chemical compound in the physiologic processes of a living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Bone Conduction: Sound transmission through the bones of the skull to the inner ear. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bottle Feeding: Use of nursing bottles for feeding. Applies to humans and animals. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breast Feeding: The nursing of an infant at the mother's breast. [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchioles: The tiny branches of air tubes in the lungs. [NIH] Bronchiolitis: Inflammation of the bronchioles. [NIH] Bronchiseptica: A small, gram-negative, motile bacillus. A normal inhabitant of the respiratory tract in man, dogs, and pigs, but is also associated with canine infectious tracheobronchitis and atrophic rhinitis in pigs. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bronchoconstriction: Diminution of the caliber of a bronchus physiologically or as a result of pharmacological intervention. [NIH] Bullous: Pertaining to or characterized by bullae. [EU] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Capsular: Cataract which is initiated by an opacification at the surface of the lens. [NIH]

Dictionary 145

Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carboplatin: An organoplatinum compound that possesses antineoplastic activity. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cefaclor: Semisynthetic, broad-spectrum antibiotic derivative of cephalexin. [NIH] Ceftriaxone: Broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to usually inaccessible infections, including those involving the meninges, eyes, inner ears, and urinary tract. [NIH] Cefuroxime: Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Division: The fission of a cell. [NIH] Cell Extracts: Preparations of cell constituents or subcellular materials, isolates, or substances. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH]

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Cephalexin: A semisynthetic cephalosporin antibiotic with antimicrobial activity similar to that of cephaloridine or cephalothin, but somewhat less potent. It is effective against both gram-positive and gram-negative organisms. [NIH] Cephalosporins: A group of broad-spectrum antibiotics first isolated from the Mediterranean fungus Acremonium (Cephalosporium acremonium). They contain the betalactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerumen: The yellow or brown waxy secretions produced by vestigial apocrine sweat glands in the external ear canal. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Child Care: Care of children in the home or institution. [NIH] Child Development: The continuous sequential physiological and psychological maturing of the child from birth up to but not including adolescence. It includes healthy responses to situations, but does not include growth in stature or size (= growth). [NIH] Chiropractic: A system of treating bodily disorders by manipulation of the spine and other parts, based on the belief that the cause is the abnormal functioning of a nerve. [NIH] Cholera: An acute diarrheal disease endemic in India and Southeast Asia whose causative agent is vibrio cholerae. This condition can lead to severe dehydration in a matter of hours unless quickly treated. [NIH] Cholesteatoma: A non-neoplastic keratinizing mass with stratified squamous epithelium, frequently occurring in the meninges, central nervous system, bones of the skull, and most commonly in the middle ear and mastoid region. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Circumcision: Excision of the prepuce or part of it. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of

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aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Clavulanic Acid: Clavulanic acid (C8H9O5N) and its salts and esters. The acid is a suicide inhibitor of bacterial beta-lactamase enzymes from Streptomyces clavuligerus. Administered alone, it has only weak antibacterial activity against most organisms, but given in combination with beta-lactam antibiotics prevents antibiotic inactivation by microbial lactamase. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collagen disease: A term previously used to describe chronic diseases of the connective tissue (e.g., rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis), but now is thought to be more appropriate for diseases associated with defects in collagen, which is a component of the connective tissue. [NIH] Colostrum: The thin, yellow, serous fluid secreted by the mammary glands during pregnancy and immediately postpartum before lactation begins. It consists of immunologically active substances, white blood cells, water, protein, fat, and carbohydrates. [NIH]

Communication Disorders: Disorders of verbal and nonverbal communication caused by receptive or expressive language disorders, cognitive dysfunction (e.g., mental retardation), psychiatric conditions, and hearing disorders. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols

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C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contamination: The soiling or pollution by inferior material, as by the introduction of organisms into a wound, or sewage into a stream. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or

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treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Cornea: The transparent part of the eye that covers the iris and the pupil and allows light to enter the inside. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortices: The outer layer of an organ; used especially of the cerebrum and cerebellum. [NIH] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cortisone: A natural steroid hormone produced in the adrenal gland. It can also be made in the laboratory. Cortisone reduces swelling and can suppress immune responses. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan, Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cytidine: A pyrimidine nucleoside that is composed of the base cytosine linked to the fivecarbon sugar D-ribose. [NIH] Cytidine Triphosphate: Cytidine 5'-(tetrahydrogen triphosphate). A cytosine nucleotide containing three phosphate groups esterified to the sugar moiety. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytomegalovirus: A genus of the family Herpesviridae, subfamily Betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH]

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Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Day Care: Institutional health care of patients during the day. The patients return home at night. [NIH] Decongestant: An agent that reduces congestion or swelling. [EU] Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Denaturation: Rupture of the hydrogen bonds by heating a DNA solution and then cooling it rapidly causes the two complementary strands to separate. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dexamethasone: (11 beta,16 alpha)-9-Fluoro-11,17,21-trihydroxy-16-methylpregna-1,4diene-3,20-dione. An anti-inflammatory glucocorticoid used either in the free alcohol or esterified form in treatment of conditions that respond generally to cortisone. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention

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of subsidiary means. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Resistance: Diminished or failed response of an organism, disease or tissue to the intended effectiveness of a chemical or drug. It should be differentiated from drug tolerance which is the progressive diminution of the susceptibility of a human or animal to the effects of a drug, as a result of continued administration. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Dura mater: The outermost, toughest, and most fibrous of the three membranes (meninges) covering the brain and spinal cord; called also pachymeninx. [EU] Dysentery: Any of various disorders marked by inflammation of the intestines, especially of the colon, and attended by pain in the abdomen, tenesmus, and frequent stools containing blood and mucus. Causes include chemical irritants, bacteria, protozoa, or parasitic worms. [EU]

Dysostosis: Defective bone formation. [NIH] Ear Diseases: Diseases of the ear, general or unspecified. [NIH] Earache: Pain in the ear. [NIH] Eardrum: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that

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act near the site of synthesis without altering functions throughout the body. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empyema: Presence of pus in a hollow organ or body cavity. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH]

Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endotoxin: Toxin from cell walls of bacteria. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Environmental tobacco smoke: ETS. Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers (second-hand smoke). Inhaling ETS is called involuntary or passive smoking. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Ephedrine: An alpha- and beta-adrenergic agonist that may also enhance release of norepinephrine. It has been used in the treatment of several disorders including asthma, heart failure, rhinitis, and urinary incontinence, and for its central nervous system stimulatory effects in the treatment of narcolepsy and depression. It has become less extensively used with the advent of more selective agonists. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum

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epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Equalization: The reduction of frequency and/or phase distortion, or modification of gain and or phase versus frequency characteristics of a transducer, by the use of attenuation circuits whose loss or delay is a function of frequency. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethmoid: An unpaired cranial bone which helps form the medial walls of the orbits and contains the themoidal air cells which drain into the nose. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Etoposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Etoposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent entry into the mitotic phase of cell division, and lead to cell death. Etoposide acts primarily in the G2 and S phases of the cell cycle. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Eustachian tube: The middle ear cavity is in communication with the back of the nose through the Eustachian tube, which is normally closed, but opens on swallowing, in order to maintain equal air pressure. [NIH] Extracellular: Outside a cell or cells. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extravasation: A discharge or escape, as of blood, from a vessel into the tissues. [EU] Facial: Of or pertaining to the face. [EU] Facial Paralysis: Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. Facial nerve diseases generally results in generalized hemifacial weakness. Neuromuscular junction diseases and muscular diseases may also cause facial paralysis or paresis. [NIH] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH]

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Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Flurbiprofen: An anti-inflammatory analgesic and antipyretic of the phenylalkynoic acid series. It has been shown to reduce bone resorption in periodontal disease by inhibiting carbonic anhydrase. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gangrenous: A circumscribed, deep-seated, suppurative inflammation of the subcutaneous tissue of the eyelid discharging pus from several points. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastritis: Inflammation of the stomach. [EU] Gastroenteritis: An acute inflammation of the lining of the stomach and intestines, characterized by anorexia, nausea, diarrhoea, abdominal pain, and weakness, which has various causes, including food poisoning due to infection with such organisms as Escherichia coli, Staphylococcus aureus, and Salmonella species; consumption of irritating food or drink; or psychological factors such as anger, stress, and fear. Called also enterogastritis. [EU] Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH]

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Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Library: A large collection of cloned DNA fragments from a given organism, tissue, organ, or cell type. It may contain complete genomic sequences (genomic library) or complementary DNA sequences, the latter being formed from messenger RNA and lacking intron sequences. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetic Code: The specifications for how information, stored in nucleic acid sequence (base sequence), is translated into protein sequence (amino acid sequence). The start, stop, and order of amino acids of a protein is specified by consecutive triplets of nucleotides called codons (codon). [NIH] Genetic testing: Analyzing DNA to look for a genetic alteration that may indicate an increased risk for developing a specific disease or disorder. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genomic Library: A form of gene library containing the complete DNA sequences present in the genome of a given organism. It contrasts with a cDNA library which contains only sequences utilized in protein coding (lacking introns). [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Gestational Age: Age of the conceptus. In humans, this may be assessed by medical history, physical examination, early immunologic pregnancy tests, radiography, ultrasonography, and amniotic fluid analysis. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glottis: The vocal apparatus of the larynx, consisting of the true vocal cords (plica vocalis) and the opening between them (rima glottidis). [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH]

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Glycosidic: Formed by elimination of water between the anomeric hydroxyl of one sugar and a hydroxyl of another sugar molecule. [NIH] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonorrhea: Acute infectious disease characterized by primary invasion of the urogenital tract. The etiologic agent, Neisseria gonorrhoeae, was isolated by Neisser in 1879. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gramicidin: Antibiotic mixture that is one of the two principle components of tyrothricin from Bacillus brevis. Gramicidin C or S is a cyclic, ten-amino acid polypeptide and gramicidins A, B, D, etc., seem to be linear polypeptides. The mixture is used topically for gram-positive organisms. It is toxic to blood, liver, kidneys, meninges, and the olfactory apparatus. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Haemophilus: A genus of Pasteurellaceae that consists of several species occurring in animals and humans. Its organisms are described as gram-negative, facultatively anaerobic, coccobacillus or rod-shaped, and nonmotile. [NIH] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH]

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Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Hearing Disorders: Conditions that impair the transmission or perception of auditory impulses and information from the level of the ear to the temporal cortices, including the sensorineural pathways. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hematoma: An extravasation of blood localized in an organ, space, or tissue. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Host: Any animal that receives a transplanted graft. [NIH]

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Hydrocortisone: The main glucocorticoid secreted by the adrenal cortex. Its synthetic counterpart is used, either as an injection or topically, in the treatment of inflammation, allergy, collagen diseases, asthma, adrenocortical deficiency, shock, and some neoplastic conditions. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypersensitivity, Immediate: Hypersensitivity reactions which occur within minutes of exposure to challenging antigen due to the release of histamine which follows the antigenantibody reaction and causes smooth muscle contraction and increased vascular permeability. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune Sera: Serum that contains antibodies. It is obtained from an animal that has been immunized either by antigen injection or infection with microorganisms containing the antigen. [NIH] Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]

effects

of

foreign

Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoelectrophoresis: A technique that combines protein electrophoresis and double immunodiffusion. In this procedure proteins are first separated by gel electrophoresis (usually agarose), then made visible by immunodiffusion of specific antibodies. A distinct elliptical precipitin arc results for each protein detectable by the antisera. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU]

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In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Incubation period: The period of time likely to elapse between exposure to the agent of the disease and the onset of clinical symptoms. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indomethacin: A non-steroidal anti-inflammatory agent (NSAID) that inhibits the enzyme cyclooxygenase necessary for the formation of prostaglandins and other autacoids. It also inhibits the motility of polymorphonuclear leukocytes. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH] Inorganic: Pertaining to substances not of organic origin. [EU]

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Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Interleukin-8: A cytokine that activates neutrophils and attracts neutrophils and Tlymphocytes. It is released by several cell types including monocytes, macrophages, Tlymphocytes, fibroblasts, endothelial cells, and keratinocytes by an inflammatory stimulus. IL-8 is a member of the beta-thromboglobulin superfamily and structurally related to platelet factor 4. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intramuscular: IM. Within or into muscle. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Introns: Non-coding, intervening sequences of DNA that are transcribed, but are removed from within the primary gene transcript and rapidly degraded during maturation of messenger RNA. Most genes in the nuclei of eukaryotes contain introns, as do mitochondrial and chloroplast genes. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of

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the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Labyrinthitis: Inflammation of the inner ear. [NIH] Laceration: 1. The act of tearing. 2. A torn, ragged, mangled wound. [EU] Lactation: The period of the secretion of milk. [EU] Language Development: The gradual expansion in complexity and meaning of symbols and sounds as perceived and interpreted by the individual through a maturational and learning process. Stages in development include babbling, cooing, word imitation with cognition, and use of short sentences. [NIH] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Laryngeal: Having to do with the larynx. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Leucocyte: All the white cells of the blood and their precursors (myeloid cell series, lymphoid cell series) but commonly used to indicate granulocytes exclusive of lymphocytes. [NIH]

Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Levofloxacin: A substance used to treat bacterial infections. It belongs to the family of drugs called quinolone antibiotics. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An

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antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH] Linkages: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Local Government: Smallest political subdivisions within a country at which general governmental functions are carried-out. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]

Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet.

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[NIH]

Mammary: Pertaining to the mamma, or breast. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Mannosidosis: Inborn error of metabolism marked by a defect in alpha-mannosidase activity that results in lysosomal accumulation of mannose-rich substrates. Virtually all patients have psychomotor retardation, facial coarsening, and some degree of dysostosis multiplex. It is thought to be an autosomal recessive disorder. [NIH] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Mastoiditis: Inflammation of the cavity and air cells in the mastoid part of the temporal bone. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Retardation: Refers to sub-average general intellectual functioning which originated during the developmental period and is associated with impairment in adaptive behavior. [NIH]

MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH]

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Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Mineralocorticoids: A group of corticosteroids primarily associated with the regulation of water and electrolyte balance. This is accomplished through the effect on ion transport in renal tubules, resulting in retention of sodium and loss of potassium. Mineralocorticoid secretion is itself regulated by plasma volume, serum potassium, and angiotensin II. [NIH] Minocycline: A semisynthetic staphylococcus infections. [NIH]

antibiotic

effective

against

tetracycline-resistant

Mitotic: Cell resulting from mitosis. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mouth Breathing: Abnormal breathing through the mouth, usually associated with obstructive disorders of the nasal passages. [NIH] Mucociliary: Pertaining to or affecting the mucus membrane and hairs (including eyelashes, nose hair, .): mucociliary clearing: the clearance of mucus by ciliary movement ( particularly in the respiratory system). [EU] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Muscular Diseases: Acquired, familial, and congenital disorders of skeletal muscle and smooth muscle. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Mutagens: Chemical agents that increase the rate of genetic mutation by interfering with the function of nucleic acids. A clastogen is a specific mutagen that causes breaks in chromosomes. [NIH] Mutate: To change the genetic material of a cell. Then changes (mutations) can be harmful, beneficial, or have no effect. [NIH] Myalgia: Pain in a muscle or muscles. [EU]

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Myocarditis: Inflammation of the myocardium; inflammation of the muscular walls of the heart. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nasal Septum: The partition separating the two nasal cavities in the midplane, composed of cartilaginous, membranous and bony parts. [NIH] Nasopharynx: The nasal part of the pharynx, lying above the level of the soft palate. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephrotoxic: Toxic or destructive to kidney cells. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neuraminidase: An enzyme that catalyzes the hydrolysis of alpha-2,3, alpha-2,6-, and alpha-2,8-glycosidic linkages (at a decreasing rate, respectively) of terminal sialic residues in oligosaccharides, glycoproteins, glycolipids, colominic acid, and synthetic substrate. (From Enzyme Nomenclature, 1992) EC 3.2.1.18. [NIH] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neutropenia: An abnormal decrease in the number of neutrophils, a type of white blood cell. [NIH] Neutrophil: A type of white blood cell. [NIH]

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Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nurse Practitioners: Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician. [NIH] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ofloxacin: An orally administered broad-spectrum quinolone antibacterial drug active against most gram-negative and gram-positive bacteria. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Ossicles: The hammer, anvil and stirrup, the small bones of the middle ear, which transmit the vibrations from the tympanic membrane to the oval window. [NIH] Otitis: Inflammation of the ear, which may be marked by pain, fever, abnormalities of hearing, hearing loss, tinnitus, and vertigo. [EU] Otitis Media: Inflammation of the middle ear. [NIH] Otitis Media with Effusion: Inflammation of the middle ear with a clear pale yellowcolored transudate. [NIH] Otolaryngologist: A doctor who specializes in treating diseases of the ear, nose, and throat. Also called an ENT doctor. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Otology: The branch of medicine which deals with the diagnosis and treatment of the disorders and diseases of the ear. [NIH] Otorhinolaryngology: That branch of medicine concerned with medical and surgical treatment of the head and neck, including the ears, nose and throat. [EU] Otorrhea: A discharge from the ear, especially a purulent one. [EU] Otosclerosis: The formation of spongy bone in the labyrinth capsule. The ossicles can

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become fixed and unable to transmit sound vibrations, thereby causing deafness. [NIH] Outer ear: The pinna and external meatus of the ear. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Oxazolidinones: Derivatives of oxazolidin-2-one. They represent an important class of synthetic antibiotic agents. [NIH] Oxidative metabolism: A chemical process in which oxygen is used to make energy from carbohydrates (sugars). Also known as aerobic respiration, cell respiration, or aerobic metabolism. [NIH] Pachymeningitis: Inflammation of the dura mater of the brain, the spinal cord or the optic nerve. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH] Parasitic Diseases: Infections or infestations with parasitic organisms. They are often contracted through contact with an intermediate vector, but may occur as the result of direct exposure. [NIH] Paresis: A general term referring to a mild to moderate degree of muscular weakness, occasionally used as a synonym for paralysis (severe or complete loss of motor function). In the older literature, paresis often referred specifically to paretic neurosyphilis. "General paresis" and "general paralysis" may still carry that connotation. Bilateral lower extremity paresis is referred to as paraparesis. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogen: Any disease-producing microorganism. [EU] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU]

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Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols. [NIH] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Penicillin: An antibiotic drug used to treat infection. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide Chain Elongation: The process whereby an amino acid is joined through a substituted amide linkage to a chain of peptides. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perforation: 1. The act of boring or piercing through a part. 2. A hole made through a part or substance. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Pertussis: An acute, highly contagious infection of the respiratory tract, most frequently affecting young children, usually caused by Bordetella pertussis; a similar illness has been associated with infection by B. parapertussis and B. bronchiseptica. It is characterized by a catarrhal stage, beginning after an incubation period of about two weeks, with slight fever, sneezing, running at the nose, and a dry cough. In a week or two the paroxysmal stage begins, with the characteristic paroxysmal cough, consisting of a deep inspiration, followed by a series of quick, short coughs, continuing until the air is expelled from the lungs; the close of the paroxysm is marked by a long-drawn, shrill, whooping inspiration, due to spasmodic closure of the glottis. This stage lasts three to four weeks, after which the convalescent stage begins, in which paroxysms grow less frequent and less violent, and finally cease. Called also whooping cough. [EU] Phagocytosis: The engulfing of microorganisms, other cells, and foreign particles by phagocytic cells. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH]

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Phlebitis: Inflammation of a vein. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Platelet Activating Factor: A phospholipid derivative formed by platelets, basophils, neutrophils, monocytes, and macrophages. It is a potent platelet aggregating agent and inducer of systemic anaphylactic symptoms, including hypotension, thrombocytopenia, neutropenia, and bronchoconstriction. [NIH] Platelet Factor 4: A high-molecular-weight proteoglycan-platelet factor complex which is released from blood platelets by thrombin. It acts as a mediator in the heparin-neutralizing capacity of the blood and plays a role in platelet aggregation. At high ionic strength (I=0.75), the complex dissociates into the active component (molecular weight 29,000) and the

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proteoglycan carrier (chondroitin 4-sulfate, molecular weight 350,000). The molecule exists in the form of a dimer consisting of 8 moles of platelet factor 4 and 2 moles of proteoglycan. [NIH]

Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pleated: Particular three-dimensional pattern of amyloidoses. [NIH] Pneumococcal Infections: Infections with bacteria of the species Streptococcus pneumoniae. [NIH]

Podophyllotoxin: The main active constituent of the resin from the roots of may apple or mandrake (Podophyllum peltatum and P. emodi). It is a potent spindle poison, toxic if taken internally, and has been used as a cathartic. It is very irritating to skin and mucous membranes, has keratolytic actions, has been used to treat warts and keratoses, and may have antineoplastic properties, as do some of its congeners and derivatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymerase Chain Reaction: In vitro method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of short oligonucleotide flanking sequences (primers). The essential steps include thermal denaturation of the double-stranded target molecules, annealing of the primers to their complementary sequences, and extension of the annealed primers by enzymatic synthesis with DNA polymerase. The reaction is efficient, specific, and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, mutation analysis, genetic testing, DNA sequencing, and analyzing evolutionary relationships. [NIH] Polymyxin: Basic polypeptide antibiotic group obtained from Bacillus polymyxa. They affect the cell membrane by detergent action and may cause neuromuscular and kidney damage. At least eleven different members of the polymyxin group have been identified, each designated by a letter. [NIH] Polymyxin B: A mixture of polymyxins B1 and B2, obtained from Bacillus polymyxa strains. They are basic polypeptides of about eight amino acids and have cationic detergent action on cell membranes. Polymyxin B is used for infections with gram-negative organisms, but may be neurotoxic and nephrotoxic. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Pons: The part of the central nervous system lying between the medulla oblongata and the mesencephalon, ventral to the cerebellum, and consisting of a pars dorsalis and a pars ventralis. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU]

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Postoperative: After surgery. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Pregnancy Tests: Tests to determine whether or not an individual is pregnant. [NIH] Prepuce: A covering fold of skin; often used alone to designate the preputium penis. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU]

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Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Conformation: The characteristic 3-dimensional shape of a protein, including the secondary, supersecondary (motifs), tertiary (domains) and quaternary structure of the peptide chain. Quaternary protein structure describes the conformation assumed by multimeric proteins (aggregates of more than one polypeptide chain). [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pseudomonas: A genus of gram-negative, aerobic, rod-shaped bacteria widely distributed in nature. Some species are pathogenic for humans, animals, and plants. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pupil: The aperture in the iris through which light passes. [NIH] Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH]

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Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radiography: Examination of any part of the body for diagnostic purposes by means of roentgen rays, recording the image on a sensitized surface (such as photographic film). [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial

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remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory syncytial virus: RSV. A virus that causes respiratory infections with cold-like symptoms. [NIH] Respiratory Syncytial Virus Infections: Pneumovirus infections caused by the respiratory syncytial viruses. Humans and cattle are most affected but infections in goats and sheep have been reported. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinitis: Inflammation of the mucous membrane of the nose. [NIH] Rhinovirus: A genus of Picornaviridae inhabiting primarily the respiratory tract of mammalian hosts. It includes the human strains associated with common colds. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rotavirus: A genus of Reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Rubella: An acute, usually benign, infectious disease caused by a togavirus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system. It is characterized by a slight cold, sore throat, and fever, followed by enlargement of the postauricular, suboccipital, and

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cervical lymph nodes, and the appearances of a fine pink rash that begins on the head and spreads to become generalized. Called also German measles, roetln, röteln, and three-day measles, and rubeola in French and Spanish. [EU] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Scleroproteins: Simple proteins characterized by their insolubility and fibrous structure. Within the body, they perform a supportive or protective function. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Septicaemia: A term originally used to denote a putrefactive process in the body, but now usually referring to infection with pyogenic micro-organisms; a genus of Diptera; the severe type of infection in which the blood stream is invaded by large numbers of the causal. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH] Serotypes: A cause of haemorrhagic septicaemia (in cattle, sheep and pigs), fowl cholera of birds, pasteurellosis of rabbits, and gangrenous mastitis of ewes. It is also commonly found in atrophic rhinitis of pigs. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Sinusitis: An inflammatory process of the mucous membranes of the paranasal sinuses that occurs in three stages: acute, subacute, and chronic. Sinusitis results from any condition

176 Ear Infections

causing ostial obstruction or from pathophysiologic changes in the mucociliary transport mechanism. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Snoring: Rough, noisy breathing during sleep, due to vibration of the uvula and soft palate. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Speech Perception: The process whereby an utterance is decoded into a representation in terms of linguistic units (sequences of phonetic segments which combine to form lexical and grammatical morphemes). [NIH] Sphenoid: An unpaired cranial bone with a body containing the sphenoid sinus and forming the posterior part of the medial walls of the orbits. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spiramycin: A macrolide antibiotic produced by Streptomyces ambofaciens. The drug is effective against gram-positive aerobic pathogens, N. gonorrhoeae, and staphylococci. It is used to treat infections caused by bacteria and Toxoplasma gondii. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH] Sputum: The material expelled from the respiratory passages by coughing or clearing the throat. [NIH] Squamous: Scaly, or platelike. [EU] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH]

Dictionary 177

Stapedius: The stapedius muscle arises from the wall of the middle ear and is inserted into the neck of the stapes. Its action is to pull the head of the stapes backward. [NIH] Stapes: One of the three ossicles of the middle ear. It transmits sound vibrations from the incus to the internal ear. [NIH] Staphylococcal Infections: Infections with bacteria of the genus Staphylococcus. [NIH] Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Sterile: Unable to produce children. [NIH] Sterilization: The destroying of all forms of life, especially microorganisms, by heat, chemical, or other means. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Steroid therapy: Treatment with corticosteroid drugs to reduce swelling, pain, and other symptoms of inflammation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Strand: DNA normally exists in the bacterial nucleus in a helix, in which two strands are coiled together. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Sublingual: Located beneath the tongue. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH]

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Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Sulfisoxazole: One of the antibacterial sulfonamides generally used for treatment of infections. It is bacteriostatic against a wide range of gram- negative and gram-positive organisms, but acquired resistance is common. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Systemic: Affecting the entire body. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tachypnea: Rapid breathing. [NIH] Tea Tree Oil: Essential oil extracted from Melaleuca alternifolia (tea tree). It is used as a topical antimicrobial due to the presence of terpineol. [NIH] Teichoic Acids: Bacterial polysaccharides that are rich in phosphodiester linkages. They are the major components of the cell walls and membranes of many bacteria. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Tenesmus: Straining, especially ineffectual and painful straining at stool or in urination. [EU] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Tetani: Causal agent of tetanus. [NIH]

Dictionary 179

Tetanic: Having the characteristics of, or relating to tetanus. [NIH] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by Clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombocytopenia: A decrease in the number of blood platelets. [NIH] Thrombophlebitis: Inflammation of a vein associated with thrombus formation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Tick-Borne Diseases: Bacterial, viral, or parasitic diseases transmitted to humans and animals by the bite of infected ticks. The families Ixodidae and Argasidae contain many bloodsucking species that are important pests of man and domestic birds and mammals and probably exceed all other arthropods in the number and variety of disease agents they transmit. Many of the tick-borne diseases are zoonotic. [NIH] Ticks: Blood-sucking arachnids of the order Acarina. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tonsillitis: Inflammation of the tonsils, especially the palatine tonsils. It is often caused by a bacterium. Tonsillitis may be acute, chronic, or recurrent. [NIH]

180 Ear Infections

Tonsils: Small masses of lymphoid tissue on either side of the throat. [NIH] Topical: On the surface of the body. [NIH] Torticollis: Wryneck; a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]

Transcriptase: An enzyme which catalyses the synthesis of a complementary mRNA molecule from a DNA template in the presence of a mixture of the four ribonucleotides (ATP, UTP, GTP and CTP). [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transfer Factor: Factor derived from leukocyte lysates of immune donors which can transfer both local and systemic cellular immunity to nonimmune recipients. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Trimethoprim-sulfamethoxazole: An antibiotic drug used to treat infection and prevent pneumocystis carinii pneumonia. [NIH] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH]

Dictionary 181

Tympanic membrane: A thin, tense membrane forming the greater part of the outer wall of the tympanic cavity and separating it from the external auditory meatus; it constitutes the boundary between the external and middle ear. [NIH] Tyrothricin: A polypeptide antibiotic mixture obtained from Bacillus brevis. It consists of a mixture of three tyrocidines (60%) and several gramicidins (20%) and is very toxic to blood, liver, kidneys, meninges, and the olfactory apparatus. It is used topically. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ultrasonography: The visualization of deep structures of the body by recording the reflections of echoes of pulses of ultrasonic waves directed into the tissues. Use of ultrasound for imaging or diagnostic purposes employs frequencies ranging from 1.6 to 10 megahertz. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Uracil: An anticancer drug that belongs to the family of drugs called alkylating agents. [NIH] Uridine Triphosphate: Uridine 5'-(tetrahydrogen triphosphate). A uracil nucleotide containing three phosphate groups esterified to the sugar moiety. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uvula: Uvula palatinae; specifically, the tongue-like process which projects from the middle of the posterior edge of the soft palate. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventilator: A breathing machine that is used to treat respiratory failure by promoting ventilation; also called a respirator. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle

182 Ear Infections

and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vinca Alkaloids: A class of alkaloids from the genus of apocyanaceous woody herbs including periwinkles. They are some of the most useful antineoplastic agents. [NIH] Vincristine: An anticancer drug that belongs to the family of plant drugs called vinca alkaloids. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral Vaccines: Suspensions of attenuated or killed viruses administered for the prevention or treatment of infectious viral disease. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH] Whooping Cough: A respiratory infection caused by Bordetella pertussis and characterized by paroxysmal coughing ending in a prolonged crowing intake of breath. [NIH]

183

INDEX A Abscess, 72, 139 Acne, 68, 77, 83, 84, 139 Acoustic, 4, 18, 54, 139 Acremonium, 139, 146 Adenine, 139 Adenosine, 71, 139 Adjuvant, 44, 139 Adjuvant Therapy, 44, 139 Adolescence, 139, 146, 168 Adrenal Cortex, 139, 149, 158, 171 Adrenergic, 139, 152, 178 Adverse Effect, 139, 175 Aerobic, 139, 167, 172, 176 Aerosol, 80, 139 Affinity, 22, 139, 140 Agar, 139, 169 Agonist, 140, 152 Airway, 80, 140 Algorithms, 140, 144 Allergens, 120, 140 Allergic Rhinitis, 74, 140 Alpha 1-Antitrypsin, 73, 140 Alpha-Defensins, 140, 150 Alpha-helix, 140, 160 Alternative medicine, 101, 140 Alveoli, 140, 181 Amino Acid Sequence, 75, 140, 141, 155 Amino Acid Substitution, 22, 140 Amino Acids, 140, 153, 155, 168, 170, 172, 180 Amniotic Fluid, 140, 155 Amoxicillin, 5, 6, 8, 11, 17, 27, 29, 30, 32, 39, 40, 64, 83, 100, 140 Ampicillin, 140, 141 Amplification, 24, 141 Anaesthesia, 141, 159 Analgesic, 137, 141, 154 Analog, 26, 71, 141, 147 Anaphylactic, 141, 169 Anatomical, 76, 141, 152, 158 Androgens, 139, 141, 149 Anesthesia, 69, 72, 140, 141 Annealing, 141, 170 Antecedent, 15, 28, 141 Antiallergic, 141, 149 Antibacterial, 26, 70, 141, 147, 166, 176, 178

Antibiotic, 5, 6, 7, 8, 9, 11, 13, 17, 18, 19, 24, 43, 44, 56, 72, 74, 77, 78, 79, 82, 84, 88, 94, 96, 100, 118, 140, 141, 143, 144, 145, 146, 147, 153, 156, 162, 164, 165, 167, 168, 170, 176, 179, 180, 181 Antibiotic Prophylaxis, 96, 141 Antibodies, 19, 22, 29, 70, 99, 141, 153, 156, 158, 162, 169 Antibody, 22, 26, 70, 139, 141, 147, 156, 158, 159, 163, 173, 176 Antigen, 26, 139, 140, 141, 148, 153, 158, 159, 163 Antihistamine, 74, 141 Anti-infective, 26, 142 Anti-inflammatory, 73, 82, 142, 149, 150, 154, 155, 159 Anti-Inflammatory Agents, 142, 149 Antimicrobial, 8, 9, 13, 17, 18, 26, 30, 36, 38, 39, 56, 64, 84, 91, 96, 142, 146, 150, 178 Antineoplastic, 142, 145, 149, 170, 182 Antiphlogistic, 73, 82, 142 Antiplasmin, 73, 142 Antipyretic, 142, 154 Antiviral, 18, 24, 48, 50, 142 Aqueous, 76, 77, 81, 82, 142, 143, 161 Arachidonate 12-Lipoxygenase, 142, 162 Arachidonate 15-Lipoxygenase, 142, 162 Arachidonate Lipoxygenases, 142, 162 Arachidonic Acid, 142, 151, 161, 171 Arterial, 142, 172 Arteries, 142, 144, 149, 163, 179 Asymptomatic, 9, 16, 142 Atelectasis, 18, 142 Atrophy, 18, 142 Attenuated, 142, 182 Attenuation, 142, 153 Audiologist, 87, 142 Audiology, 38, 41, 54, 87, 124, 143 Auditory, 39, 92, 93, 143, 151, 157, 163, 181 Aural, 122, 143 Autacoids, 143, 159 Azithromycin, 5, 9, 27, 28, 36, 100, 104, 143 B Bacteremia, 56, 68, 83, 143 Bacterial Infections, 93, 143, 161 Bacteriophage, 143, 169 Bacteriostatic, 143, 153, 178

184 Ear Infections

Bacterium, 22, 30, 143, 179 Base, 71, 139, 143, 149, 150, 155, 160, 178 Basophils, 143, 156, 161, 169 Benign, 21, 143, 156, 174 Beta-Defensins, 143, 150 Beta-Thromboglobulin, 143, 160 Bilateral, 64, 143, 167 Bile, 143, 154, 162, 177 Bile Acids, 143, 154, 177 Biochemical, 140, 143 Biosynthesis, 22, 29, 142, 144 Biotechnology, 27, 30, 91, 101, 111, 144 Bladder, 68, 144, 159, 181 Blood vessel, 144, 145, 152, 160, 162, 176, 177, 179, 181 Bone Conduction, 6, 144 Bone Marrow, 144, 158, 162, 164 Bottle Feeding, 122, 144 Bowel, 144, 150, 160 Bowel Movement, 144, 150 Branch, 49, 50, 133, 144, 155, 162, 163, 166, 167, 172, 176, 179 Breast Feeding, 42, 144 Broad-spectrum, 140, 141, 144, 145, 146, 166 Bronchi, 144 Bronchial, 78, 144, 157 Bronchioles, 140, 144 Bronchiolitis, 24, 144 Bronchiseptica, 144, 168 Bronchitis, 78, 144, 146 Bronchoconstriction, 144, 169 Bullous, 93, 124, 144 Burns, 77, 144 Burns, Electric, 144 C Capsular, 26, 144 Carbohydrate, 26, 145, 149, 155, 170 Carboplatin, 55, 145 Carcinogenic, 145, 177 Cardiac, 145, 152, 165, 177 Cardiovascular, 145, 161 Case report, 10, 38, 145 Caudal, 145, 170 Causal, 23, 145, 175, 178 Cause of Death, 79, 145 Cefaclor, 27, 39, 145 Ceftriaxone, 6, 17, 28, 145 Cefuroxime, 6, 17, 29, 145 Cell Cycle, 145, 146, 153 Cell Division, 143, 145, 153, 169, 175 Cell Extracts, 24, 145

Cell membrane, 145, 169, 170 Cellulitis, 58, 78, 83, 145 Cellulose, 145, 154, 169 Central Nervous System, 45, 145, 146, 152, 156, 161, 170 Cephalexin, 145, 146 Cephalosporins, 5, 146 Cerebral, 146, 153, 172 Cerumen, 4, 14, 146 Cervical, 146, 175, 180 Chemotherapy, 36, 39, 55, 56, 96, 139, 146 Child Care, 12, 37, 94, 95, 122, 146 Child Development, 87, 146 Chiropractic, 54, 55, 58, 116, 146 Cholera, 146, 175 Cholesteatoma, 6, 18, 72, 92, 94, 117, 146 Cholesterol, 143, 146, 177 Chromosomal, 141, 146, 169 Chronic Disease, 74, 146, 147 Chronic Obstructive Pulmonary Disease, 79, 146 Ciliary, 71, 146, 164 Ciprofloxacin, 33, 36, 49, 50, 82, 146 Circumcision, 72, 146 Cisplatin, 55, 146 Clarithromycin, 9, 28, 146 Clavulanic Acid, 39, 83, 147 Clindamycin, 11, 147 Clinical trial, 21, 63, 64, 111, 147, 168, 172, 173 Cloning, 144, 147 Clot Retraction, 147, 169 Cochlea, 147, 159 Cochlear, 33, 34, 56, 147, 179 Cofactor, 147, 172 Cognition, 15, 147, 161 Collagen, 147, 154, 158 Collagen disease, 147, 158 Colostrum, 70, 147 Communication Disorders, 26, 63, 65, 110, 117, 118, 122, 123, 125, 147 Complement, 147, 148 Complementary and alternative medicine, 53, 60, 148 Complementary medicine, 53, 148 Computational Biology, 111, 148 Confounding, 15, 148 Congestion, 71, 72, 78, 136, 148, 150 Conjugated, 19, 148 Conjunctiva, 148, 159 Connective Tissue, 144, 145, 147, 148, 154, 162, 174

Index 185

Consciousness, 141, 148, 151 Consultation, 15, 148 Contamination, 148, 174 Contraindications, ii, 148 Contralateral, 6, 149 Cornea, 73, 82, 149 Coronary, 149, 163 Coronary Thrombosis, 149, 163 Cortex, 149, 153 Cortices, 149, 157 Corticosteroid, 74, 82, 149, 177 Cortisone, 149, 150 Cranial, 149, 153, 156, 167, 168, 176 Crossing-over, 149, 173 Cryptosporidiosis, 70, 143, 149 Curative, 77, 149, 179 Cyclic, 149, 156 Cyst, 72, 149 Cysteine, 149, 150 Cytidine, 71, 149 Cytidine Triphosphate, 71, 149 Cytokine, 23, 25, 28, 29, 149, 160 Cytomegalovirus, 56, 149 Cytosine, 149, 150 Cytotoxicity, 146, 150 D Databases, Bibliographic, 111, 150 Day Care, 6, 9, 13, 15, 20, 72, 98, 150 Decongestant, 74, 150 Defensins, 84, 140, 143, 150 Degenerative, 150, 157 Delivery of Health Care, 150, 156 Denaturation, 150, 170 Dental Caries, 20, 69, 70, 150 Dexamethasone, 73, 82, 150 Diagnostic procedure, 67, 101, 150 Diarrhea, 55, 78, 135, 149, 150 Diffusion, 150, 159 Digestive system, 65, 150 Diphtheria, 12, 150 Diploid, 150, 169 Direct, iii, 5, 26, 103, 150, 167, 173 Dissociation, 139, 151 Distal, 151, 154, 172 Dizziness, 72, 120, 136, 151, 181 Dorsal, 151, 170 Drug Interactions, 105, 151 Drug Resistance, 9, 19, 151 Drug Tolerance, 151 Dura mater, 151, 163, 167 Dysentery, 70, 151 Dysostosis, 151, 163

E Ear Diseases, 71, 151 Earache, 121, 124, 136, 151 Eardrum, 4, 14, 68, 69, 75, 76, 91, 92, 94, 117, 119, 151 Efficacy, 5, 17, 19, 23, 25, 26, 28, 29, 32, 36, 56, 63, 64, 151 Effusion, 3, 4, 7, 8, 9, 10, 11, 12, 14, 15, 16, 18, 19, 23, 30, 31, 32, 33, 38, 43, 48, 50, 63, 72, 74, 75, 77, 89, 90, 93, 94, 96, 100, 117, 119, 122, 125, 135, 151, 166 Eicosanoids, 73, 82, 151 Electrolyte, 149, 152, 164 Electrons, 143, 152, 160, 173 Embryo, 152, 159 Emphysema, 78, 140, 146, 152 Empiric, 6, 17, 152 Empyema, 72, 152 Enamel, 150, 152, 160 Encapsulated, 69, 152 Endocarditis, 56, 152 Endocardium, 152 Endothelial cell, 152, 160 Endotoxin, 152, 180 Environmental Health, 110, 112, 152 Environmental tobacco smoke, 6, 152 Enzymatic, 78, 148, 150, 152, 157, 170 Enzyme, 23, 26, 73, 82, 140, 142, 152, 159, 162, 165, 169, 170, 171, 172, 178, 180, 182 Eosinophils, 152, 156, 161 Ephedrine, 78, 152 Epidemiological, 23, 56, 57, 152 Epidermis, 152, 160 Epithelial, 22, 23, 143, 153, 157 Epithelial Cells, 23, 143, 153, 157 Epithelium, 23, 153, 160 Epitopes, 22, 153 Equalization, 80, 153 Erythromycin, 11, 104, 143, 146, 153 Esophagus, 150, 153, 154, 162, 168, 176, 177 Ethmoid, 153, 167 Ethnic Groups, 122, 153 Etoposide, 55, 153 Eukaryotic Cells, 153, 159 Eustachian tube, 5, 6, 20, 71, 72, 78, 80, 93, 124, 153 Extracellular, 49, 50, 148, 153, 154 Extraction, 24, 76, 81, 153 Extravasation, 153, 157 F Facial, 120, 153, 163

186 Ear Infections

Facial Paralysis, 120, 153 Family Planning, 111, 153 Fat, 142, 144, 147, 149, 153, 162, 174, 176, 178 Fatty acids, 80, 151, 154, 155, 162, 171, 179 Fibrin, 142, 147, 154, 169, 179 Fibroblasts, 154, 160 Fibrosis, 78, 154 Fistula, 39, 154 Flurbiprofen, 73, 82, 154 Fungi, 154, 163, 164 Fungus, 146, 154 G Gallbladder, 150, 154 Gangrenous, 154, 175 Gas, 150, 154, 158, 172, 174, 181 Gas exchange, 154, 174, 181 Gastric, 140, 154, 157 Gastric Acid, 140, 154 Gastritis, 70, 154 Gastroenteritis, 154, 174 Gastroesophageal Reflux, 31, 154 Gastrointestinal, 70, 146, 154, 155, 161, 178 Gastrointestinal tract, 70, 155, 161 Gene, 23, 29, 34, 75, 78, 91, 144, 155, 160, 175 Gene Expression, 34, 155 Gene Library, 155 General practitioner, 11, 155 Genetic Code, 155, 166 Genetic testing, 155, 170 Genetics, 22, 38, 155 Genital, 146, 155 Genomic Library, 34, 155 Genotype, 25, 155 Gestational, 15, 19, 36, 155 Gestational Age, 15, 19, 155 Gland, 139, 149, 155, 162, 163, 167, 169, 175, 177, 178 Glottis, 155, 168 Glucocorticoid, 150, 155, 158 Glycerol, 155, 169 Glycerophospholipids, 155, 169 Glycoprotein, 140, 142, 155, 180 Glycosidic, 156, 165, 166 Goats, 156, 174 Gonadal, 156, 177 Gonorrhea, 145, 156 Governing Board, 156, 171 Graft, 156, 157 Grafting, 156, 158 Gramicidin, 83, 156

Gram-negative, 22, 144, 145, 146, 156, 166, 170, 172 Gram-positive, 26, 84, 145, 146, 156, 166, 176, 177, 178 Granulocytes, 156, 161, 182 Growth, 7, 18, 20, 68, 92, 139, 141, 142, 143, 146, 156, 165, 169 H Haemophilus, 4, 8, 10, 11, 13, 22, 27, 28, 29, 30, 32, 34, 38, 75, 76, 79, 80, 81, 145, 156 Half-Life, 10, 145, 156 Haploid, 156, 169 Haptens, 139, 156 Headache, 136, 156, 159 Health Care Costs, 7, 22, 23, 156, 157 Health Education, 96, 157 Health Expenditures, 156, 157 Hearing Disorders, 116, 124, 147, 157 Heart failure, 152, 157 Hematoma, 120, 157 Heme, 30, 157 Hemoglobin, 157 Hemorrhage, 156, 157, 177 Hepatitis, 53, 157 Hepatocytes, 157 Heredity, 122, 155, 157 Heritability, 35, 157 Heterogeneity, 139, 157 Histamine, 141, 157, 158 Hormonal, 142, 149, 157 Hormone, 139, 149, 151, 157, 171, 174 Hormone therapy, 139, 157 Host, 5, 12, 23, 26, 38, 68, 75, 91, 143, 150, 157, 158, 161, 181, 182 Hydrocortisone, 83, 158 Hydrogen, 143, 145, 150, 158, 164 Hydrolysis, 146, 158, 165, 170, 172, 180 Hypersensitivity, 140, 158, 161, 174 Hypersensitivity, Immediate, 140, 158 Hypotension, 158, 169 I Id, 51, 57, 117, 124, 125, 126, 132, 134, 158 Immune response, 10, 139, 141, 149, 156, 158, 178, 181, 182 Immune Sera, 158 Immune system, 158, 161, 162, 181, 182 Immunity, 75, 79, 150, 158, 180 Immunization, 26, 27, 29, 30, 158, 171 Immunoelectrophoresis, 140, 142, 158 Immunologic, 13, 155, 158 Immunology, 74, 139, 158

Index 187

Impairment, 15, 16, 18, 39, 72, 94, 120, 123, 143, 158, 163 Implantation, 34, 158 In situ, 23, 159 In Situ Hybridization, 23, 159 In vitro, 14, 22, 24, 30, 159, 170 In vivo, 24, 159, 179 Incompetence, 154, 159 Incontinence, 152, 159 Incubation, 159, 168 Incubation period, 159, 168 Indicative, 88, 159, 167, 181 Indomethacin, 73, 82, 159 Induction, 26, 141, 159 Infancy, 14, 16, 159 Infarction, 143, 149, 159, 163 Infiltration, 23, 159 Influenza, 18, 19, 23, 24, 26, 28, 36, 48, 50, 159 Inhalation, 139, 159, 170 Inner ear, 69, 71, 102, 144, 145, 159, 161 Inorganic, 146, 159, 164 Insight, 22, 160 Interleukin-8, 49, 50, 160 Intestinal, 140, 149, 160 Intestine, 144, 157, 160, 161, 177, 180 Intracellular, 24, 159, 160 Intramuscular, 6, 17, 160 Intrinsic, 4, 15, 139, 160 Introns, 155, 160 Invasive, 158, 160 Involuntary, 152, 160, 165, 176 Ions, 143, 151, 152, 158, 160 Iris, 149, 160, 172 Irritants, 151, 160 Ischemia, 142, 160 J Joint, 136, 146, 160 K Kb, 110, 160 Keratin, 72, 160 Keratinocytes, 160 Keratolytic, 150, 161, 170 L Labyrinth, 147, 159, 161, 166, 175, 181 Labyrinthitis, 56, 94, 161 Laceration, 161, 179 Lactation, 147, 161 Language Development, 3, 15, 88, 92, 119, 121, 123, 161 Language Disorders, 16, 147, 161 Large Intestine, 150, 160, 161, 173

Laryngeal, 31, 161 Larynx, 49, 50, 89, 155, 161 Latent, 161, 171 Lens, 73, 82, 144, 161 Lesion, 43, 92, 161, 181 Leucocyte, 73, 161 Leukocytes, 23, 73, 82, 143, 144, 152, 156, 159, 161, 164, 180 Leukotrienes, 48, 50, 142, 151, 161 Levofloxacin, 64, 161 Library Services, 132, 161 Lincomycin, 39, 147, 161 Linkages, 157, 162, 165, 178 Lipid, 80, 155, 162 Lipopolysaccharide, 38, 156, 162 Lipoxygenase, 73, 82, 142, 161, 162 Liver, 142, 143, 149, 150, 154, 156, 157, 162, 181 Local Government, 54, 162 Localized, 71, 150, 152, 157, 159, 162, 169, 179, 181 Locomotion, 162, 169 Lower Esophageal Sphincter, 154, 162 Lumen, 80, 162 Lymph, 146, 152, 162, 175 Lymph node, 146, 162, 175 Lymphatic, 159, 162, 174, 176, 179 Lymphatic system, 162, 174, 176, 179 Lymphocyte, 141, 162, 163 Lymphoid, 141, 161, 162, 180 M Macrolides, 9, 162 Malignancy, 31, 55, 162 Malnutrition, 142, 162 Mammary, 147, 163 Manifest, 74, 163 Mannosidosis, 38, 163 Mastitis, 77, 163, 175 Mastoiditis, 13, 45, 72, 93, 94, 163 Maxillary, 163, 167 Meatus, 151, 163, 167, 181 Mechanical ventilation, 7, 163 Mediator, 79, 163, 169 Medical Records, 163, 174 MEDLINE, 111, 163 Membrane, 4, 14, 30, 75, 78, 140, 145, 148, 151, 153, 156, 161, 163, 164, 165, 169, 174, 181 Meninges, 145, 146, 151, 156, 163, 181 Meningitis, 6, 13, 26, 30, 58, 72, 102, 163 Mental Disorders, 65, 163, 171, 172

188 Ear Infections

Mental Health, iv, 21, 65, 110, 112, 163, 171, 172 Mental Retardation, 147, 163 MI, 36, 68, 83, 137, 163 Microbiological, 56, 57, 163 Microbiology, 7, 26, 31, 32, 40, 163 Microorganism, 147, 164, 167, 182 Micro-organism, 150, 164, 175 Mineralocorticoids, 139, 149, 164 Minocycline, 56, 164 Mitotic, 153, 164 Mobility, 4, 164 Modification, 153, 164, 172 Molecular, 23, 29, 38, 79, 111, 113, 142, 144, 148, 164, 169, 180 Molecule, 141, 143, 148, 151, 156, 158, 164, 169, 170, 173, 180 Monocytes, 160, 161, 164, 169 Mononuclear, 164, 180 Motility, 159, 164 Motion Sickness, 164, 165 Mouth Breathing, 15, 164 Mucociliary, 72, 164, 176 Mucosa, 49, 50, 74, 164, 165 Mucus, 79, 151, 164 Muscular Diseases, 153, 164 Mutagenesis, 27, 164 Mutagens, 164 Mutate, 22, 164 Myalgia, 159, 164 Myocarditis, 150, 165 Myocardium, 163, 165 N Narcolepsy, 152, 165 Nasal Cavity, 78, 165, 167 Nasal Mucosa, 159, 165 Nasal Septum, 165 Nasopharynx, 26, 32, 76, 78, 81, 165 Nausea, 78, 136, 154, 165 NCI, 1, 65, 109, 165 Necrosis, 159, 163, 165 Need, 3, 9, 19, 68, 71, 76, 80, 83, 84, 87, 91, 95, 101, 127, 139, 165 Neomycin, 73, 82, 165 Neonatal, 56, 76, 81, 165 Neoplastic, 146, 158, 165 Nephrotoxic, 165, 170 Nerve, 54, 139, 141, 146, 153, 163, 165, 167, 174, 177, 179, 180 Nervous System, 145, 163, 165, 168, 178 Neuraminidase, 26, 165 Neurologic, 14, 165

Neuromuscular, 153, 165, 170 Neurotoxic, 165, 170 Neutropenia, 165, 169 Neutrophil, 140, 165 Nonverbal Communication, 147, 166 Norepinephrine, 139, 152, 166 Nuclei, 152, 153, 160, 166, 174 Nucleic acid, 24, 150, 155, 159, 164, 166 Nurse Practitioners, 9, 166 O Office Visits, 9, 12, 22, 72, 75, 166 Ofloxacin, 34, 41, 44, 60, 83, 166 Oligosaccharides, 13, 78, 165, 166 Ophthalmology, 73, 82, 166 Oral Health, 166 Oral Hygiene, 69, 166 Ossicles, 166, 177 Otolaryngologist, 18, 91, 92, 93, 166 Otology, 33, 35, 38, 39, 44, 45, 54, 55, 91, 92, 93, 166 Otorhinolaryngology, 4, 14, 34, 41, 43, 53, 56, 93, 166 Otorrhea, 72, 91, 92, 166 Otosclerosis, 124, 166 Outer ear, 120, 167 Outpatient, 9, 12, 77, 167 Oxazolidinones, 68, 83, 167 Oxidative metabolism, 161, 167 P Pachymeningitis, 163, 167 Palate, 165, 167, 176, 181 Palliative, 167, 179 Palsy, 54, 167 Pancreas, 150, 167, 180 Pancreatic, 154, 167 Pancreatic Juice, 154, 167 Paranasal Sinuses, 74, 167, 175 Parasitic, 117, 149, 151, 167, 179 Parasitic Diseases, 117, 167, 179 Paresis, 153, 167 Paroxysmal, 167, 168, 182 Patch, 167, 180 Pathogen, 5, 14, 22, 28, 80, 159, 167 Pathogenesis, 5, 7, 10, 19, 22, 23, 25, 26, 27, 80, 92, 167 Pathologic, 93, 149, 158, 167, 174 Pathophysiology, 10, 56, 91, 168 Patient Education, 118, 122, 124, 130, 132, 137, 168 Patient Selection, 7, 93, 168 Pediatrics, 8, 11, 15, 18, 20, 32, 36, 40, 41, 42, 44, 48, 49, 50, 95, 99, 120, 122, 168

Index 189

Penicillin, 5, 11, 26, 28, 29, 30, 141, 168 Peptide, 147, 160, 168, 170, 171, 172 Peptide Chain Elongation, 147, 168 Perception, 157, 168 Perforation, 18, 72, 91, 92, 94, 117, 168 Periodontal disease, 154, 168 Peripheral Nervous System, 167, 168, 178 Pertussis, 12, 168, 182 Phagocytosis, 41, 168 Pharmaceutical Preparations, 77, 145, 168 Pharmacodynamic, 30, 168 Pharmacologic, 80, 141, 143, 156, 168, 180 Pharynx, 89, 154, 159, 165, 168 Phlebitis, 56, 169 Phospholipids, 73, 80, 82, 153, 169 Physical Examination, 14, 155, 169 Physiologic, 13, 140, 144, 156, 169, 173, 174 Physiology, 87, 102, 123, 124, 169 Pituitary Gland, 149, 169 Plants, 76, 81, 150, 166, 169, 172, 175, 180 Plaque, 69, 169 Plasma, 140, 141, 142, 143, 145, 157, 164, 169 Plasma cells, 141, 169 Plasmid, 79, 169 Plasmin, 73, 142, 169 Plasminogen, 142, 169 Plasminogen Activators, 169 Platelet Activating Factor, 48, 50, 169 Platelet Factor 4, 160, 169 Platelets, 142, 143, 169, 170, 179 Platinum, 146, 170 Pleated, 160, 170 Pneumococcal Infections, 8, 170 Podophyllotoxin, 153, 170 Poisoning, 154, 165, 170 Polymerase, 10, 23, 170 Polymerase Chain Reaction, 10, 23, 170 Polymyxin, 83, 170 Polymyxin B, 83, 170 Polypeptide, 140, 147, 156, 169, 170, 172, 181 Polysaccharide, 36, 141, 145, 170 Pons, 153, 170 Posterior, 73, 82, 92, 151, 160, 167, 170, 176, 181 Postoperative, 122, 124, 171 Practice Guidelines, 15, 112, 124, 171 Preclinical, 11, 171 Precursor, 142, 152, 166, 169, 171 Predisposition, 7, 171 Pregnancy Tests, 155, 171

Prepuce, 146, 171 Prevalence, 13, 14, 16, 17, 19, 30, 80, 87, 95, 122, 171 Primary Prevention, 12, 171 Private Sector, 14, 171 Progesterone, 171, 177 Progression, 5, 10, 171 Progressive, 151, 156, 165, 171 Prone, 7, 9, 13, 23, 171 Prophylaxis, 56, 171, 181 Prospective Studies, 3, 11, 171 Prostaglandins, 142, 151, 159, 171 Prostaglandins A, 159, 171 Protease, 48, 49, 73, 140, 171 Protein C, 140, 143, 155, 160, 172 Protein Conformation, 140, 160, 172 Protein S, 91, 144, 146, 153, 155, 165, 172, 179 Proteins, 26, 29, 30, 79, 80, 84, 140, 141, 145, 147, 153, 158, 160, 164, 168, 169, 172, 175, 180 Proteolytic, 140, 148, 169, 172 Protocol, 8, 172 Protozoa, 151, 163, 164, 172 Proximal, 83, 151, 165, 172 Pseudomonas, 42, 45, 56, 73, 83, 172 Psychiatric, 147, 163, 172 Psychiatry, 172, 181 Psychomotor, 163, 172 Public Health, 11, 12, 14, 17, 18, 33, 34, 78, 112, 172 Public Policy, 111, 172 Publishing, 5, 27, 68, 172 Pulmonary, 6, 78, 80, 140, 161, 172, 174, 178, 181 Pulmonary Ventilation, 172, 174 Pupil, 149, 172 Purulent, 139, 166, 172 Q Quality of Life, 4, 43, 172 Quinolones, 18, 173 R Radiation, 139, 173 Radiation therapy, 139, 173 Radioactive, 156, 158, 173 Radiography, 155, 173 Randomized, 11, 20, 36, 43, 63, 151, 173 Randomized Controlled Trials, 43, 173 Reagent, 24, 173 Receptor, 22, 26, 48, 50, 141, 173 Recombination, 38, 173 Rectum, 144, 150, 154, 159, 161, 173

190 Ear Infections

Recurrence, 8, 9, 173 Refer, 1, 147, 151, 154, 162, 173, 181 Refraction, 173, 176 Refractory, 4, 48, 49, 173 Regimen, 7, 151, 173 Regurgitation, 154, 173 Relapse, 8, 173 Remission, 173 Resorption, 154, 174 Respirator, 163, 174, 181 Respiratory Physiology, 174, 181 Respiratory syncytial virus, 18, 19, 24, 174 Respiratory Syncytial Virus Infections, 18, 174 Respiratory System, 79, 164, 174 Response rate, 16, 174 Retina, 161, 174 Retrospective, 3, 6, 55, 174 Retrospective study, 6, 55, 174 Rheumatism, 174 Rheumatoid, 70, 147, 174 Rheumatoid arthritis, 70, 147, 174 Rhinitis, 90, 144, 152, 174, 175 Rhinovirus, 22, 24, 48, 50, 174 Ribose, 139, 149, 174 Rigidity, 169, 174 Risk factor, 6, 9, 12, 13, 14, 18, 19, 43, 53, 87, 93, 95, 102, 119, 120, 122, 174 Rod, 89, 143, 156, 172, 174 Rotavirus, 70, 174 Rubella, 12, 174 S Salivary, 149, 150, 175 Salivary glands, 149, 150, 175 Saponins, 175, 177 Scleroproteins, 160, 175 Screening, 22, 43, 90, 125, 147, 175 Secretion, 23, 124, 149, 157, 161, 164, 175 Secretory, 28, 73, 88, 140, 175 Segregation, 173, 175 Semicircular canal, 159, 175 Semisynthetic, 140, 145, 146, 147, 153, 164, 175 Septic, 56, 175 Septicaemia, 175 Sequencing, 170, 175 Serotypes, 22, 175 Serous, 48, 49, 94, 124, 147, 175 Serum, 14, 140, 147, 158, 164, 175, 180 Shock, 158, 175 Side effect, 5, 103, 139, 175, 180

Signs and Symptoms, 20, 25, 94, 120, 173, 175 Sinusitis, 10, 11, 22, 31, 74, 78, 84, 89, 175 Skull, 144, 146, 176, 178 Sneezing, 168, 176 Snoring, 15, 176 Social Environment, 172, 176 Soft tissue, 68, 83, 144, 176 Spasmodic, 168, 176 Spatial disorientation, 151, 176 Specialist, 16, 127, 176 Species, 80, 154, 156, 167, 170, 172, 176, 177, 179, 180, 182 Specificity, 25, 139, 142, 176 Spectrum, 24, 176 Speech Perception, 4, 176 Sphenoid, 167, 176 Spinal cord, 145, 146, 151, 163, 165, 167, 168, 176, 178 Spiramycin, 37, 176 Spleen, 149, 162, 176 Sputum, 78, 176 Squamous, 146, 176 Squamous Epithelium, 146, 176 Stapedius, 33, 177 Stapes, 177 Staphylococcal Infections, 31, 177 Staphylococcus, 11, 83, 154, 164, 177 Statistically significant, 6, 15, 177 Sterile, 10, 17, 177 Sterilization, 72, 177 Steroid, 31, 73, 82, 93, 149, 175, 177 Steroid therapy, 93, 177 Stimulus, 143, 160, 177, 179 Stomach, 150, 153, 154, 155, 157, 162, 165, 168, 176, 177 Strand, 170, 177 Streptococci, 28, 177 Stress, 14, 17, 18, 154, 165, 171, 174, 177 Stroke, 65, 110, 177 Subacute, 159, 175, 177 Subclinical, 43, 159, 177 Subcutaneous, 145, 154, 177 Sublingual, 77, 177 Subspecies, 176, 177 Substance P, 153, 175, 178 Substrate, 165, 178 Sulfisoxazole, 11, 104, 178 Suppression, 149, 178 Suppurative, 8, 31, 33, 36, 37, 39, 40, 44, 49, 50, 56, 75, 93, 145, 154, 178 Surfactant, 48, 50, 80, 178

Index 191

Sweat, 146, 178 Sweat Glands, 146, 178 Sympathetic Nervous System, 178 Sympathomimetic, 78, 166, 178 Symptomatic, 9, 25, 178 Systemic, 19, 78, 94, 104, 147, 150, 159, 169, 173, 178, 180 T Tachycardia, 143, 178 Tachypnea, 143, 178 Tea Tree Oil, 53, 178 Teichoic Acids, 156, 178 Temporal, 8, 25, 92, 93, 157, 163, 178 Tenesmus, 151, 178 Testicular, 21, 178 Testis, 178 Tetani, 178, 179 Tetanic, 179 Tetanus, 12, 41, 56, 178, 179 Tetracycline, 73, 82, 164, 179 Therapeutics, 21, 24, 55, 73, 82, 105, 179 Thermal, 151, 170, 179 Threshold, 6, 179 Thrombocytopenia, 169, 179 Thrombophlebitis, 78, 179 Thrombosis, 72, 143, 172, 177, 179 Thromboxanes, 142, 151, 179 Thrombus, 149, 159, 179 Thymus, 158, 162, 179 Tick-Borne Diseases, 56, 179 Ticks, 179 Tinnitus, 89, 166, 179 Tonsillitis, 12, 179 Tonsils, 99, 179, 180 Topical, 36, 44, 49, 50, 60, 68, 71, 77, 78, 82, 83, 178, 180 Torticollis, 55, 180 Toxic, iv, 150, 156, 158, 165, 170, 180, 181 Toxicity, 151, 180 Toxicology, 112, 180 Toxins, 141, 159, 180 Toxoplasmosis, 143, 180 Transcriptase, 10, 23, 180 Transdermal, 68, 180 Transfection, 144, 180 Transfer Factor, 158, 180 Translation, 153, 165, 180 Translocation, 146, 153, 180

Transmitter, 163, 166, 180 Transplantation, 158, 180 Treatment Failure, 5, 6, 9, 17, 180 Trimethoprim-sulfamethoxazole, 17, 180 Trypsin, 140, 180 Tumor Necrosis Factor, 23, 180 Tympanic membrane, 4, 14, 17, 18, 72, 82, 91, 92, 166, 181 Tyrothricin, 156, 181 U Ulcer, 145, 181 Ultrasonography, 155, 181 Unconscious, 158, 181 Uracil, 181 Uridine Triphosphate, 71, 181 Urinary, 145, 146, 152, 159, 181 Urinary tract, 145, 181 Urine, 144, 159, 181 Uvula, 176, 181 V Vaccination, 12, 43, 96, 181 Vaccine, 7, 8, 12, 19, 22, 26, 30, 36, 42, 48, 49, 50, 51, 75, 97, 98, 104, 139, 172, 181 Valves, 25, 181 Vascular, 73, 82, 158, 159, 169, 179, 181 Vein, 169, 179, 181 Venous, 143, 172, 181 Ventilation, 12, 13, 18, 121, 124, 181 Ventilator, 163, 174, 181 Vertigo, 166, 181 Vestibular, 89, 92, 181 Vestibule, 147, 159, 175, 181 Veterinary Medicine, 111, 182 Vinca Alkaloids, 182 Vincristine, 54, 182 Viral, 5, 7, 10, 12, 14, 19, 20, 23, 24, 25, 42, 45, 49, 50, 70, 72, 77, 78, 81, 116, 118, 159, 179, 182 Viral Vaccines, 5, 182 Virulence, 22, 26, 27, 29, 38, 142, 180, 182 Virus, 13, 18, 19, 20, 24, 25, 26, 28, 30, 48, 50, 53, 104, 143, 169, 174, 182 Vitro, 182 Vivo, 24, 29, 182 W White blood cell, 141, 147, 161, 162, 164, 165, 169, 182 Whooping Cough, 168, 182

192 Ear Infections

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