PREVENTION OF OTITIS MEDIA IN INFANTS AND CHILDREN

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This program is a collaborative effort of investigators with expertise in otolaryngology, pediatrics, microbiology, immunology, speech and language, psychology, and biostatistics and of Boston institutions including Children's Hospital Medical Center, Boston City Hospital, Harvard University, Boston University School of Education and pediatric clinics and private practices. The program is organized into four projects: I. Otitis Media in the First Year of Life: epidemiology; chemoprophylaxis for preventions of recurrent and severe otitis media; and sequential measures of speech, language, cognitive ability, mother-child communicative interaction, and family interaction. II. Medical and Surgical Interventions for Cure and Prevention of Chronic Otitis Media with Effusion. III. Otitis Media in the High-Risk Newborn Infant. IV. Experimental Models of Viral and Bacterial Otitis Media (including studies in the chinchilla and mouse.) We have chosen for investigation the following major themes: A. Prevention of Otitis Media: chemophorphylaxis - use of antimicrobial agents to prevent otitis media in the firt year of life; immunoprophylaxis - studies of the outer-membrane proteins of non-typable strains of Hemophilus influenzae and antigens of respiratory syncytial virus with goals of development of safe and effective vaccines or use of passive protection by administration of immunoglobulins. B. Otitis Media in the Young Infant: newborn infant - studies of incidence, clinical course, microbiology and sequelae; first year of life - studies of chemoprophylaxis and long term sequela of speech, language and cognitive abilities. C. Gaps in Knowledge of Otitis Media: epidemiology - importance of race, day care, smoking, method of feeding (breast or bottle); family interaction and mother-child communicative interaction - effects of otitis media specifically and as representative of a chronic disease; audiology - assessment of hearing in infants with otitis media in the first year of life; and virology - role of primary and recurrent respiratory syncytial virus in pathogenesis of otitis media. D. Unresolved Issues of Critical Importance : management of chronic otitis media with effusion - optimal surgical or medical interventions; and development of speech, language and cognitive abilities in infants with severe and recurrent otitis media in the first year of life.