A randomised controlled trial of surgery for glue ear. Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets). A prospective randomized trial of adenoidectomy vs grommet insertion in the treatment of glue ear. A randomized study of the surgical management of children with persistent otitis media with effusion associated with a hearing impairment. OTOSCOPIC, IMPEDANCE, AND AUDIOMETRIC FINDINGS IN GLUE EAR TREATED BY ADENOIDECTOMY AND TONSILLECTOMY: A Prospective Randomised Study Grommets and Glue Ear: A Five-Year Follow up of a Controlled Trial 1 Prospective study of tympanosclerosis developing after grommet insertion. The mini-grommet and tympanosclerosis: results at two years. Bacteriological aspects of swimming with grommets. The long term outcome of secretory otitis media in children and the effects of surgical treatment: a ten year study. Perforation rates after ventilation tube insertion: does the positioning of the tube matter? The effectiveness of adenoidectomy in the treatment of glue ear: a randomized controlled trial. Aspiration of middle ear effusions prior to grommet insertion an etiological factor in tympanosclerosis. A prospective trial of unilateral grommets for bilateral secretory otitis media in children. The prevalence of ear, nose and throat disorders in preschool children with Down's syndrome in Glasgow A prospective randomized study of wound approximation with tissue glue in circumcision in children. Ventilation tubes in secretory otitis media. A randomized, controlled study of the course, the complications, and the sequelae of ventilation tubes. Chronic otitis media with effusion (glue ear) and adenotonsillectomy: prospective randomised controlled study. Improving referrals for glue ear from primary care: are multiple interventions better than one alone? Randomised controlled trial of early surgery versus watchful waiting for glue ear: the effect on behavioural problems in pre-school children. Early surgery compared with watchful waiting for glue ear and effect on language development in preschool children: a randomised trial Efficacy of myringotomy with and without tympanostomy tubes for chronic otitis media with effusion Matched Child Savings Accounts in Low-Resource Communities: Who Saves?
OBJECTIVE --To assess the effect of five different surgical treatments for glue ear ( secretory otitis media ) on improvement in hearing and , assuming one or more treatments to be effective , to identify the appropriate indications for surgery . DESIGN --R and omised controlled trial of children receiving ( a ) adenoidectomy , bilateral myringotomy , and insertion of a unilateral grommet ; ( b ) adenoidectomy , unilateral myringotomy , and insertion of a unilateral grommet ; ( c ) bilateral myringotomy and insertion of a unilateral grommet ; and ( d ) unilateral myringotomy and insertion of a grommet .  Children were followed up at seven weeks , six months , 12 months , and 24 months by symptom history and clinical investigations . SETTING --Otolaryngology department in an urban hospital . PATIENTS --149 Children aged 4 - 9 years who were admitted for surgery for glue ear and who had no history of previous operations on tonsils , adenoids , or ears and no evidence of sensorineural deafness . Inadequate follow up information on levels of hearing and on middle ear function was obtained from 22 . MAIN OUTCOME MEASURES --Mean hearing loss ( dB ) of the three worst heard frequencies between 250 and 4000 Hz , results of impedance tympanometry , and parental views on their child 's progress . RESULTS --In the 127 children for whom adequate information was available ears in which a grommet had been inserted performed better in the short term ( for at least six months ) than those in which no grommet had been inserted , irrespective of any accompanying procedure . Most of the benefit had disappeared by 12 months . Adenoidectomy produced a slight improvement that was not significant , though was sustained for at least two years . The ears of children who had had an  adenoidectomy  with myringotomy and grommet insertion , however , continued to improve so that two years after surgery about 50 % had abnormal tympanometry compared with 83 % of those who had had only myringotomy and grommet insertion , and 93 % of the group that had had no treatment . Logistic regression analyses identified preoperative hearing level as the single best predictor of good outcome from surgery . Other variables contributed little additional predictive power . CONCLUSIONS --If the principal objective of surgery for glue ear is to restore hearing then our study shows that insertion of grommets is the treatment of choice . The addition of an adenoidectomy will increase the likelihood of restoration of normal function of the middle ear but will not improve hearing . When deciding appropriate indications for surgery , a balance has to be made between performing unnecessary operations and failing to treat patients who might benefit from surgical intervention . Preoperative audiometry scores might be the best predictor in helping to make this decision OBJECTIVE --To measure the time to spontaneous resolution of severe chronic otitis media with effusion ( glue ear ) in children and study the effects of adenoidectomy , adenotonsillectomy , and ventilation tubes ( grommets ) . DESIGN --R and omised controlled study over 12 years . SETTING --Paediatric otorhinolaryngology clinics and in-patient unit . SUBJECTS--228 children aged 2 - 9 years with pronounced hearing loss from glue ear and persistent bilateral middle ear effusions confirmed on three occasions over three months . INTERVENTIONS --Children were r and omly allocated to adenotonsillectomy , adenoidectomy , or neither procedure . In all groups a Shepard type ventilation tube was inserted in one r and omly chosen ear . Follow up was annually for five years and then less often for up to seven years four months . For analysis the two operated groups were combined . MAIN OUTCOME MEASURES --Otoscopic clearance of fluid , change in tympanogram , and improvement in mean audiometric hearing threshold . RESULTS --Survival analysis showed appreciable otoscopic and tympanometric resolution of fluid with ventilation tubes alone and adenoidectomy alone compared with no surgery . Further improvement was seen after combination of both treatments . Mean audiometric hearing thresholds improved with fluid resolution . Resolution was delayed in younger children and in those whose parents smoked , irrespective of treatment . Whereas a single insertion of a Shepard tube resolved the glue for a mean ( SD ) period of 9.5 ( 5.2 ) months , the effect of adenoidectomy was sustained throughout follow up . CONCLUSIONS --Treatment of glue ear considerably shortened the time to fluid resolution , combined adenoidectomy and tube insertion being better than either procedure alone . Resolution was longer in younger children and those whose parent(s ) smoked , irrespective of treatment The  treatment of deafness secondary to glue ear by grommet insertion  is compared to The object of this study was to compare the effect on the hearing of the insertion of a grommet , with or without adenoidectomy , against a non-surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion . Seventy-eight children ( 44 boys , 34 girls , mean age 5.8 years ) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment ( pure tone average air conduction thresholds over 0.5 , 1 and 2 kHz of > or = 25 dB HL ) over a three month period were admitted to a r and omized , controlled trial . Each child was r and omized to have or not to have an adenoidectomy . The ears in each child were then r and omly allocated to have a grommet ( tympanostomy tube ) inserted . The children 's hearing status was review ed six and 12 months post-operatively . During follow-up , should a child redevelop a persistent bilateral hearing impairment ( as defined above ) for three months they were managed with a hearing aid . Thus no child had repeat insertion of a grommet . Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post-operatively but not at 12 months when it was no different from natural resolution . If resolution of the otitis media with effusion is the outcome measure , then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls . Even in boys it only resolves about 60 per cent of effusions . However , when combined with a grommet ( one insertion ) adenoidectomy gives no greater resolution ( 89 per cent compared with 86 per cent ) . ( ABSTRACT TRUNCATED AT 250 WORDS 150 children aged between 2 and 9 years ( mean 5.25 years ) with chronic bilateral otitis media with effusion were r and omly allocated to three groups who , in addition to unilateral myringotomy and grommet insertion  , would have an adenotonsillectomy , an adenoidectomy , or neither . The contralateral ear was assessed . Otoscopic , impedance , and audiometric findings were recorded preoperatively and at six and twelve months postoperatively . Subtraction of the no-surgery results indicates that at twelve months adenoidectomy produces otoscopic resolution of OME in 41.7 % and no-peak/peak conversion of impedance in 29.8 % . The hearing gain from adenoidectomy alone was similar to that result ing from insertion of a grommet alone , but the children having adenoidectomy required fewer reinsertions to maintain adequate subjective hearing thresholds in the treated ear ( 26 % versus 54 % ) . Tonsillectomy conferred no additional benefit . Without treatment there was a small but significant improvement in all indices at twelve months but not at six months postoperatively Material and methods Sixty children aged between 4 and 10 years with seromucinous otitis media in both ears were originally included , but 5 failed to attend for follow up , thus leaving a total of 55 ( 92 % followup rate ) . In each instance the diagnosis was made on a careful history , otoscopy and pure tone audiometry . Under a general anaesthetic both ears were inspected with the microscope , and at r and om selection only one ear was drained and a Shephard grommet was inserted anteroinferiorly through a radial incision . A careful adenoidectomy was performed , along with whatever other surgery was required in the upper respiratory tract . Pure tone audiometry was repeated forty-eight hours postoperatively and prior to discharge from hospital . Thereafter , follow up was carried out at three-monthly intervals for the first year and then review ed five years later . On each visit otoscopy and pure tone audiometry were performed and at the five-year review impedance measurement was also carried out Grommets have been used as a treatment for middle-ear effusions since their introduction by Armstrong in 1954 . However , it is now accepted that the presence of a grommet in a tympanic membrane is associated with the development of tympanosclerosis in that membrane . Furthermore , it has been shown that this is a progressive phenomenon and that the incidence increases with time to as much as 65 per cent at 3 to 4 years after grommet insertion ( Mawson and Fagan , 1972 ; Tos and Poulsen , 1976 ) . Initially it was suggested that the development of tympanosclerosis might be due to the middle ear disease rather than to the grommet ( McKinnon , 1971 ) . However , most recent studies have found that , in bilateral cases of effusion , tympanosclerosis develops more frequently in ears with a grommet than in those without ( Brown , Richards and Ambegaokar , 1978 ; Lildholt , 1979 ) . This prospect i ve study was design ed to show the development of tympanosclerosis in the tympanic membrane of children treated for bilateral middle-ear effusions and to elicit any factors from the clinical history and operative technique which might be associated with the pathogenesis of the complication One hundred and sixteen children with otitis media with effusion ( OME ) underwent surgery with grommet insertion . A conventional Shah grommet was used in one ear , and a Mini-Shah grommet in the other . Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted . This benefit might have result ed from the lesser mass of the mini-tube or its shorter duration in situ A prospect i ve bacteriological and symptomatic study was carried out on 50 swimmers and 50 non-swimmers who had grommets inserted for secretory otitis media . The risk of developing otorrhoea with positive bacterial pathogens was similar for swimmers ( 7.9 % ) and non-swimmers ( 8.0 % ) . Subdividing the non-swimmers into ' wetters ' and ' strictly dry ' there was a similar risk of ear symptoms and pathogens . All children who swim before the insertion of grommets should continue to do so postoperatively with no added risk of ear infections Two hundred and twenty two children with bilateral secretory otitis media were allocated at r and om for adenoidectomy , adenotonsillectomy  or for neither  procedure . In all cases only a unilateral grommet was inserted . The contralateral unoperated ear was examined during a ten year period to show otoscopic clearance , change in tympanometric status and improvement in mean hearing threshold .  Adenoidectomy or insertion of a grommet alone produces similar improvement but in combination are more effective than either procedure in isolation . The unoperated ear in cases not receiving either procedure reflects the natural history of the condition . It shows a steady improvement in all outcome measures as time passes A prospect i ve study was performed of children undergoing bilateral ventilation tube insertion . One hundred and twenty-one children aged between 9 months and 10 years 3 months were admitted for surgery for secretory otitis media ( glue ear ) . Each child had a ventilation tube inserted anteriorly in the tympanic membrane of one ear and posteriorly in the tympanic membrane of the other . They underwent regular clinical and audiological assessment until extrusion of the ventilation tubes occurred . Perforations were noted in 2.75 % of tympanic membranes ( 4.6 % of the children ) . The rate with posteriorly placed  ventilation tubes  was higher than with the anteriorly placed ventilation tubes ( 3.7 % compared with 1.8 % ) though this is not statistically significant One hundred children with glue ear , in whom surgical treatment was indicated , were r and omly allocated to 1 of 4 treatment groups . Children in 2 of the groups underwent adenoidectomy plus various combinations of ear operations while in the other 2 groups surgery was confined to the ears . The effect of adenoidectomy was assessed 6 weeks , 6 months and 1 year after surgery by means of audiometry , impedance tympanometry and parental opinion . Improvements in hearing were greater in those children who underwent an adenoidectomy than in those who did not ( 4.0 dB at 6 weeks ; 2.4 dB at 6 months ; 0.7 dB at 1 year ) . However , these differences are of little clinical significance and were only statistically significant ( P less than 0.05 ) 6 weeks after surgery . Middle ear function , measured by tympanometry , revealed a similar pattern of response to treatment . Despite this , 6 months after surgery a higher proportion of parents were satisfied with their child 's condition if an adenoidectomy had been performed . Possible explanations of this discrepancy between clinical and parental assessment s of outcome are discussed Fifty-five children with bilateral middle ear effusions were entered into a prospect i ve r and omized double blind trial to determine whether aspiration of middle ear effusions prior to ventilation tube insertion influences ventilation tube extrusion time or the development of tympanosclerosis .  Following myringotomy , aspiration of the left or right ear only was performed r and omly prior to ventilation tube insertion . The tympanic membranes were inspected six-monthly to determine whether ventilation tube extrusion had occurred , and at 24 months after surgery for the presence of tympanosclerosis . Results showed no significant difference in extrusion time between aspirated and non-aspirated ears . Aspiration was found to be a factor in the development of tympanosclerosis . We conclude that routine aspiration of the middle ear effusion prior to ventilation tube insertion is associated with an increased risk of tympanosclerosis Fifty-four children with established chronic secretory otitis media , who had failed to respond to medical measures were treated with adenoidectomy and insertion of 1 grommet on a side chosen at r and om . Both sides improved and remained significantly improved at 12 months ( P less than 0.001 ) . At 3 months , the side with the grommet improved significantly more than the other side ( P less than 0.05 ) but at 12 months there was no significant difference between the 2 sides ( P greater than 0.1 ) Guidelines suggest that all children with Down 's syndrome have hearing testing on a regular basis . Since 2004 , the ear , nose and throat ( ENT ) , audiology and education services have conducted a joint clinic for annual ENT health and hearing surveillance of all preschool children with Down 's syndrome in Greater Glasgow . The aim of this study is to report the prevalence of ENT problems in this well-defined birth cohort , and the proportion of children for whom ENT surgery is required . A prospect i ve data base has been kept since 2004 , detailing the ENT health status of every child attending the community-based surveillance clinic . Between September 2004 and September 2008 , 87 preschool ( aged 9 months to 6 years ) children with Down 's syndrome were sent appointments for the clinic . Of these , 48 ( 55 % ) were female and 39 were male . Data were available for 79 ( 91 % ) . Over the course of the study , 37 % were listed for surgery at some point , either adenotonsillectomy for obstructive symptoms or grommet insertion for otitis media with effusion ( OME ) . The prevalence of OME was 93 % at age 1 , falling to 68 % by age 5 . None had significant sensorineural hearing impairment . Obstructive symptoms were also common , with 79 % of children having either currently symptomatic upper airways obstruction or a history of adenotonsillectomy by age 5 . One child had laryngomalacia and two had symptomatic congenital subglottic stenosis . The prevalence of ENT problems in these children is high . Surgical intervention is frequently required . We advocate a proactive approach of regular ENT and audiology surveillance leading to early intervention , with the aim of maximizing health and educational achievement in the long term OBJECTIVE Bleeding and wound infection are the most common complications of circumcision . Cyanoacrylate tissue glue has been cl aim ed to have the advantage of being haemostatic , bacteriostatic and easy to use . The purpose of this study is to assess the feasibility of using the tissue glue in approximation of circumcision wound in children . METHODOLOGY A prospect i ve r and omized trial was carried out on 86 boys consecutively admitted into the Duchess of Kent Children 's Hospital , Hong Kong . The results of wound approximation with cyanoacrylate tissue glue and suturing with interrupted 4/0 plain catgut were compared . The operations were carried out by the same surgeon using identical technique except for the wound approximation . The wound was assessed 1 day , 2 days , 3 days , 1 week and 1 month postoperatively . RESULTS There was no statistically significant difference between the two groups in the rates of wound inflammation , infection , bleeding , dehiscence and cosmetic appearance , but the duration of operation was longer using tissue glue ( 19.8 min vs 16.5 min , P = 0.002 ) . CONCLUSIONS We conclude that tissue glue approximation of circumcision wounds in children is a feasible alternative , but it offers no extra advantage when compared to suturing The purpose of this study has been to evaluate the use of ventilation tubes in the treatment of cases of primary secretory otitis media . Bilateral cases were selected and a tube inserted in one ear while the other ear was left intact . Adenoidectomy was performed on all children , tonsillectomy in 34 % of the cases . A total of 150 children ( mean age = 3.9 years ) were included during the years 1976 - 1979 and check-ups performed every 3 - 6 months . The follow-up rate was 89.3 % . The condition of each individual was assessed after a 5-year period , the mean period of observation was 3.2 years . The results of tympanometry and audiometry from the two types of ears were , on average , similar . Repeat operation was carried out in 17 % of the cases and later otomicroscopy revealed a higher incidence of atrophy in these eardrums ( p less than 0.01 ) . A period of suppuration was noted in 25 % of the ears with a ventilation tube , 2 months or more after operation ; a higher incidence of tympanosclerosis was later found ( p = 0.02 ) . Twentythree per cent of the treated eardrums were characterized at the final check-up as " normal " by means of otomicroscopy , in contrast to 83 % of the intact ears . The " end- result " of each ear was estimated using tympanometry , audiometry as well as otomicroscopy , and a difference in favour of the intact ears was found ( p less than 0.01 ) . A similar estimate for each child gave the result that 31 % had one ear categorized as " pathological " while this was the case in both ears of 9 % of the children . The children subjected to initial tonsillectomy showed a worse " end- result " ( p less than 0.05 ) . It is concluded that the use of ventilation tubes in children with primary secretory otitis media is not justified . Observation has shown that only a small proportion will require surgical treatment of the middle ear . A ventilation tube may be indicated in order to combat hearing loss , but it should be borne in mind that its use involves a high risk of complications and sequelae which may result in chronic middle ear disease A prospect i ve study was conducted of the effects of adenoidectomy and adenotonsillectomy on established otitis media with effusion unresponsive to medical treatment . The operations were performed at r and om with a controlled no surgery group on a cohort of 103 children with the condition and the results assessed six weeks , three months , six months , nine months , and one year later . After adenoidectomy the rate of resolution of the condition increased from 39 % at six weeks to 72 % at one year ; and after adenotonsillectomy the rate increased from 59 % at six weeks to 62 % at one year . In the no surgery group the rate increased from 16 % at six weeks to 26 % at one year . Compared with the no surgery group the effect of adenoidectomy alone at one year was highly significant ( p less than 0.001 ) , and similarly the effect of  adenotonsillectomy  was significant ( p less than 0.01 ) . There was , however , no increased benefit from the addition of tonsillectomy compared with adenoidectomy alone . Thus there was resolution of 36 - 46 % of chronic effusions as a result of adenoidectomy Objectives : To evaluate the effect of a risk factor checklist and training video for general practitioners  in reducing inter- practice variation and improving the appropriateness of referrals ( assessed by their positive predictive value or PPV ) of patients with suspected otitis media with effusion ( OME or ' glue ear ' ) to secondary care . Methods : Fifty general practice s ( 177 practitioners ) from the NHS Trent region and the West of Scotl and were cluster-r and omised either to a control group ( n = 12 ) or to one of three intervention groups ( training video ( n = 16 ) , checklist ( n = 11 ) , or both ( n = 11 ) ) . Data on all  paediatric ear , nose and throat ( ENT ) referrals and diagnostic results at ENT clinics were collected for a one-year period pre- and post-intervention . Referral rates for OME and for closely related conditions were calculated for children aged 0 - 15 years , based on each practice 's list size . PPV was defined as the proportion of referrals result ing in bilateral hearing loss ≥ 20 dB at the ENT outpatient department . Results : There was a significant improvement in the PPV , adjusted for patients ' waiting time between general practitioner ( GP ) referral and being seen at the ENT department . The improvement in PPV pre- and postintervention was 15 % ( 95 % confidence interval , CI : -12.1 % to 41.7 % ) for the practice s receiving both interventions , compared with a degradation of 20 % pre- and post-intervention ( 95 % CI : -32.9 % to -6.4 % ) for practice s receiving only one intervention and a degradation of 34 % for those receiving no intervention . Conclusions : Disseminating a risk factor checklist and training video on glue ear to GPs using a multi-channel approach can improve the quality of referrals to ENT This trial was design ed to compare early surgery with watchful waiting for persistent bilateral otitis media with effusion ( OME ) in terms of hearing loss and behavioural problems in pre-school children . A r and omised controlled trial compared the effects of early treatment with ventilation tubes versus watchful waiting for 9 months . Results were analysed by intention-to-treat . One hundred and eighty-two pre-school children ( date of birth between 1 April 1991 and 31 December 1992 ) , mean age of 2.9 years ( SD 0.85 ) with at least a 3-month history of bilateral OME and hearing loss of greater than 25 dB were treated in Bristol Children 's Hospital between November 1993 and January 1996 .  Bilateral ventilation tubes were inserted within 6 weeks of r and omisation or within 6 weeks of re assessment after 9 months of watchful waiting , with a final assessment at 18 months . The main outcome measures were behavioural problems , measured by the Richman Behaviour Checklist , and hearing loss at 4000 Hz in the better hearing ear . Early surgical intervention significantly reduced behavioural problems by 17 % ( 95 % CI , 2 % - 33 % ) . This difference was largely mediated by concurrent hearing loss . After 18 months , there was no longer a significant difference ( 95 % Cl , -19 % to + 10 % ) . However , the majority ( 85 % ) of the Watchful Waiting group had required surgery and 22 % of all children still had behavioural problems BACKGROUND Otitis media with effusion ( OME ) is the most common cause of hearing loss in children and is generally treated by elective surgery . We compared in children with persistent OME the effect on speech and language development of immediate surgery ( ventilation-tube insertion ) and watchful waiting before surgery . METHODS We did a r and omised controlled trial with masked outcome assessment in Bristol Children 's Hospital , Bristol , UK . We included 186 children born between April 1 , 1991 , and Dec 31 , 1992 , who had confirmed bilateral OME and bilateral hearing impairment of 25 - 70 dB of at least 3 months ' duration . Children were r and omly assigned surgery within 6 weeks ( n=92 ) , or 9 months of watchful waiting ( n=90 ) , after which bilateral tube insertion was done if required . We assessed hearing loss , expressive language , and verbal comprehension at 9 months and 18 months . FINDINGS At 9 months , st and ardised scores for expressive language and verbal comprehension differed between groups with marginal significance after adjustment for baseline differences ( p=0.04 and p=0.028 , respectively ) . At 9 months , verbal comprehension and expressive language skills in the watchful-waiting group were 3.24 months behind those in the early-surgery group . The watchful-waiting group was delayed on these two measures compared with their age-expected levels . 18 months after r and omisation , 85 % of children in the watchful-waiting group had received surgery and groups did not differ significantly . INTERPRETATION There is some benefit from ventilation-tube insertion for expressive language and verbal comprehension but the timing of surgery is not critical In a previous trial involving 109 children with chronic otitis media with effusion of at least a 2 months ' duration that had been unresponsive to medical treatment , we compared the efficacy of myringotomy with tube insertion , myringotomy alone and no surgical intervention with regard to time with middle ear effusion , hearing status and other indices over a 3-year period . Because interpretation of the results was rendered difficult by certain complexities of study design , the present trial with a revised protocol was carried out in an additional group of 111 children . As in the previous trial , myringotomy with tube insertion result ed in less time with effusion and better hearing than did either myringotomy alone or no surgery . However , acute and chronic otorrhea and tympanic membrane perforation developed not uncommonly after tube insertion . Myringotomy alone offered no advantage over no surgery regarding the percent of time with effusion or the number of episodes of acute otitis media . Currently for children with long-st and ing middle ear effusion , we recommend either watchful waiting with periodic hearing assessmetn or myringotomy with tube insertion , individualizing the recommendation for each child This study examines variations in saving behavior among poor families enrolled in a Child Savings Account program for orphaned and vulnerable school-going children in Ug and a. We employ multilevel analyses using longitudinal data from a cluster-r and omized experimental design . Our analyses reveal the following significant results : ( 1 ) given the average number of months during which the account was open ( 18 months ) , families saved on average , USD 54.72 , which , after being matched by the program ( 2:1 match rate ) comes to USD 164.16—enough to cover approximately five academic terms of post- primary education ; ( 2 ) children ’s saving behavior was not associated with quality of family relations ; it was , however , significantly associated with family financial socialization ; ( 3 ) family demographics were significantly associated with children ’s saving behavior in the matched Child Savings Account program ; and ( 4 ) children enrolled in some schools saved better compared to children enrolled in other schools within the same treatment group
ConclusionS -carboxymethylcysteine is effective in the treatment of children with glue ear .
Objective To establish the clinical relevance of S-carboxymethylcysteine in the treatment of glue ear in children using measures approximating those saving a child from operation for grommet insertion .