***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To test a method of measuring the related cost of  acute otitis media ( AOM ) and to provide a preliminary calculation of the indirect and directs costs associated with a single , medically treated episode of AOM . DESIGN The Otitis Media Diary was used to measure indirect and direct costs associated with AOM in a prospect i ve cohort study . Measured values included the parental time spent in otitis-specific child care and the number and type of medications used . A previously developed economic model was used to calculate the monetary costs associated with the value of caregiver time and the total opportunity cost of AOM . SETTING The pediatric clinic of Madigan Army Medical Center , Tacoma , Wash. PATIENTS A cohort of 25 children ( 12 with AOM and 13 controls ) aged 1 to 3 years . MAIN OUTCOME MEASURES Caregiver time and medication use . RESULTS The total cost attributable to AOM in the 3-month period following diagnosis was $ 1330.58 ( 95 % confidence interval , $ 1008.75-$1652.43 ) , with the majority of that cost stemming from the indirect , rather than direct , costs of illness . After conservative estimates of unmeasured expenses , such as clinic visits and transportation , were accounted for , indirect costs , accrued primarily by parental time , accounted for nearly 90 % ( 95 % confidence interval , 87.1%-92.3 % ) of the total 3-month cost associated with AOM and its medical treatment . The cost items of the Otitis Media Diary were also highly correlated with each other and with other measures of clinical and functional health status . CONCLUSIONS Otitis Media Diary measures of parental time and medication use appear to provide a more accurate means of calculating the real social costs attributable to the AOM disease process in this cost-effectiveness analysis The  treatment of deafness secondary to glue ear by grommet insertion  is compared to OBJECTIVE To assess the change in quality of life in a group of Australian children with recurrent acute otitis media ( AOM ) and /or otitis media with effusion ( OME ) who were treated with ventilating tube ( VT ) insertion .  METHODS Prospect i ve pre- and post-intervention outcome study at the Women 's and Children 's Hospital , North Adelaide , South Australia . The Otitis Media 6-item ( OM-6 ) survey was used as a measure of disease-specific quality of life prior to surgery and then again at 6 weeks post-operatively . Any patients who were listed for any additional ear , nose or throat ( ENT ) procedures at the same time were excluded . RESULTS Complete responses for both pre- and post-surgery question naires were obtained from the parents of 53 patients . The age range was 11 months to 15.4 years ( average 5.1 years ) , and 39.6 % ( n=21 ) were suffering from recurrent AOM whilst the remaining 60.4 % ( n=32 ) were suffering from OME . Overall ear-related quality of life was found to improve significantly following insertion of ventilating tubes ( p<0.001 ) , as was the mean OM-6 score ( p<0.001 ) . Furthermore , statistically significant improvements were noted in each individual domain making up the OM-6 survey ( physical suffering , hearing loss , speech impairment , emotional distress , activity limitations and caregiver concerns ) . CONCLUSIONS The disease-specific quality of life of a group of Australian pediatric patients with otitis media was found to significantly improve following insertion of ventilating tubes as measured by the OM-6 survey . Improvements were found in global ear-related quality of life , in the mean OM-6 score , as well as in all individual domains of the OM-6 survey In this study the reliability and validity of generic and disease-specific question naires has been assessed focusing on responsiveness . This is part of a study on the effects of recurrent acute otitis media ( rAOM ) on functional health status ( FHS ) and health-related quality of life ( HRQoL ) in 383 children with rAOM participating in a r and omized clinical trial . The following generic question naires were studied : 1 . R AND general health rating index , 2 . Functional Status Question naire ( FSQ Generic and FSQ Specific ) , 3 . TNO-AZL Infant Quality of Life ( TAIQOL ) , and the following disease-specific question naires : 1 . Otitis Media-6 ( OM-6 ) , 2 . Numerical rating scales ( NRS ) for child and caregiver ( NRS Child and NRS Caregiver ) , and 3 . a new Family Functioning Question naire ( FFQ ) . Reliability was good to excellent ( Cronbach ’s α range 0.80–0.90 , intraclass correlation coefficient range 0.76–0.93 ) . Moderate to strong correlations were found between the question naires as well as between question naires and relevant clinical indicators ( r = 0.29–0.49 ) , demonstrating construct validity . Discriminant validity for children with few versus frequent episodes of acute otitis media per year was good for most question naires ( P < 0.004 ) but poor for the otitis media-related subscales of the TAIQOL ( P = 0.10–0.97 ) and both NRS ( P = 0.22 and 0.48 ) . Except for the TAIQOL subscales , change scores were significant ( P < 0.003 ) for generic and disease-specific question naires . Effect sizes were somewhat higher for disease-specific compared to generic question naires ( 0.55–0.95 versus 0.32–0.60 ) except for the TAIQOL subscales , which showed very poor sensitivity to change . Anchor-based methods result ed in a somewhat larger range of estimates of MCID than distribution-based methods . Combining distribution-based and anchor-based methods result ed in similar ranges for the minimally clinical important differences for generic and disease-specific question naires : 2–15 points on a 0–100 scale . Apart from the generic TAIQOL subscales , both generic and disease-specific question naires used in this study showed good psychometric qualities and responsiveness for use in clinical studies on children with rAOM We studied 109 children with otitis media with effusion of 2 months ' duration or longer that was unresponsive to medical management . Eighty-six subjects who had neither " significant " hearing loss nor defined symptoms were r and omly assigned to receive myringotomy , myringotomy with tympanostomy tube insertion , or no surgery , and 23 subjects with significant hearing loss , defined symptoms , or both were r and omly assigned to receive either myringotomy or myringotomy with tube insertion . Myringotomy with tube insertion provided more disease-free time and better hearing than either myringotomy alone or no surgery ; however , some subjects who underwent myringotomy with tube insertion developed otorrhea or persistent perforation of the tympanic membrane .  Myringotomy offered no advantage over no surgery regarding percent of time with middle-ear effusion , number of acute otitis media episodes , and number of subsequent surgical procedures . These results may not properly be extrapolated to less severely affected children OBJECTIVES To test the effect of adenoidectomy in connection with tympanostomy compared with tympanostomy only in preventing otitis media in children younger than 2 years . DESIGN Prospect i ve trial with r and omized and nonr and omized arms . SETTING Primary care study clinics . PARTICIPANTS AND INTERVENTIONS The study participants were selected from 2497 children who had been enrolled in the Finnish Otitis Media Vaccine Trial at the age of 2 months . A total of 306 children , aged 1 to 2 years , who had experienced recurrent episodes of otitis media were r and omized into 2 treatment groups : tympanostomy with or without adenoidectomy . Of the 306 children , 137 were operated on according to r and om basis ( r and omized trial ) . The 169 children whose parents declined participation in the r and omized trial were operated on according to the parents ' preferences ( nonr and omized trial ) . All children were followed up until 2 years of age . The mean follow-up time was 7 months . MAIN OUTCOME MEASURE The rate of acute otitis media episodes . RESULTS The average reduction in the rate of all acute otitis media episodes in the adenoidectomy group was 19 % ( 95 % confidence interval [ CI ] , -14 % to 43 % ) among children enrolled in the r and omized trial and 25 % ( 95 % CI , -13 % to 50 % ) in the nonr and omized trial . The reduction in the r and omized trial was mainly due to reduction in the rate of pneumococcal otitis media ( 58 % , 95 % CI , 16%-79 % ) . CONCLUSION In children younger than 2 years , concurrent adenoidectomy during the insertion of tympanostomy tubes does not seem to have a major advantage over the insertion of tympanostomy tubes alone in preventing otitis media Otitis media has long been recognized as one of the most common diseases of childhood . A prospect i ve r and omized study was design ed with patients who had multiple episodes of acute purulent otitis media . Comparison of infection rates was made between patients treated with conventional antibiotic therapy for each episode and patients who had tympanostomy tubes placed . Placement of tympanostomy tubes significantly decreased the number of episodes of acute purulent otitis media and was shown to be an effective method of prophylaxis in the " otitis prone " child . Immunoglobulin levels in the middle ear in this group of patients were found to be similar to those levels in patients with otitis media with effusion . This supports the hypothesis that a dynamic relationship between the different clinical entities of otitis media exists To determine the efficacy of amoxicillin prophylaxis and of tympanostomy tube insertion in preventing recurrences of acute otitis media  , we r and omized 264 children 7 to 35 months of age who had a history of recurrent otitis media but were free of middle ear effusion to receive either amoxicillin prophylaxis , bilateral tympanostomy tube insertion or placebo . The average rate of new episodes per child year of either acute otitis media or otorrhea was 0.60 in the amoxicillin group , 1.08 in the placebo group and 1.02 in the tympanostomy tube group ( amoxicillin vs. placebo , P < 0.001 ; tubes vs. placebo , P = 0.25 ) . The average proportion of time with otitis media of any type was 10.0 % in the amoxicillin group , 15.0 % in the placebo group and 6.6 % in the tympanostomy tube group ( amoxicillin vs. placebo , P = 0.03 ; tubes vs. placebo , P < 0.001 ) . At the 2-year end point , the rate of attrition was 42.2 % in the amoxicillin group , 45.5 % in the placebo group and 26.7 % in the tympanostomy tube group . Adverse drug reactions occurred in 7.0 % of the amoxicillin group and persistent tympanic membrane perforations developed in 3.9 % of the tympanostomy tube group . The observed degree of efficacy of amoxicillin prophylaxis and of tympanostomy tube insertion must be viewed in light of the fact that study subjects proved not to have been at as high risk for acute otitis media as had been anticipated and in view of the differential attrition rates . We conclude that in the age group we studied , amoxicillin prophylaxis is the preferred first measure in attempting to prevent recurrences of acute otitis media and that tympanostomy tube insertion is a reasonble next alternative Otitis media has long been recognized as one of the most common diseases of childhood . Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media ( AOM ) . A blinded , prospect i ve , r and omized study was design ed to determine the efficacy of tympanostomy tubes , antibiotic prophylaxis , and placebo .  Children with recurrent AOM were entered in the study and followed for at least 6 months . A total of 65 children completed the protocol . Sixty-three of those were under the age of 4 years .  Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months . Five of 22 children in the tympanostomy tube group failed , compared to 12 of 20 in the placebo group ( p = .02 ) . There were 8 or 21 treatment failures in the sulfisoxazole group . Children with otitis media with effusion ( OME ) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes . Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings . Improvement of recurrent AOM was observed in the sulfisoxazole group , but was not statistically significant OBJECTIVE To examine the effects of a history of acute otitis media and different extrinsic factors on the risk of chronic otitis media with effusion in infancy . DESIGN A retrospective birth cohort with a 2-year follow-up . Infection data were gathered from medical records and background information came from question naires . The monthly risk of chronic otitis media with effusion was dynamically modeled to control the confounding effects and time-dependency of the risk factors . SETTING Primary health care centers , hospitals , and private practice s in 10 r and omly selected local government districts in the two northern most provinces of Finl and . SUBJECTS A r and om sample of 2512 children from the cohort . MAIN OUTCOME MEASURES Chronic otitis media with effusion , defined as a minimum of 2 months of middle-ear effusion , usually is disclosed by tympanocentesis and specific operative findings . RESULT 
    Output:
    
Ventilation tubes have a significant role in maintaining a ' disease-free ' state in the first six months after insertion .