A new trial is underway to determine if a short course of oral steroids can improve the hearing of children suffering from glue ear.
Glue ear is the most common reason for childhood surgery, with approximately 25,000 operations carried out each year in the UK. Also known as otitis media with effusion (OME), the condition is caused by an accumulation of sticky fluid in the middle ear and affects around 80% of children by the age of four.
For most children, glue ear gets better by itself. But for thousands of children each year it results in deafness that can affect speech, social development and learning. This in many cases leads to depression, as well as behavioural and attention disorders.
With a substantial award from the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme, researchers from Cardiff University

Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons

Severity of emphysema, as measured by computed tomography (CT), is a strong independent predictor of all-cause, cardiovascular, and respiratory mortality in ever-smokers with or without chronic obstructive pulmonary disease (COPD), according to a study from researchers in Norway. In patients with severe emphysema, airway wall thickness is also associated with mortality from respiratory causes.
‘Ours is the first study to examine the relationship between degree of emphysema and mortality in a community-based sample and between airway wall thickness and mortality,’ said lead author Ane Johannessen, PhD, post-doctoral researcher at Haukeland University Hospital in Bergen, Norway. ‘Given the wide use of chest CT scans around the world, the predictive value of these measures on mortality risk is of substantial clinical importance.’
The study included a community-based cohort of 947 ever-smokers with and without COPD who were followed for eight years. All subjects underwent spirometry and CT scanning. Degree of emphysema was categorised as low, medium, or high based on the percent of low attenuation areas (areas with lower density than normal) on CT. COPD was diagnosed by spirometric measurement of airway obstruction. Of the 947 patients, 462 had COPD.
During follow-up, four percent of the 568 subjects with a low degree of emphysema died, compared with 18 percent of the 190 patients with a medium degree of emphysema and 44 percent of the 189 patients with a high degree of emphysema.
After adjustment for sex, COPD status, age, body mass index, smoking and measures of lung function, survival in the low emphysema group was 19 months longer than survival in the middle and high emphysema groups for all-cause mortality. Compared with subjects in the low emphysema group, subjects with a high degree of emphysema had 33 months shorter survival for respiratory mortality and 37 months shorter survival for cardiovascular mortality.
Emphysema was a significant predictor of all cause-specific mortalities, with increasing emphysema levels predicting shorter survival. While airway wall thickness was not an independent predictor of mortality, increased airway wall thickness reduced survival time in patients with more severe emphysema.
‘The relationship between emphysema levels and mortality we found can be used in the risk assessment of these patients,’ concluded Dr. Johannessen. ‘Accurately predicting mortality risk may help target patients for specific therapeutic interventions which may improve outcomes.’ EurekAlert

Most children with isolated skull fractures may not need to stay in the hospital, which finding has the potential to save the health care system millions of dollars a year (‘Isolated Skull Fractures: Trends in Management in U.S. Pediatric Emergency Departments’). In addition, a new device more accurately estimates children’s weights, leading to more precise drug dosing in the ER (‘Evaluation of the Mercy TAPE: Performance Against the Standard for Pediatric Weight Estimation’). Two studies showcase some of the work emergency physicians are doing to improve care for children in the nation’s emergency departments.
One study posits that most children who are hospitalised with isolated skull fractures may instead be discharged home safely from the ER. Researchers found that of children hospitalised with isolated skull fractures between 2005 and 2011, 85 percent were discharged within 1 day and 95 percent were discharged within 2 days. A very small number

Most people know a colonoscopy requires some preparation by the patient. Now, a Mayo Clinic physician suggests an additional step to lower the risk of colorectal cancer: Ask for your doctor’s success rate detecting easy-to-miss polyps called adenomas.
The measure of success is called the adenoma detection rate, or ADR, and has been linked to a reduced risk of developing a new cancer after the colonoscopy. The current recommended national benchmark is at least 20 percent, which means that an endoscopist should be able to detect adenomas in at least 1 of 5 patients getting a colonoscopy.
Recently, the Mayo Clinic in Florida developed a two-hour course designed to increase a doctor’s ADR rate in order to reduce development of colorectal cancer.
They found the short course made a big difference in even experienced endocopsists, the physicians who perform colonoscopies.
‘Numerous studies have shown that increased detection and removal of potentially pre-cancerous polyps lowers the incidence of colorectal cancer,’ says Michael Wallace, M.D., M.P.H., chair of the Division of Gastroenterology and Hepatology at Mayo Clinic in Florida. ‘We also know that there is a lot of variability in how proficient physicians are at finding those polyps.’
A team of Mayo physicians and researchers led by Dr. Wallace, has long been working to help endoscopists better detect polyps.
Dr. Wallace and his team developed a two-hour training course that describes polyps that can be difficult to see, such as flat lesions, but are often the most dangerous.
The research team turned to Mayo Clinic endoscopists to study whether the course helps. Researchers first looked at the adenoma detection rate in 15 physicians and found it was 35 percent