Ear, nose and throat disorders in children : presentation and management in general practice
The aims and hypotheses of this thesis investigated three broad themes. (a) That the management of E.N.T. disorders in children will depend on both parents' and doctors' responses to the symptoms and signs of these disorders. (b) That the effectiveness of conventional approaches to the use of decongestant/antihistamine mixtures and antibiotics can be tested by clinical trials in the setting of general practice. (c) That referral for specialist opinion is not only related to the physical components of a child's condition, but the factors related to the mother's ability to cope. Studies of management by parents prior to seeking medical advice and their expectations of treatment for their children's respiratory illness highlighted the important role played by parents in the care of children. Children referred to E.N.T. specialists had mothers who received an excess of psychotropic drugs compared to mothers of children not referred, and this finding showed that clinical management of children is frequently linked to the health of their mothers. Using acute otitis media as the model condition, clinical trials in the setting of general practice showed: (a) that neither decongestant nor antihistamine confirmed any benefit over placebo in the relief of symptoms of middle ear infection or prevention of recurrence of upper respiratory symptoms and otitis media and (b) that high dose short course antibiotic treatment was as effective as the conventional one week course in the resolution of symptoms and signs of acute middle ear infections, and this simplified treatment regimen was acceptable to parents. The type of antibiotic treatment had no appreciable effect on recurrence of otitis media or hearing loss at follow up. The overall conclusion of this thesis was that the care of E.N.T. problems in children is not merely related to the presenting symptoms and signs, but to parents' understanding and capacity to cope with their children's complaints.