Highlights

Autoinflation for glue ear

Having children with chronic otitis media with effusion inflate a balloon device through their nose three times a day was more likely than usual care to resolve the effusion. This pragmatic randomized trial enrolled 320 children aged 4–11 years from 43 family practices in the UK. The presence of middle ear fluid was confirmed at baseline and in follow-up using tympanometry. Autoinflation is feasible, safe and effective, and should be used more often, say the authors. See Research, page 961

Autoinflation, a technique that works on the principles of the Valsalva manoeuvre, can be used effectively to treat secretory otitis media (glue ear) in children. As a low-cost, nonsurgical, nondrug intervention, it may appeal to parents, but clinicians must be able demonstrate the technique properly. See Commentary, page 949

Diagnosing cancer in physicians

It is unknown whether cancers in physicians are diagnosed at a different stage from the general population. In this study, the authors found that generally they are not — with the exception of more frequent presentation of stage IV cancers of the cervix and breast in female physicians. See Research, page E412

Reducing pain during vaccine injections

Pain from vaccine injections is common, and such concerns contribute to vaccine hesitancy across the lifespan. This guideline provides practical recommendations for reducing pain during vaccine injections in all age groups. See Guidelines, page 975

Spontaneous transverse rib fracture

Spontaneous transverse rib fracture was diagnosed in a 66-year-old woman with a history of treated osteopenia and breast cancer. Is this fracture related to osteopenia or secondary to a metastasis? What investigations does she require? Harris presents an approach to investigating spontaneous rib fracture. See Decisions, page 988

Paget–Schroetter syndrome

After presenting with swelling of her left arm, shortness of breath and chest pain after heavy lifting, a 45-year-old woman was found to have Paget–Schroetter syndrome. This syndrome (thoracic outlet syndrome with venous thrombosis) should be considered in any young, otherwise healthy person who presents with unexplained, acute-onset, unilateral swelling of an upper extremity, say Stein and colleagues. See Cases, page 990

Venom anaphylaxis

About 3% of adults and 0.8% of children will have anaphylactic reactions to insect stings. Because one in five will have a biphasic reaction, patients with venom anaphylaxis should be monitored regardless of their initial response to epinephrine, and an action plan in case of future exposure should be put in place. See Five things to know about …, page 994

Acute calcific retropharyngeal tendonitis

A 40-year-old man presented with a one-day history of low-grade fever, acute neck pain and odynophagia. He was given the diagnosis of acute calcific retropharyngeal tendonitis, a self-limited inflammatory process caused by deposition of calcium hydroxyapatite crystals in the longus colli. Clinicians may wish to keep this underdiagnosed benign condition in mind as part of the differential diagnosis of neck pain and odynophagia. See Clinical images, page 995

Humanities

There’s lots of scope for research merging social sciences and biology, but conceptual issues are a huge stumbling block. See Medicine and Society, page 998

Physicians, like journalists, strive to find humanity in the most humble of places, such as an impoverished basti in Nepal. One profession provides depth to the public health story; the other honours the lives and strengths of the people. See Encounters, page 1000