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Efforts to decrease childhood injuries from bicycle accidents should be directed towards education about helmets and safe riding skills. The medical records of 52 children injured in bicycle accidents were reviewed. The patients and their guardians were then interviewed, and accident reports were reviewed when available. Of the 52 cases, 56% were caused by a fall, and 44% by collision with another vehicle. Of these collisions, 87% were the fault of the cyclist, and 43% involved the cyclist's failure to stop or yield at an intersection. None of the cyclists was wearing a helmet and 56% of them suffered head injuries. The primary reasons for not wearing a helmet were that the riders or their families never thought of it, or they thought it was unnecessary.

The use of cotton-tipped swabs to clean children's ears may lead to earwax impaction. The formation of a plug of wax in the ear is called impaction. The ear-cleaning habits of 651 children between the ages of two weeks and 20 years were evaluated. Children or their parents completed questionnaires about their use of cotton-tipped swabs, ear drops and soap and water. The children's ears were then examined by a pediatrician who rated the degree of wax blocking the ear canal. Blockage was similar in both ears in 85% of the children. Blockage of at least 75% occurred in 7% of both the left and right ears. Blockage of 100% of the ear canal occurred in 2.9% of the left ears and 2.6% of the right ears. Those who ever used cotton-tipped swabs had the highest level of blockage in both ears. Among those who had used the swabs in the previous two months, association with significant blockage was found only for the left ear.

The accurate measurement of body temperature is essential to making valid diagnoses, especially in children. Central nervous system thermoreceptors, located in the hypothalamus of the brain, are involved in body temperature regulation. The tympanic membrane (eardrum) and the hypothalamus share the same vascular supply, and the tympanic membrane is a readily accessible site for the measurement of core body temperature. Thermoscan is a device developed for measuring tympanic membrane temperatures (TMT). Without direct contact, it measures the thermal infrared energy emitted from the eardrum. Temperature readouts are instantaneously and easily obtained, the procedure is noninvasive, and risks for patients and health care providers are minimal. A study conducted at the Cleveland Clinic Foundation enrolled 137 children less than 18 years of age to: (1) compare TMT readings with temperatures obtained using IVAC electronic thermometers for oral and rectal measurements; (2) determine the effect of middle ear disease on TMT; and (3) identify parent, patient and physician acceptance of the TMT procedure. The speed (2.5 seconds per reading), ease, and patient acceptance of the TMT procedure impressed parents and physicians. There was strong agreement between oral, rectal and tympanic membrane temperature readings. The results of the small number of patients with ear disease and wax build-up were not conclusive. The issue of examiner variability was not addressed; all readings were made by a single investigator. Some parental concerns were raised about the accuracy of the TMT readings. These concerns should be addressed by public education programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children with serous otitis media have accumulation of a thin, viscid serum-like fluid in their middle ear. The condition can result in the loss of hearing. Preliminary studies have suggested that serous otitis media may be successfully treated with the glucocorticoid steroid dexamethasone, given through the nose. The research on steroid treatment of serous otitis media since 1966 is reviewed and summarized. Treatment with antibiotics for bacterial infections, one of the possible causes of serous otitis media, plus a brief treatment with steroids may cause a temporary beneficial effect. However, the effectiveness of treatment with steroids, given through the nose or systemically (throughout the whole body), has not been proven without doubt. No adverse effects of treatment of middle ear infections with steroids have been shown. Large carefully controlled studies with long-term follow-up are needed to further evaluate the effectiveness of treatment of serous otitis media with steroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

Telephone follow-up calls to parents who brought their child to a free immunization fair were not successful in encouraging them to take their child to a pediatrician for a regular exam. The fairs were held at two sites in Cleveland, one in a white working class suburb and one in a poor black community.