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This Week in JAMA
JAMA. 1999;282:919.
Pharyngeal Surgery for Recurrent Otitis Media
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 (SEE ARTICLE)
The Toll of Traumatic Brain Injury
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.
(SEE ARTICLE) and editorial (SEE ARTICLE)
Frequency of TBI in High School Athletes
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.
(SEE ARTICLE)
Neuropsychological Outcomes of TBI in Athletes
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 concussions.
(SEE ARTICLE) and (SEE ARTICLE)
Rehabilitation of Individuals With TBI
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.
(SEE ARTICLE)
A Piece of My Mind
"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."
(SEE ARTICLE)
Contempo 1999
Update in physical medicine and rehabilitation: Comprehensive day rehabilitation programs, musculoskeletal medicine, and women's musculoskeletal health.
(SEE ARTICLE)
Medical News & Perspectives
A major effort to classify tumors based on their molecular makeup will revolutionize the diagnosis and treatment of malignancies.
(SEE ARTICLE)
Commentary
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.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on head injury.
(SEE ARTICLE)
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