To evaluate the efficacy of adenoidectomy and adenotonsillectomy for
the treatment of recurrent otitis media, Paradise and colleagues studied more
than 400 children aged 3 to 15 years with persistent or recurrent otitis media
who had not had prior treatment with tympanostomy tubes. Children without
recurrent throat infection or tonsillar hypertrophy were randomly assigned
to treatment with adenoidectomy, adenotonsillectomy, or nonsurgical treatment
(3-way trial), and children with indications for tonsillectomy, to treatment
with adenotonsillectomy or control (2-way trial). Differences between surgical
and control groups in the occurrence rate of episodes of acute otitis media
and in the estimated proportion of time with otitis media were generally small
and limited to the first follow-up year. In an editorial, Gates reviews the
medical and surgical treatment of recurrent otitis media and the therapeutic
implications of this study.
See Article and editorial Article
Six articles in this issue of THE JOURNAL address traumatic brain injury
(TBI) and highlight the serious risk and consequences of TBI associated with
participation in competitive sports. More than 1 million individuals in the
United States sustain a traumatic injury to the brain each year and, as noted
by Kelly in an editorial, an estimated 300,000 cases of TBI occur annually
in association with sports and recreational activities. In an analysis of
data from the National Hospital Discharge Survey, Thurman and Guerrero report
that the annual rate of hospitalization associated with TBI has decreased
from 199 to 98 cases per 100,000 people between 1980 and 1995, an estimated
overall decline of 51%. The hospitalization rate declined 61% for mild TBI
and 19% for moderate TBI, but increased 90% for severe TBI—trends that
most likely reflect changes in hospital admission practices.
In this 3-year study by Powell and Barber-Foss of high school athletes
in 10 varsity sports, certified athletic trainers at 235 high schools reported
23,566 sports injuries, of which 1219 (5.5%) were mild TBIs (concussions).
Based on these data, the authors estimate that the annual incidence of mild
TBI in high school athletes participating in the 10 sports is 62,816 cases,
of which 63% occur among football players.
Collins and colleagues evaluated 393 college football players using
a clinical interview and a battery of neuropsychological tests. A history
of prior concussion and of learning disability were independently associated
with poorer neuropsychological performance. Football players with a history
of 2 or more prior concussions in addition to a history of learning disability
performed significantly worse on 2 neuropsychological measures than those
who had multiple prior concussions but no history of learning disability.
In a cross-sectional study of amateur soccer players, Matser and colleagues
found that the performance of amateur soccer players was significantly worse
on measures of planning and memory compared with a control group of amateur
runners and swimmers. Among soccer players, poorer performance on 6 of the
16 neuropsychological tests was correlated with the number of soccer-related
See Article and Article
This consensus statement from the National Institutes of Health Consensus
Development Panel on Rehabilitation of Persons With Traumatic Brain Injury
describes the epidemiology, pathophysiology, and consequences of TBI and the
efficacy of therapeutic interventions, and lists recommendations for rehabilitation
practices and further research.
"How we respond to patients—in mood and action—reflects
the core of the physician we are striving to become." From "Facing Our Morality:
The Virtue of a Common Life."
Update in physical medicine and rehabilitation: Comprehensive day rehabilitation
programs, musculoskeletal medicine, and women's musculoskeletal health.
A major effort to classify tumors based on their molecular makeup will
revolutionize the diagnosis and treatment of malignancies.
Pellegrino and Relman assert that economic self-interest
is threatening the moral foundation of professional medical associations and
propose specific ethical guidelines to govern them.
For your patients: A primer on head injury.
This Week in JAMA. JAMA. 1999;282(10):919. doi:10.1001/jama.282.10.919