This study estimated the prevalence of hearing disorders and associated risk factors in a 10% sample of all secondary-school students in Ismailia city, Egypt. All participants were given a questionnaire and Weber and Rinne tests for hearing disabilities. Among 2633 students, the prevalence of hearing loss was 22.2%, mostly sensorineural hearing loss. More students at technical schools had mixed sensorineural and conductive hearing loss (46.2%) than students at general (28.6%) or commercial (25.3%) schools. Multivariate logistic regression analysis identified the number of attacks of otitis media, history of ear disease treatment, history of admission to fever hospital and history of ear surgery as independent risk factors for sensorineural hearing loss.

The aim of this study is to illustrate a method for adjusting the internationally used National Center for Health Statistics (NCHS) growth curves for local use in the assessment of nutritional status of Saudi children. All children 1-60 months in three semiurban-rural communities in Asir region, Saudi Arabia (N = 1168) were subjected to weight and height (or length) measurements. These measurements were individually compared with those of the NCHS reference population. The distribution of the study population was found to be significantly shifted to the left of the normal distribution for reference population on the percentile growth curves (P < 0.001). This denoted the inappropriateness of the NCHS reference standards for local use. Accordingly, the lower limits for the expected normal on the growth curves has been shifted from the 3rd percentile line to -3 standard deviation line, to be suitable for the Saudi children. This led to 70%& 56% reductions in the estimation of undernutrition, based on wt/age and ht/age indicators respectively. It is recommended that this adjustment be supported by other studies locally and in other developing countries.

The aim of this study was to determine the attitude of Saudi Arabians to research involving storage and use of human tissues from which genetic information may be derived and to assess their willingness to donate tissue samples to biobanks. In a cross-sectional interview study of 1051 outpatients at a hospital in Riyadh city, 68.8% had a positive attitude towards biomedical research and 78.4% were willing to allow use of excess surgical tissues for research purposes. Participants were less willing to allow the use of tissue or organs from a deceased relative. Logistic regression analysis found that predictors for a positive attitude to biomedical research and to use of tissue in research were: female sex, higher level of education, previous experience of blood testing and previous participation in health-related research. The attitudes towards biomedical research among the participants were satisfactory and comparable to findings from other countries.

A study in Riyadh, Saudi Arabia investigated the prevalence of gestational diabetes mellitus (GDM) and its predictors in a high-parity group of pregnant women (n = 633, 50.1% grand multiparas). The prevalence of GDM was 12.5% and 3.8% by World Health Organization and American Diabetes Association criteria respectively. Multiparous women were 8.29 times more likely to have GDM than nulliparous women. However, after adjustment for maternal age and history of abortion, nulliparous women were 2.95 times more likely to develop GDM than parous women. The probability of GDM for a parous woman increased from 2% to 21% when age increased from 20 to 40 years. The high rate of GDM among grand multiparas may be due to the confounding effect of maternal age.

Selected indicators for structure, process and outcome of care were used to audit diabetes care in 3 centres in Alexandria. Structure was poor: main problems included absence of appointment and recall system, deficiencies in laboratory resources and lack of educational material. Process of care was poor for 69.2% of patients: deficiencies included absence of essential information in records and missing some essential clinical examinations. Degree of control was poor for 49.2% of patients and only 30.6% had no complications. Compliance to appointment was good for about 80% of patients. Better outcome (fewer complications and higher compliance) was significantly associated with poor process of care. This cannot, however, be considered a valid predictor of outcome as good care might be initiated by the presence of complications.

Through a home-based survey, all people aged 18 years and over (n = 1800) in the catchment areas of 12 primary health care centres in 4 Egyptian governorates were subjected to standardized waist and hip measurements. Central obesity was determined based on the waist circumference (WC) and waist-to-hip ratio (WHR) indicators. The age-adjusted prevalence of central obesity among adults was 24.1% and 28.7% based on the WC and WHR indicators respectively. After adjustment for sex and other confounding factors, WC was significantly associated with the risk of diabetes and hypertension, while WHR was not significantly associated with either diabetes or hypertension. No significant association was seen between body mass index and diabetes or hypertension.

We assessed health-related lifestyles and their determinants among 600 Alexandria University students living in university hostels. Data were collected by questionnaires, and anthropometric and blood pressure measurements were taken. Most students were not satisfied with their situation in terms of accommodation, health and support. About 86% ate unhealthy diets, 33.8% were physically inactive, 25.3% were overweight or at risk of becoming overweight, 17.5% of male students were current smokers and 32.2% had poor sleep behaviours. About 28% of the students adopted 3 or more risk behaviours. About 23% reported low perceived health status and 80.3% felt they had low to moderate social support. There were significant sex differences regarding some behaviours.

Background: Peripheral lymphadenopathy can be caused by benign and malignant diseases. In this logistic regression model, we attempted to identify the clinical findings predicting high probability of nodal malignancy. Materials and Methods: Two hundred and twenty cases diagnosed by peripheral lymph node biopsy were studied. Of these, 164 had benign lymph node pathology, while the other 56 were malignant. The patientsâ medical charts were reviewed and a logistic regression model used to identify physical signs and simple investigations that will predict nodal malignancy. Results: Hard lymph node consistency, negative Mantoux test and positive abdominal ultrasound (showing hepatosplenomegaly with or without lymphadenopathy) were found to correlate with a higher probability of nodal malignancy. Conclusion: A logistic regression model is proposed to calculate the probability of lymph node malignancy at different ages and both sexes in relation to lymph node consistency, Mantoux test and abdominal ultrasound results.

Background: The aim of this study was to estimate the prevalence of smoking among university students of King Saud University in Abha City, to determine ecological factors for the problem, and to assess the studentsâ knowledge about the health effects of smoking, and attitudes towards public action against smoking. Materials and Methods: All medical students at the University College of Medicine (MC)(n=202), and a representative sample of students of the College of Education (CE)(n=300), were subjected to a modified Arabic version of the World Health Organization standard questionnaire for young people to study their knowledge, attitudes and practices of smoking. Results: The study revealed the following results among students of the CE and those of the MC, respectively. Prevalence of regular smoking (17.5% vs. 13.6%; P=0.25); heavy smokers (39.5% vs. 27.8%; P=0.38); smokers of moderate- to high-nicotine yield (92.7% vs. 50%, P=0.0004), and tar yield (48.8% vs. 16.7%, P=0.02). Curiosity was the main reason for initiation of smoking (41.2% vs. 51.9%), followed by the desire to show off (27.5% vs. 51.9%, P=0.03), and peer pressure (27.5% vs. 7.4%, P=0.04). Friends were the main source of the first cigarette (53.1% vs. 55.6%), followed by parents (2% vs. 40.7%, P=0.0001). Most students were knowledgeable about smoking and had favorable attitudes against it. However, MC students were significantly more knowledgeable than those of the CE. Conclusion: Smoking still constitutes a major problem among university students in Abha, in spite of their knowledge of its hazards. This may be due to the addictive effect of smoking, peer pressure, negative parental attitudes and other reasons. There is a need to implement an anti-smoking program for college students, and possibly legislation to limit the amount of tar and nicotine in cigarettes.

Background: There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India. Method: A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry. Results: Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children. Conclusion: Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation.

Spontaneous temporal meningoencephaloceles are unusual. When they do occur, they present with a variety of signs and symptoms, which can make diagnosis and management challenging. We report the interesting case of a 49-year-old woman with bilateral congenital temporal meningoencephaloceles. She presented with a 12-month history of bilateral fluctuating hearing loss, and she more recently developed right-sided acute otitis media with meningitis. The presentation of bilateral extensive tegmental defects and meningoencephaloceles with a fluctuating hearing loss and meningitis associated with acute otitis media affecting one ear and then subsequently the other ear is extremely rare and difficult to diagnose. It requires a very careful clinical and radiologic assessment. Methods of surgical repair differ depending on the size of the defects.

BACKGROUND/OBJECTIVE Deaf persons are equally susceptible to other otologic diseases as the rest of the population; however, there may be increased morbidity among the deaf population. The aim of the study is to determine common otologic problems and their prevalence among the deaf and to offer treatment where appropriate. MATERIALS AND METHODS Six hundred and twenty students aged between 5 and 38 years with profound hearing loss were recruited from a special school for the deaf. Hearing level was assessed and full ENT examination including otoscopy was done. RESULTS 22.4%[139] of the deaf students had otologic diseases, with 69.1% of them having wax impaction and chronic suppurative otitis media and otitis media with effusion accounting for 21.6 and 7.2% respectively. CONCLUSION The study showed that wax impaction is a common problem and this can be quite uncomfortable for some of the students. A routine general and otologic screening program targeted at the deaf and deaf-blind is recommended.

Hearing loss from otitis media (OM) can affect young children's development. Some children with persistent OM-related hearing loss and associated problems can benefit from treatment, but researchers and clinicians are still unclear on how to identify them best. The present study aims to determine which factors are most related to the hearing loss in OM, as a first step towards an effective case-finding instrument for detecting infants with persistent OM-related hearing loss. The full PEPPER ('Persistent Ear Problems, Providing Evidence for Referral') item pool includes a wide range of risk factors for OM in a single questionnaire, and is easily completed by parents or guardians. The questionnaire was sent to all children invited for the universal hearing screen at age 9 months in Limburg, The Netherlands. Repeatedly failing of the hearing screen was used as outcome marker indicative of OM-related chronic hearing loss. Univariate analyses were conducted to determine statistically significant risk factors predicting 'fail' cases at this hearing screen. Five items were found as individually predictive of hearing screen failure and subsequent referral:'having severe cold symptoms','attending day care with >4 children','having siblings','severe nasal congestion' and 'male gender'. Suitably worded parental questions document risk factors for OM-related hearing loss in infants, broadly consistent with past general literature on OM risk factors, but more focused. The findings justify further optimising and evaluation of an additive or multiplicative combination of these questions as a means for selecting and routing an infant with diagnosed or suspected OM to further care.

UNLABELLED Chronic suppurative otitis media is one of the common ear diseases of the ear, particularly in childhood. It is the commonest cause of persistent mild to moderate hearing impairment in children and young adults. AIM To find out the prevalence of chronic suppurative otitis media among school children studying in urban private schools of Nepal. MATERIAL AND METHODS This study was carried out among 500 school children aged between 5 -15 years. Students were selected from urban private schools of four districts of Nepal. In all students, history was taken and otoscopic examination done from May 2006 to October 2006. Data were described using frequency and percentage. STUDY DESIGN Prospective cross sectional study. RESULTS Results showed that the prevalence of chronic suppurative otitis media in children studying in urban private schools of Nepal is 5.0%. Unilateral disease was seen in 72.0%, 76.0% had a tubotympanic disease and 24.0% had atticoantral disease. CONCLUSION The prevalence of chronic suppurative otitis media in urban private school children in Nepal is higher than other studies done in private school children. Health education, improvement of socioeconomic status and health facilities will be helpful in reducing the prevalence of chronic suppurative otitis media.

The objective of this study is to identify the prevalence of otitis media with effusion (OME) in primary school children and to value the possible predisposing factors focusing on relationship between allergy and OME in Western Sicily. 2,097 children attending primary school were screened from September 2006 to June 2007 in Sciacca. Children underwent pneumatic otoscopy, skin tests, tympanogram and acoustic reflex tests. Audiogram was performed if the child had a type B or a type C tympanogram. The criteria for diagnosis of OME were: documented persistent middle ear effusion by otoscopic examination for a minimum of 3 months, presence of B or C tympanogram, absence of ipsilateral acoustic reflex and a conductive hearing loss greater than 25 dB at any one of the frequencies from 250 Hz to 4 kHz. OME was identified in 143 children, in 61 of whom OME was unilateral and in 82 of whom it was bilateral. The overall prevalence of OME was 6.8%, with a maximum prevalence of 12.9% between 5 and 6 years of age. By increasing age, the prevalence of OME decreased. Also, we found a higher prevalence rate of OME in children with positive skin tests (62.9%) than those with negative skin tests (37.1%). The present study evidences the high social impact of OME, whose prevalence is directly correlated to age and atopy. Moreover, our finding supports the literature data that climatic and environmental factors may also have a role in the occurrence of OME.

OBJECTIVE To determine the impact of environmental, epidemiologic and familial factors in the development of persistent otitis media with effusion (OME-OME treated with antibiotics and followed additional 12 weeks) in primary school children in Istanbul. MATERIALS AND METHODS A total of 1800 children who were attending 4 different primary schools in Sisli and Beyoglu districts of Istanbul were screened and 1740 children who met the inclusion criteria were enrolled into this study. Questionnaires prepared in the Otorhinolaryngology Clinics of Taksim Research and Training Hospital and the forms were delivered to the parents to be filled the day before examination of each child. The forms were collected during the otoscopic examinations. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed as OME by otoscopic examination. The association between the children diagnosed as OME and the answers to the questionnaires was evaluated. RESULTS The prevalence of persistent OME in this paper was 8.7%(152/1740). Frequency of smoking in both parents (p<0.01) and mothers alone (p<0.0001), the frequency of acute otitis media (AOM) and upper respiratory tract infection (URTI) in past 1 year (p<0.0001), incidence of attending day care centers and crèches (p<0.0001), allergy history (p<0.05), the number of siblings (p<0.0001) and poor educational status of the parents (p<0001) were statistically significant factors among children with OME compared to normal children. Sex factors (p>0.05), mothers smoke history during pregnancy (p>0.05), relative marriage (p>0.05), smoking history of the fathers (p>0.05) and duration of breastfeeding (p>0.05) were not statistically significant. CONCLUSION Environmental, epidemiologic and familial factors in the etiology of OME are important. The parents must be informed about the risk factors and symptoms of OME and by this way, the development or delayed diagnosis of the disease that may lead to permanent hearing loss may be prevented.

OBJECTIVE This was to determine the prevalence of acute otitis media in children with pyrexia in an area with malaria endemicity and also the relevance of socio-economic factors on AOM. METHODS This prospective study was conducted between January 2004 and June 2005 at the emergency paediatric unit of the hospital among children aged 0-15 years presenting with pyrexia. All the children had full ENT examinations in addition to the evaluation by the emergency paediatricians. Diagnosis of AOM was based on history, examinations and otoscopic findings. RESULTS Two-hundred children with pyrexia were seen and the age range was 3 months to 15 years (mean 4.73). The male/female ratio was 1.7:1.03 years; 32 had features of AOM. Two third of the children were from the low socio-economic class. CONCLUSION AOM with late presentation in the suppurative stage of the disease is a common cause of pyrexia in children with a male preponderance and two third of the children were from the low socio-economic status. There is the need for otoscopic examinations of all pyretic children as the resultant hearing loss is related to difficulties in language acquisition in children below 2 years of age with effects on literacy and school achievement.

We conducted a cross-sectional study to determine the prevalence of hearing loss among 1,500 Nigerian schoolchildren aged 9 to 15 years who had chronic suppurative otitis media (CSOM). We also attempted to ascertain the effect that this hearing loss had on their academic performance. The study population was drawn from three schools in different socioeconomic tiers-low (n = 300), medium (n = 400), and high (n = 800). Overall, CSOM was present in 35 of these children (2.3%)-12 from the low-status school (4.0%), 11 from the middle-status school (2.8%), and 12 from the high-status school (1.5%); the overall difference in prevalence among the three schools was statistically significant (chi(2)= 6.40; degrees of freedom [df]= 2; p = 0.04). In all, 52 ears were affected by CSOM; of these, 18 (34.6%) had a pure-tone average (PTA) within normal limits, 20 (38.5%) had a mild conductive hearing loss, and 14 (26.9%) had a moderate loss. All but 2 of 160 control ears (1.2%) had hearing thresholds within normal limits. The difference in PTAs across groups was statistically significant (chi(2)= 114.89; df = 2; p< 0.001). As for academic performance, cumulative average test scores were significantly lower in the CSOM patients than in the controls-chi(2)= 14.57; df = 3; p = 0.002. At the higher end of the academic scale, scores of 66% and higher were obtained by 40.0% of patients and 51.3% of controls, and scores of 50 to 65% were achieved by 20.0% of patients and 37.5% of controls. At the lower end, scores of 40 to 49% were obtained by 31.4% of patients and 6.3% of controls, and scores of 39% and lower were obtained by 8.6% and 5.0%, respectively. We conclude that hearing loss was a significant sequela of CSOM in our study population and that it had an adverse effect on their academic performance. Children in the low socioeconomic group appeared to be more vulnerable.

Chronic suppurative otitis media (CSOM), a severe form of middle ear infection, affects most Australian Aboriginal children with up to 50% in some communities suffering hearing loss as a consequence. To date, there is no information on whether repeated exposure to the pathogens that characterize CSOM and that are present in the upper respiratory airway affect olfactory function. Accordingly, this study aimed to determine whether 1) there was a high prevalence of olfactory loss in Aboriginal children and 2) hearing loss is a predictor of olfactory loss. Two hundred and sixty one 9- to 12-year-old Aboriginal children from 16 rural communities reported to have high prevalences of CSOM and hearing loss were assessed for olfactory loss using a 16-odor identification test and hearing loss. One child was found to be anosmic, 4 were slightly hyposmic, and 42 had hearing loss. No relationship was found between olfactory loss and hearing loss. The test-retest reliability of the 16-odor identification test was 0.98. It was concluded that CSOM does not appear to affect olfactory function in the long term and that hearing loss in Aboriginal children is not a predictor of olfactory loss.