Volume 110, Issue 5

Context: Osteopathic physicians have used osteopathic manipulative medicine (OMM) to treat patients with acute otitis media (AOM) and its sequelae (eg, middle ear effusion [MEE], conductive hearing loss) for more than a century. However, few clinical trials document the efficacy of OMM, perhaps because of various challenges related to OMM clinical trials. Objectives: To describe a research protocol studying the efficacy of OMM on MEE after an episode of AOM, comment on the feasibility of the protocol and statistical analysis, and report on lessons learned in the first 9 months of the study. Methods: Dual-site, prospective, randomized, blinded, controlled clinical trial comparing OMM plus standard care to standard care only for MEE after an episode of AOM. Standard care comprised antibiotics and surgery. Patients were aged between 6 months and 24 months, were diagnosed as having AOM, were referred to the study by a participating pediatric provider, and had abnormal tympanogram results on entry into the study. All patients had 5 weekly study visits, and patients in the intervention group received OMM on visits 1 through 3. Patients received weekly tympanogram and acoustic reflectometer readings as well as daily at-home acoustic reflectometer readings for 30 days. Results: Fifty-six patients were screened, 34 subjects were enrolled, and 26 subjects completed the study protocol in the first 9 months of the study. This resulted in 22 “ears” in the standard card only group and 18 “ears” in the standard care plus OMM group, resulting in 40 cases of AOM studied in the first year of the trial. The OMM treatment protocol was easily administered without serious adverse events. Protocols for interpretation of tympanogram readings and conversion of data for statistical analysis resulted in analyzable data. Conclusions: The OMM protocol can be administered with no serious adverse events. Subject recruitment is difficult, and a full-time research assistant at the referring site improves subject referral, enrollment and retention. Accepting only confirmed cases of AOM from trained pediatric providers reduces the patient pool but increases the reliability of the data. (ClinicalTrials.gov number NCT00520039)

Context: Influenza remains a serious threat and is the most frequent cause of death from a vaccine-preventable disease. Physicians' understanding of influenza and its management and prevention can potentially reduce the spread of disease in the community. Objective: To ascertain physicians' knowledge of the prevention, identification, and treatment of seasonal and avian influenza. Methods: A 14-question survey regarding seasonal and avian influenza was distributed to emergency physicians at a medical staff meeting in 2005. Results: The survey was given to 360 physicians, of whom 54 (15%) submitted completed surveys. Of the 51 physicians (94%) in favor of vaccines, only 32 (59%) received the influenza vaccine and only 21 (39%) always received the yearly vaccine. Eight physicians (15%) washed their hands before seeing patients, 18 (33%) washed their hands after seeing patients, 21 (39%) washed their hands before and after seeing patients, and 7 (13%) stated they only wash their hands sometimes. Seven (13%) always “alcohol” their stethoscope between patients; 28 (52%) responded “sometimes;” and 4 (7%), “never.” When taking patient histories, 31 (58%) stated that they always or sometimes ask about travel history; 15 (28%) stated that they never ask about travel history. Thirty-six respondents (67%) would take oseltamivir phosphate if they had avian influenza. Conclusion: This survey-based study reveals that physicians may lack information in the domains of influenza prevention, identification, and management. Emergency physicians must take the lead in the hospital to ensure that we as a profession are aware of emerging pathogens, how to recognize those pathogens and treat infected patients, and how to protect ourselves.

Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient.

De Quervain tenosynovitis is characterized by pain that overlies the radial aspect of the wrist and that is aggravated by ulnar deviation of the hand. The most common cause of de Quervain tenosynovitis is overuse of the thumb musculature. The authors report a case of bilateral de Quervain tenosynovitis observed in a woman aged 48 years at a rural outpatient primary care office. The condition was induced by the patient's excessive use of the text messaging feature on her cellular telephone. Treatment, including naproxen, cock-up wrist splints, and limitation of texting, resulted in complete recovery of the patient. The authors urge physicians to be aware of the potential association between a patient's tenosynovitis symptoms and excessive texting.