Pediatric_Otolaryngology RSS : Gourt

A case of Klippel-Feil syndrome with congenital enlarged Eustachian tube.

A case of Klippel-Feil syndrome with congenital enlarged Eustachian tube. Int J Pediatr Otorhinolaryngol. 2012 Jan 31; Authors: Jovankovičová A, Jakubíková J, Durovčíková D Abstract The Klippel-Feil syndrome is a congenital anomaly characterized by fusion of the cervical vertebrae. It is often associated with serious congenital anomalies of the nervous, cardiovascular and urogenital systems. One of the anomalies which have not been thoroughly investigated to date are that accompanying Klippel-Feil syndrome and enlarged Eustachian tube. We report a case of type III Klippel-Feil syndrome with associated rib anomalies such as hypoplastic and bifid ribs, scoliosis and elevated scapula (Sprengel's disease). The patient also presented hemifacial microsomia and central facial palsy of the lower right side of the face, urogenital and cardiovascular anomaly, congenital anorectal atresia and right-sided congenital aural atresia with microtia. Computer tomography of temporal bone showed abnormal extension of the right Eustachian tube with anomalies of the middle and inner ear on this particular side. In this case report we discuss the associated anomalies of the patient with Klippel-Feil syndrome. The aim of this case report is to draw attention to very rare case of patient with Klippel-Feil syndrome and enlarged pharyngotympanic tube. PMID: 22301355 [PubMed - as supplied by publisher]

Rhinoconjunctivitis prevalence and associated factors in school children aged 6-7 and 13-14 years old in Bogota, Colombia.

Rhinoconjunctivitis prevalence and associated factors in school children aged 6-7 and 13-14 years old in Bogota, Colombia. Int J Pediatr Otorhinolaryngol. 2012 Jan 31; Authors: Peñaranda A, Aristizabal G, García E, Vásquez C, Rodríguez-Martinez CE Abstract OBJECTIVE: Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of rhinoconjunctivitis and determine clinical, social and environmental associated factors, among school children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia. METHODS: We used ISAAC (International Study of Asthma and Allergies in Childhood) phase III study methodology and questionnaire for design and data collection, and we did a secondary analysis of these data. The sample consisted of 3830 registers from adolescents between 13 and 14 years old and 3256 registers from children between 6 and 7 years. RESULTS: The prevalence of rhinoconjunctivitis symptoms in the last year was 17.2% (95% CI, 15.9-18.5) in children vs. 24.9% (95% CI, 23.6-26.3) in adolescents. In both groups there was a female predominance in children (17.8% vs. 16.5%), and in the teenagers group (28.0% vs. 21.4%), though the differences were not statistically significant. The factors associated with rhinoconjunctivitis in the group of 6-7 years where: asthma [OR 3.9; (95% CI, 2.8-5.4)], atopic dermatitis [OR 2.3; (95% CI, 1.7-3.1)], use of acetaminophen in the last year [OR 2.6; (95% CI, 1.4-4.9)], use of antibiotics in the first year of live [OR 1.7; (95% CI, 1.3-2.3)], higher maternal education [OR 1.5; (95% CI, 1.0-2.3)] and cesarean delivery [OR 1.6; (95% CI, 1.2-2.1)]. Among the 13-14 year age-group, factors associated with rhinoconjunctivitis included: asthma [OR 2.6; (95% CI, 2.0-3.4)], atopic dermatitis [OR 1.8; (95% CI, 1.4-2.3)], use of acetaminophen in the last year [OR 1.8; (95% CI, 1.4-2.4)], consumption of fast-food three times or more per week [OR 1.5; (95% CI, 1.2-2.0), ever smoked [OR 1.4; (95% CI, 1.2-1.7)] and meat consumption was protective factor [OR 0.7; (95% CI, 0.5-0.9)]. CONCLUSION: In both studied groups, the estimated prevalence of rhinoconjunctivitis symptoms was relatively high. Future in-depth research is needed to assess the complex interactions between allergic rhinoconjunctivitis symptoms and social and environmental factors. PMID: 22301354 [PubMed - as supplied by publisher]

Neck tumour - lung hernia in a 10-year-old girl - diagnostic difficulties.

Neck tumour - lung hernia in a 10-year-old girl - diagnostic difficulties. Int J Pediatr Otorhinolaryngol. 2012 Jan 30; Authors: Chmielik LP, Zawadzka-Głos L, Brzewski M, Ryczer T, Roik D, Koziołek R, Dębska M Abstract Spontaneous hernias of the pleural cupola are extremely rare tumours in the neck area. The most common tumours in children are lymph node abnormalities, and cysts that are remnants of the branchial arches. Due to diagnostic and therapeutic difficulties, we would like to present the case of a 10-year-old girl, with a neck tumour that was observed during coughing and was accompanied by dyspnea. The girl was admitted to the Paediatric Hospital of Warsaw Medical University. Finally, the neck tumour was diagnosed as a hernia of the pleural cupola, which was subsequently treated surgically. In a review of the literature we found two case reports of similar disorders that appeared spontaneously. All cases of neck tumours in children require very precise radiological diagnostic investigation. Spontaneous lung hernia is an extremely rare cause of neck tumours, which is treated surgically if it becomes symptomatic. PMID: 22297211 [PubMed - as supplied by publisher]

Circulating phospholipase-A2 activity in obstructive sleep apnea and recurrent tonsillitis.

Circulating phospholipase-A2 activity in obstructive sleep apnea and recurrent tonsillitis. Int J Pediatr Otorhinolaryngol. 2012 Jan 30; Authors: Ezzeddini R, Darabi M, Ghasemi B, Jabbari Y, Abdollahi S, Rashtchizadeh N, Gharahdaghi A, Darabi M, Ansarin M, Shaaker M, Samadi A, Karamravan J Abstract OBJECTIVE: Phospholipase A2 (PLA2) plays a major part in growth regulation, differentiation and inflammation. It has been proposed as an evaluating marker for infection and inflammation. The aim of this study was to investigate activity of serum type II secretory PLA2 (sPLA2 IIa) in obstructive sleep apnea (OSA) and recurrent infective tonsillitis (RT) in children. METHODS: Activity of serum sPLA2 IIa was determined in children who underwent tonsillectomy, including OSA in 126 cases and RT in 60. Serum enzyme activities were measured using the standard assay with Diheptanoyl Thio-Phosphatidylcholin as substrate. RESULTS: The sPLA2 IIa activity of serum was significantly higher in RT than in OSA (P<0.01). Serum sPLA2 IIa activity in the RT patients was positively correlated with BMI (r=0.26; P=0.02), which was not apparent in OSA (r=0.14; P=0.09). CONCLUSION: This study suggests that serum sPLA2 IIa activity may be considered as a supportive diagnostic marker in suspected or clinically unclear cases of RT children. PMID: 22297210 [PubMed - as supplied by publisher]

Training children with ADHD to minimize impulsivity in auditory contralateral masking.

Training children with ADHD to minimize impulsivity in auditory contralateral masking. Int J Pediatr Otorhinolaryngol. 2012 Jan 30; Authors: Gray L, Miller BS, Evans SW Abstract OBJECTIVE: Impulsivity and distractibility are among the important symptoms of attention deficit hyperactivity disorder (ADHD). In this study, impulsivity is operationally measured using false-alarm rates in an auditory, contralateral-masking task. Intensive auditory training was attempted to decrease false alarm rates. METHODS: In contralateral masking there is a distracting noise in one ear on every trial and a threshold-level tone in the other ear on half of those trials. Participants indicated whether the tone was present or not and received immediate feedback. The intensity of the masked tone was adaptively varied to track threshold. False alarms are the error of commission, saying that a stimulus is present when it is not. Seven school-aged children with ADHD (ages 10-16) and four adults without ADHD were trained on this task for 900 trials per day over four consecutive days. RESULTS: False alarms from the children with ADHD decreased over the four days of training, beginning at the high level and ending at the low level expected from previous studies. There was no generalization to a different masking task. Results from the four adults were unexpected: soon after the training began they behaved no differently than the children with ADHD. CONCLUSION: Children with ADHD can be trained to become less impulsive in an auditory detection task. PMID: 22297209 [PubMed - as supplied by publisher]

The use of botulinum toxin for pediatric cricopharyngeal achalasia.

The use of botulinum toxin for pediatric cricopharyngeal achalasia. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1210-4 Authors: Barnes MA, Ho AS, Malhotra PS, Koltai PJ, Messner A Abstract OBJECTIVES: Cricopharyngeal achalasia is an uncommon cause of feeding difficulties in the pediatric population, and is especially rare in infants. Traditional management options include dilation or open cricopharyngeal myotomy. The use of botulinum toxin has been preliminarily reported for cricopharyngeal achalasia in children as a modality for diagnosis and management. This study describes the use of botulinum toxin as a definitive treatment for pediatric cricopharyngeal achalasia. METHODS: A retrospective analysis was performed of three patients who were diagnosed with cricopharyngeal achalasia and underwent botulinum toxin injections to the cricopharyngeus muscle. The charts were reviewed for etiology, botulinum toxin dosage delivered, length of follow-up, postoperative need for nasogastric tube placement, and swallow studies. RESULTS: A total of 7 botulinum toxin injections into the cricopharyngeus muscle were performed in three infants with primary cricopharyngeal achalasia between April 2006 and February 2011. Mean dosage was 23.4 units per session (range: 10-44 units), or 3.1 U/kg (range: 1.4-5.3 U/kg). Mean interval period between injections was 3.3 months (range: 2.7-4.0 months). Mean follow-up period was 22.1 months (range: 3.4-44.5 months). One patient required hospital readmission after injection for presumed aspiration but recovered without need for surgical intervention. No long-term complications were noted post-operatively. All patients improved clinically and ultimately had their nasogastric feeding tubes removed. CONCLUSIONS: Botulinum toxin appears to be a safe and effective option in the management of primary cricopharyngeal achalasia in children, and may prevent the need for myotomy. PMID: 21972448 [PubMed - indexed for MEDLINE]

Mucocele after transnasal endoscopic repair of traumatic anterior skull base fistula in children.

Mucocele after transnasal endoscopic repair of traumatic anterior skull base fistula in children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1137-42 Authors: Verillaud B, Genty E, Leboulanger N, Zerah M, Garabédian EN, Roger G Abstract OBJECTIVES: To report the long-term sinonasal complications after endoscopic repair of anterior skull base fractures in children. This study describes mucocele formation in 6 patients treated endoscopically for posttraumatic CSF fistulae. We aim to address possible etiologic factors, specific treatments and follow-up modalities. PATIENTS AND METHODS: 12 children, mean age 5.8 years (3-10), treated endoscopically at our institution between 2004 and 2010 for an anterior cranial base fracture complicated by a CSF fistula. An iatrogenic mucocele was observed in 6 cases. A retrospective review of the files of these 6 patients was carried out demonstrating demographic characteristics, presenting signs/symptoms, site of skull base defect, repair technique, timing and onset of the mucoceles, their presentation and management. A systematic CT-scan and/or MRI was carried out at 3 months, 1 year and then annually. RESULTS: 3 patients presented after cranial trauma with persistent CSF nasal leak, and 4 with meningitis. Posttraumatic defects reached the posterior wall of the frontal sinus and the junction of ethmoid and frontal bone in 3 cases, and the cribriform plate in 3 cases. Endoscopic closure was performed in all cases, with the middle turbinate as an overlay patch. No recurrence of a CSF leak was observed. After a mean period of 16 months, a single iatrogenic mucocele was observed in 4 patients (radiological detection only), and multiple mucoceles in 2 patients. Surgical treatment was advocated in cases of proptosis, quick expansion of the mucocele leading to sinus bony wall remodelling or erosion (2 cases), and meningitis related to an erosion of the cribriform plate by the mucocele. Three mucoceles were successfully treated endoscopically, and 1 required an external approach. CONCLUSION: Mucocele incidence after endoscopic repair of skull base fractures in children is not insignificant (50% in our 12 patients series). Paediatric anatomical features, cranial trauma, and the transethmoidal approach may play a role in mucocele pathogenesis. Long-term clinical and radiological follow-up is therefore recommended. These mucoceles may be managed endoscopically with good outcomes. PMID: 21820187 [PubMed - indexed for MEDLINE]

Postoperative massive tongue edema in craniosynostotic children.

Postoperative massive tongue edema in craniosynostotic children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1173-5 Authors: Carie CM, White DR, Discolo CM Abstract OBJECTIVE: Although rarely encountered in the clinical setting, massive tongue edema is a known phenomenon that can occur in craniosynostotic children in the postoperative period. In 1998, Kunhert described an encounter with an adolescent patient with Crouzon syndrome who required craniectomy for complications associated with Chairi malformation [1]. Following her procedure she had rapid tongue edema which was felt to be secondary to obstruction of the venous drainage of the tongue. Despite extensive workup and unsuccessful medical attempts to reduce the swelling, she was extubated with rapid resolution of the tongue edema [1]. METHODS AND RESULTS: In our facility, two children with underlying craniofacial diagnoses underwent elective surgical procedures. During their postoperative course, they encountered postoperative massive tongue swelling which ultimately required tracheotomy to relieve the compression and upper airway obstruction. CONCLUSION: We describe the clinical manifestations, treatment, and postoperative outcomes identified in these two cases. PMID: 21784537 [PubMed - indexed for MEDLINE]

Usefulness of dextranomer/hyaluronic acid copolymer in bronchoscopic treatment of recurrent tracheoesophageal fistula in children.

Usefulness of dextranomer/hyaluronic acid copolymer in bronchoscopic treatment of recurrent tracheoesophageal fistula in children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1191-4 Authors: Briganti V, Coletta R, Giannino G, Calisti A Abstract OBJECTIVE: Endoscopic repair of recurrent tracheoesophageal fistula (RTF) in infants who underwent surgery at birth for esophageal atresia (EA) is under investigation as an alternative to open surgery, which is technically challenging and associated with high morbidity. The aims of this paper are to present the experience of a single institution in treating RTF using a novel submucosal bronchoscopic injection of biocompatible dextranomer/hyaluronic acid (Dx/HA) copolymer, and to discuss the indications and limitations of this technique. METHODS: From 2000 to 2007, 6 children (2 boys; 4 girls) aged 1-48 months, weighing 2.5-18 kg were referred to our hospital for respiratory symptoms (pneumonia and failure to thrive) secondary to suspected RTF. All infants had undergone surgery at birth for EA with inferior tracheoesophageal fistula. Bronchoscopy revealed that five infants had RTF and one had a large remnant tracheal upper-pouch fistula. The bronchoscopic intervention was performed under general anesthesia, using a pediatric rigid bronchoscope with a 0° telescope and telemonitoring. The fistula wall mucosa was gently abraded to promote adhesion, and Dx/HA was then injected at two points in the fistula submucosa to obtain a stable swelling of the wall and closure of the RTF. RESULTS: In two infants (aged 1 month and 18 months) complete resolution of the RTF was achieved following two separate procedures with a 1-month interval. In three children (aged 2, 18 and 25 months) complete closure of the fistula was not achieved; however, the partial closure was sufficient to address the respiratory symptoms and allow subsequent standard open thoracic surgery without requiring recovery in the intensive care unit. Complete resolution of respiratory symptoms was also obtained following a single endoscopic procedure with two Dx/HA injections in the child with residual pouch fistula. CONCLUSION: Bronchoscopic treatment of RTF with Dx/HA is a simple, minimally invasive, low-risk procedure that enables complete closure of RTF or reduction and resolution of respiratory symptoms, which in turn facilitates uncomplicated thoracic surgery. The technique also provides good results in remnant tracheal upper-pouch fistula. PMID: 21782257 [PubMed - indexed for MEDLINE]

GJB2 and mitochondrial DNA 1555A>G mutations in students with hearing loss in the Hubei Province of China.

GJB2 and mitochondrial DNA 1555A>G mutations in students with hearing loss in the Hubei Province of China. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1156-9 Authors: Chen G, He F, Fu S, Dong J Abstract OBJECTIVES: The GJB2 and MTRNR1 1555A>G mutations are the prevalent causes of hearing loss worldwide. However, the mutation profiles of the two genes are dependent on the ethnic or geographic origins. Therefore, this study was to characterize the forms and frequencies of the two genes in 813 students with hearing loss in Hubei province, Central China. METHODS: Blood samples from 813 students were obtained with informed consent. Genomic DNA was extracted from peripheral blood leukocytes. The target fragments were amplified by polymerase chain reaction (PCR). Sequencing (or enzyme digestion) was applied to identify sequence variations. RESULTS: Ten different mutations were identified in GJB2 in 146 of the 813 (17.96%) patients and 11.81% (96/813) patients had homoplasmic mtDNA 1555A>G mutation. CONCLUSIONS: This study demonstrated the high prevalence of GJB2 and mtDNA 1555A>G mutations in Central Chinese population. Therefore, it will be effective to perform GJB2 and mtDNA 1555A>G mutation analysis for genetic screening for hearing loss in this population. PMID: 21777984 [PubMed - indexed for MEDLINE]

Obliteration of temporal dorsal bulla in guinea pigs using different types of calcium phosphate.

Obliteration of temporal dorsal bulla in guinea pigs using different types of calcium phosphate. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1176-80 Authors: Park YH, Kim SG, Lee JW, Yoon YH Abstract OBJECTIVE: The purpose of this study was to evaluate the applicability of different calcium phosphate types after mastoid obliteration procedure using the guinea pig as an animal model. MATERIALS AND METHODS: Twenty six male guinea pigs were used for the experimental study. Four guinea pigs were used as a normal control group, with the remaining used for the experimental group. After bulla mucosa was removed, non-obliterated ears were used as control and granular (Polybone-G) or powder (Polybone-P) types of Polybone (tricalicium phosphate and polyphosphate) were applied into the dorsal bulla. The radiological and histologic findings were obtained from each animal at 8 and 20 weeks after obliteration. RESULTS: On radiological examination, thickening of the bulla wall observed in all experimental groups compared with normal group. Increased homogenous bony densities continuous with the bulla wall were observed in the Polybone-G group compared to the other experimental groups, and some isolated bony densities were observed in the Polybone-P group. Histopathologic findings showed increased new bone formations and less inflammatory reactions in the Polybone-G group compared to the Polybone-P group. CONCLUSION: This study demonstrates that granular type calcium phosphate can be used as effective material than powder type in mastoid obliteration. PMID: 21774997 [PubMed - indexed for MEDLINE]

KTP laser ablation of extensive tracheal hemangiomas.

KTP laser ablation of extensive tracheal hemangiomas. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1200-3 Authors: Rameau A, Zur KB Abstract We are reporting the case of a female child presenting for the management of symptomatic extensive tracheal hemangiomas who was successfully treated with multiple ablative procedures using KTP laser. This is the first description in the English literature of the use of KTP laser as primary treatment modality for the endoscopic ablation of tracheal hemangiomas in a child. We review treatment recommendations for symptomatic airway hemangiomas in the pediatric population, highlighting the advantages of KTP laser for tracheal lesions. PMID: 21774996 [PubMed - indexed for MEDLINE]

Pierre Robin sequence: an institutional experience in the multidisciplinary management of airway, feeding and serous otitis media challenges.

Pierre Robin sequence: an institutional experience in the multidisciplinary management of airway, feeding and serous otitis media challenges. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1152-5 Authors: Glynn F, Fitzgerald D, Earley MJ, Rowley H Abstract OBJECTIVES: To evaluate the course and prognosis of airway obstruction, feeding difficulties and hearing abnormalities in patients with Pierre Robin sequence (PRS). METHODS: A retrospective review was conducted, of 69 patients with PRS, attending between 1991 and 2010 at the Children's University Hospital in Dublin. Data regarding airway management, nutritional status and hearing difficulties was collected prospectively. RESULTS: Airway obstruction requiring intervention other than positional therapy was seen in 39% (27) patients. Fifty nine percent (16/27) of these patients, who failed positional therapy, were successfully managed with a nasopharyngeal airway. Following failed intervention with nasopharyngeal airways, two patients had airway maintenance achieved with a successful glossopexy procedure. One patient had an adequate airway achieved with nasal continuous positive airway pressure. Eight patients (12%) required a surgical tracheostomy. Of those who required a tracheostomy, six patients had isolated PRS, one patient had PRS in association with Stickler syndrome and one patient had Nager acro-facial dystosis. Duration of tracheostomy tube ranged from 10 to 19 months, mean 13 months. Seventy percent (48 patients) required supplementary feeding in the form of nasogastric (NG) or gastrostomy tube. Forty-four patients were successfully managed with a temporary NG tube. One patient required a prolonged NG tube, and three required a gastrostomy tube. Twenty-one (30%) patients were successfully managed with a specialised Haberman bottle. Twenty-four patients (35%) who had their airway managed successfully by positional therapy, still required supplemental feeding. Thirty-one patients (45%) demonstrated a conductive hearing loss at some stage, which affected their speech and language development. Twenty-four patients (35%) required tympanostomy tube insertion once, while 7 (10%) of patients required ventilation tube insertion twice or more. CONCLUSION: Airway management in the majority of PRS can be successfully achieved by conservative methods. Even in the presence of an adequate airway, many patients will require supplemental feeding. Early audiological assessment is necessary as many patients will need tympanostomy tube placement to ensure adequate speech and language development. PMID: 21764465 [PubMed - indexed for MEDLINE]

Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children.

Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1195-9 Authors: Alves M, Baratieri C, Nojima LI, Nojima MC, Ruellas AC Abstract OBJECTIVES: The aim of this study was to assess the pharyngeal airway space (PAS) in nasal and mouth-breathing children using cone beam computed tomography (CBCT). METHODS: Volume, area, minimum axial area and linear measurements (PAS-NL, PAS-UP, PAS-OccL, PAS-UT, PAS-Bgo, PAS-ML, PAS-TP) of the pharyngeal airway of 50 children (mean age 9.16 years) were obtained from the CBCT images. The means and standard deviations were compared according to sexes (28 male and 22 female) and breathers patterns (25 nasal breathers and 25 mouth breathers). RESULTS: There were no statistically significant differences (p>0.05) between all variables when compared by sexes. Comparisons between nasal and mouth breathers showed significant differences only in two linear measurements: PAS-OccL (p<0.001) and PAS-UP (P<0.05). Airway volume (p<0.001), area (p<0.001) and minimum axial area (p<0.01) had significant differences between the groups. CONCLUSIONS: The CBCT evaluation showed that pharyngeal airway dimensions were significantly greater in nasal-breathers than in mouth-breathers. PMID: 21764464 [PubMed - indexed for MEDLINE]

Value of ultrasonography in diagnosis of pediatric vocal fold paralysis.

Value of ultrasonography in diagnosis of pediatric vocal fold paralysis. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1186-90 Authors: Wang LM, Zhu Q, Ma T, Li JP, Hu R, Rong XY, Xu W, Wang ZC Abstract OBJECTIVES: To investigate the appearance of the pediatric larynx on ultrasound images and the diagnostic potential of ultrasound in cases of pediatric vocal fold paralysis. METHODS: First, we confirmed the ultrasonographic features of the laryngeal landmarks in 2 pediatric cadaveric larynxes. Secondly, 45 children were enrolled in a clinical study (13 patients with vocal fold paralysis and 32 normal children). Quantitative analysis of vocal fold mobility was carried out by measuring the maximum glottic angle (MGA) and vocal fold-arytenoid angle (VAA). RESULTS: All the paralyzed vocal folds showed abnormal mobility, and were flaccid during breathing and phonation. The rima glottis appeared as a hyperechoic air-column band in ultrasound images during phonation. The mean value of the MGA was 61.47 ± 9.00 in the normal larynx and 42.25 ± 10.41 in the paralyzed larynx. In the affected side of the paralyzed larynx, the VAA in maximum abduction was smaller than that in the normal larynx or in the unaffected side. The median difference of the VAA between maximum abduction and maximum adduction was less than that in the normal larynx. The kappa value was 0.96. CONCLUSION: MGA and VAA are quantitative indicators of vocal fold immobility. Ultrasound is a reliable method of diagnosis of pediatric VFP. To diagnose VFP from an ultrasound image, the criteria are: (1) abnormal mobility (this was the most important and direct evidence), (2) hyperechoic air-column band of the glottic rima during phonation, (3) flaccid vocal fold and (4) asymmetry of the glottal structures. PMID: 21763007 [PubMed - indexed for MEDLINE]

Recurrent neck infection with branchial arch fistula in children.

Recurrent neck infection with branchial arch fistula in children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1181-5 Authors: Madana J, Yolmo D, Kalaiarasi R, Gopalakrishnan S, Saxena SK, Krishnapriya S Abstract OBJECTIVE: Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side. METHODS: A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases. RESULTS: The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence. CONCLUSION: Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically. PMID: 21763006 [PubMed - indexed for MEDLINE]

Cleft palate, retrognathia and congenital heart disease in velo-cardio-facial syndrome: a phenotype correlation study.

Cleft palate, retrognathia and congenital heart disease in velo-cardio-facial syndrome: a phenotype correlation study. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1167-72 Authors: Friedman MA, Miletta N, Roe C, Wang D, Morrow BE, Kates WR, Higgins AM, Shprintzen RJ Abstract OBJECTIVE: Velo-cardio-facial syndrome (VCFS) is caused by a microdeletion of approximately 40 genes from one copy of chromosome 22. Expression of the syndrome is a variable combination of over 190 phenotypic characteristics. As of yet, little is known about how these phenotypes correlate with one another or whether there are predictable patterns of expression. Two of the most common phenotypic categories, congenital heart disease and cleft palate, have been proposed to have a common genetic relationship to the deleted T-box 1 gene (TBX1). The purpose of this study is to determine if congenital heart disease and cleft palate are correlated in a large cohort of human subjects with VCFS. METHODS: This study is a retrospective chart review including 316 Caucasian non-Hispanic subjects with FISH or CGH microarray confirmed chromosome 22q11.2 deletions. All subjects were evaluated by the interdisciplinary team at the Velo-Cardio-Facial Syndrome International Center at Upstate Medical University, Syracuse, NY. Each combination of congenital heart disease, cleft palates, and retrognathia was analyzed by Chi square or Fisher exact test. RESULTS: For all categories of congenital heart disease and cleft palate or retrognathia no significant associations were found, with the exception of submucous cleft palate and retrognathia (nominal p=0.0325) and occult submucous cleft palate and retrognathia (nominal p=0.000013). CONCLUSIONS: Congenital heart disease and cleft palate do not appear to be correlated in human subjects with VCFS despite earlier suggestions from animal models. Possible explanations include modification of the effect of TBX1 by genes outside of the 22q11.2 region that may further influence the formation of the palate or heart, or the presence of epigenetic factors that may effect genes within the deleted region, modifying genes elsewhere, or polymorphisms on the normal copy of chromosome 22. Lastly, it is possible that TBX1 plays a role in palate formation in some species, but not in humans. In VCFS, retrognathia is caused by an obtuse angulation of the skull base. It is unknown if the correlation between retrognathia and cleft palate in VCFS indicates a developmental sequence related to skull morphology, or direct gene effects of both anomalies. Much work remains to be done to fully understand the complex relationships between phenotypic characteristics in VCFS. PMID: 21763005 [PubMed - indexed for MEDLINE]

Endoscopic transsphenoidal approach versus microscopic approach in children.

Endoscopic transsphenoidal approach versus microscopic approach in children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1132-6 Authors: Rigante M, Massimi L, Parrilla C, Galli J, Caldarelli M, Di Rocco C, Paludetti G Abstract OBJECTIVES: To confirm the efficacy and safeness of the endoscopic endonasal transsphenoidal (ETS) approach in the treatment of sellar and parasellar lesions in children compared with the conventional microscopic transsphenoidal approach (CTS). STUDY DESIGN: Case series with chart review. SETTING: A. Gemelli - University Hospital - Catholic University of Sacred Heart - Rome. SUBJECT AND METHODS: We retrospectively evaluate 21 children (mean age 8.3 years) affected by sellar/parasellar lesions: 11 were treated via microscopic sublabial approach between 1995 and 2005 and 10 were treated with ETS approach between 2006 and 2009. RESULTS: The past series (group A) comprised all sellar/suprasellar lesions and we observed: gross total surgical excision in 81.2% of cases, permanent morbidity in 1/11 patients, CSF fistula in 1/11 patients, mean hospitalization time of 5.8 days and PICU was required. The present series (group B) included 8 sellar/suprasellar and 2 clival lesions and we observed: GTS excision in 80% of the cases, no permanent morbidity, a mean hospitalization time of 4.1 days (P=0.01), CSF fistula in 2/10 patients and the PICU was not required. 10/11 patient of group A underwent to blood transfusion vs 4/10 of the group B (P=0.008). The mean pain score of group A was 5.8 ± 1.7 on the contrary in the group B it was 4.1 ± 1.5 (P=0.006). CONCLUSION: The ETS approach to the sellar and parasellar region has proved its reliability and effectiveness in the adults. The minimal invasiveness makes it ideal for the treatment of pediatric lesion of this region, in which it is essential to preserve the integrity of the hypothalamic-pituitary axis and of the naso-facial structures to assure the correct growth of the child. PMID: 21763004 [PubMed - indexed for MEDLINE]

Type IV laryngotracheoesophageal cleft: report of long-term survivor successfully decannulated.

Type IV laryngotracheoesophageal cleft: report of long-term survivor successfully decannulated. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1207-9 Authors: Owusu JA, Sidman JD, Anderson GF Abstract Laryngotracheoesophageal cleft (LTEC) is a rare congenital anomaly that results from failed posterior fusion of the cricoid cartilage and incomplete development of the tracheoesophageal septum. LTEC presents with increased secretions, respiratory distress, aspiration and recurrent pulmonary infections. The severity of presenting symptoms is dependent on the type of cleft. LTEC is most commonly classified into four types (I, II, III and IV) based on the inferior extent of the cleft. Types III and IV LTEC are associated with high morbidity and mortality and require timely diagnosis and repair for survival. Most patients who survive repair of Type IV LTEC have long-term tracheotomy dependency with minimal chance of decannulation. We report on a case of a long-term survivor of Type IV who has been safely decannulated. PMID: 21752479 [PubMed - indexed for MEDLINE]

Prevalence of Epstein-Barr virus in tonsils and adenoids of United Arab Emirates nationals.

Prevalence of Epstein-Barr virus in tonsils and adenoids of United Arab Emirates nationals. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1160-6 Authors: Al-Salam S, Dhaheri SA, Awwad A, Daoud S, Shams A, Ashari MA Abstract OBJECTIVE: Given that Epstein-Barr virus (EBV) often inhabits human tonsils and adenoids, it remains to be distinctively determined its prevalence and in which cell and microenvironment the virus is present. METHODS: To determine the prevalence of EBV in the tonsils and adenoids of the United Arab Emirates (UAE) nationals and to provide a basis for understanding the origin and biology of EBV-infected cells, the immunophenotype of all EBV-infected cells in 46 tonsils and 46 adenoids was determined by EBER in situ hybridization and immunohistochemistry with monoclonal antibodies to T cells (CD3), B cells (CD20), and epithelial cells (cytokeratin AE1/AE3), as well as immunostaining with antibodies to EBV latent membrane protein-1 (LMP-1). RESULTS: EBV was found in 43% of tonsillectomy specimens and 15% of adenoidectomy specimens. All EBV-infected cells were found to be B lymphocytes. About 90% of the infected B cells are found in the interfollicular regions of tonsils and adenoids and the remaining 10% are found within the follicles. There is no significant association between EBV infection, age (P=0.324) and gender (P=0.442). CONCLUSION: EBV is associated with tonsillar hypertrophy and is prevalent in 43% of our cases. EBV is only detected in B lymphocytes and we believe that B lymphocytes are sites of primary infection and latency. In situ hybridization is the gold standard for the detection of EBV in tissue. PMID: 21752478 [PubMed - indexed for MEDLINE]

Transoral approach for direct and complete excision of vallecular cysts in children.

Transoral approach for direct and complete excision of vallecular cysts in children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1147-51 Authors: Chen EY, Lim J, Boss EF, Inglis AF, Ou H, Sie KC, Manning SC, Perkins JA Abstract OBJECTIVE: To review the presentation, evaluation, and treatment of children with vallecular cysts and introduce a new technique of transoral excision for this entity. METHODS: Retrospective case series of children diagnosed with vallecular cyst between 2001 and 2008 at a single tertiary care children's hospital. Data collected, including age at diagnosis, presenting symptoms, additional diagnoses, diagnostic modality, prior and subsequent surgical therapy, length of hospital stay, length of follow-up, and recurrence were analyzed with descriptive statistics. RESULTS: Seven children (mean age 198 days, range 2 days to 2.9 years) were included in this series. Five children presented with respiratory distress and/or swallowing difficulties. Vallecular cyst was diagnosed by initial flexible fiberoptic laryngoscopy (5/7), MRI (1/7), and intubating laryngoscopy (1/7). All children underwent complete cyst excision via transoral surgical approach. Two children underwent additional supraglottoplasty for concomitant laryngomalacia, one of whom underwent tracheotomy for persistent respiratory distress and vocal cord immobility. The average length of hospital stay postoperatively was 9.5 days, and four patients stayed less than 2 days. No patients experienced recurrence of the vallecular cyst at last follow-up (range 4-755 days, mean 233 days). CONCLUSIONS: Vallecular cysts are rare but should be considered in children with respiratory distress and dysphagia. Awake, flexible fiberoptic laryngoscopy with particular attention to the vallecular region should be performed on any child presenting with these symptoms. Direct, transoral approach for excision of the vallecular cyst is our preferred method of treatment with no recurrences to date. PMID: 21752477 [PubMed - indexed for MEDLINE]

Subglottic stenosis: another challenge for intubation and potential mechanism of airway obstruction in Pierre Robin Sequence.

Subglottic stenosis: another challenge for intubation and potential mechanism of airway obstruction in Pierre Robin Sequence. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1075-7 Authors: Knapp K, Powitzky R, Digoy P Abstract OBJECTIVE: To determine the endotracheal tube (ETT) size and presence of subglottic narrowing in children less than 1 year old with Pierre Robin Sequence (PRS). MATERIALS AND METHODS: We performed a retrospective review from 2005 to 2009 of infants with PRS who underwent diagnostic laryngoscopy (DL) and intubation. RESULTS: Fifteen children with a median age of 25 days were reviewed. All patients, except one, were born full term. Subglottic narrowing was visualized in 5 patients (33%). 73% of all patients required an ETT size smaller than what is recommended by intubation guidelines in the literature in regards to normative data based on age and weight. CONCLUSION: Infants with PRS may have a higher incidence of subglottic stenosis and require a smaller ETT compared to the normal population. This pilot study warrants a larger prospective investigation to validate these findings. PMID: 21742387 [PubMed - indexed for MEDLINE]

Complications and clinical analysis of 416 consecutive cochlear implantations.

Complications and clinical analysis of 416 consecutive cochlear implantations. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1143-6 Authors: Qiu J, Chen Y, Tan P, Chen J, Han Y, Gao L, Lu Y, Du B Abstract OBJECTIVES: Cochlear implantation is a safe technique with a relatively low complication rate. However, certain complications may require specific attention to treat. The purpose of this study was to investigate complications of cochlear implantation for prevention and therapy. STUDY DESIGN: Retrospective case series at a tertiary referral center in China. METHODS: The patients (n=416) who received cochlear implants in our department between 2000 and 2010 were followed up (range, 3 months to 10 years). The complications were identified as "minor" or "major". All complications were systematically reviewed, and their causes were analyzed for prevention and therapy. RESULTS: There were a total of 29 complications (7%). The minor were 23 cases (5.5%), including postoperative subcutaneous hematoma in 13 cases, acute otitis media in 2 cases, postoperative wound infection in 2 cases, delayed facial paralysis in 1 case, clonic facial spasm in 1 case, and severe vertigo in 4 cases. The major were 6 cases (1.5%), including cerebrospinal fluid leakage in 2 cases, implant-related infection and extrusion in 1 case, tympanic membrane perforation induced electrode exposed in 1 case, implantation failure due to cochlear ossification in 1 case, and magnet displacement in 1 case. CONCLUSIONS: Although cochlear implantation is popular, it is essential to decrease the incidence of complications. PMID: 21741711 [PubMed - indexed for MEDLINE]

Ototoxicity of Povidone-Iodine applied to the middle ear cavity of guinea pigs.

Ototoxicity of Povidone-Iodine applied to the middle ear cavity of guinea pigs. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1078-81 Authors: Ichibangase T, Yamano T, Miyagi M, Nakagawa T, Morizono T Abstract OBJECTIVE: Povidone-Iodine preparation is used as a disinfectant in otological surgeries. The ototoxicity of Povidone-Iodine preparation was evaluated using infant, young and adult guinea pigs. The effects of different concentrations and of different exposure durations on compound action potentials were also studied. MATERIALS & METHODS: Povidone-Iodine was used to fill one middle ear cavity of the guinea pig, and the compound action potential (CAP) was measured from the round window membrane at 24h, 7 days, and 28 days. The contralateral side was filled with saline as control. Test sounds used were clicks and tone bursts of 2, 4, and 8 kHz. RESULTS: At 24h, Povidone-Iodine solution showed a significant toxic effect in the infant group. In the young animal group, no toxic effect was seen. In the adult group, a mild degree of deafness for 2 kHz was found. At 7 days, the young group showed significant hearing loss for all frequencies, but the adult group did not show any hearing loss. With a half strength solution, both young and adult group did not show hearing loss. At 28 days, with a full strength solution, hearing loss became prominent for all sound stimulation. With 1/8th dilution, the young group showed a moderate hearing loss, but the adult group did not. CONCLUSION: The thicker round window membrane in human is expected to provide more protection to the human cochlea than in the guinea pig model that we have studied. Mild hearing loss at 24h and 7 days using 10% solution, but no hearing loss with 5% solution at 7 days may indicate that rinsing of the middle ear cavity with saline during surgery should minimize the ototoxic effect of this product. The age of the animals does influence the outcome of the ototoxicity experiment. From this experiment, Povidone-Iodine preparations in the infant should be used with caution. Povidone scrub should not be used for otologic surgery. PMID: 21741096 [PubMed - indexed for MEDLINE]

Lingual tonsils hypertrophy; a cause of obstructive sleep apnea in children after adenotonsillectomy: operative problems and management.

Lingual tonsils hypertrophy; a cause of obstructive sleep apnea in children after adenotonsillectomy: operative problems and management. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1127-31 Authors: Abdel-Aziz M, Ibrahim N, Ahmed A, El-Hamamsy M, Abdel-Khalik MI, El-Hoshy H Abstract OBJECTIVE: Although adenotonsillar hypertrophy has been reported to be the commonest cause of pediatric obstructive sleep apnea (OSA), enlargement of the lingual tonsils is increasingly being recognized as a cause, even after adenotonsillectomy. The aim of our study was to elucidate the lingual tonsils hypertrophy as a cause of pediatric OSA and also to evaluate the efficacy of lingual tonsillectomy in relieving symptoms of the disease considering the peri-operative problems and management. METHODS: Sixteen children with lingual tonsils hypertrophy after adenotonsillectomy were included in the study. Computerized tomography (CT) and/or magnetic resonance imaging (MRI) were used for detection of the lesions. They underwent lingual tonsillectomy with special anesthetic care, flexible laryngoscopy and polysomnography were done pre- and post-operatively. Follow up of the patients was carried out for at least 1 year. RESULTS: Three cases developed post-operative airway obstruction that is caused by tongue base edema. Complete improvement of snoring and apnea was achieved in 10 cases. Despite complete ablation of lingual tonsils, persistent snoring was detected in six cases, while apnea was detected in two cases. Down's syndrome, mucopolysaccharidoses, and obesity may be underlying factors for persistent symptoms. CONCLUSIONS: Lingual tonsils hypertrophy could be the cause of obstructive sleep apnea in children after adenotonsillectomy, lingual tonsillectomy is an effective treatment for these cases, however peri-operative airway problems should be expected and can be managed safely. Persistent symptoms after lingual tonsillectomy may be due to the presence of co-morbidities such as cranio-facial deformities, obesity, and/or mucopolysaccharidoses. PMID: 21737150 [PubMed - indexed for MEDLINE]

Intraoperative electrically evoked stapedius reflex thresholds in children undergone cochlear implantation: round window and cochleostomy approaches.

Intraoperative electrically evoked stapedius reflex thresholds in children undergone cochlear implantation: round window and cochleostomy approaches. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1123-6 Authors: Karatas E, Aud MD, Baglam T, Durucu C, Baysal E, Kanlikama M Abstract OBJECTIVES: To study the best electrically stimulation in cochlear implant surgery with round window (RW) and Promontory cochleostomy approaches with electrically evoked stapedius reflex thresholds (ESRT) intraoperatively. METHODS: Thirty-nine children underwent CI surgery were included for this study. The surgical procedures consisted of RW and Promontory cochleostomy. ESRT for each 1st, 3rd, 6th and 12th electrodes (E) were determined. Statistical evaluation was done for the comparison of the thresholds and duration times for both groups. RESULTS: The duration times of ESRT for E1, E3, E6 and E12 electrodes was shorter in RW group compared with the Promontory group (p<0.05). The statistical evaluation of ESRT measurements of E1, E3, E6 found p<0.001 and E12 electrode p<0.05 in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. CONCLUSION: The duration of electrically stimulation thresholds were shorter in RW group. ESRT measurements were recorded at lower threshold in the RW group compared with the Promontory group. RW insertion offers best electrically stimulation relative to electrode insertion via a promontory cochleostomy. PMID: 21737149 [PubMed - indexed for MEDLINE]

Management of supraglottic dysgenesis presenting as laryngomalacia.

Management of supraglottic dysgenesis presenting as laryngomalacia. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1204-6 Authors: Aynehchi BB, Goldstein NA, Goldsmith AJ Abstract Laryngomalacia is a common source of stridor and can lead to significant upper airway obstruction and feeding disturbances in infants. We describe a unique case of supraglottic dysgenesis presenting as laryngomalacia featuring a prominent "s-shaped" epiglottis with both posterior edges fused to the right aryepiglottic fold/arytenoid complex. Although this anomaly is not accounted for in any of the current laryngomalacia classification schemes, modified laser supraglottoplasty was a satisfactory approach leading to successful decannulation. Laryngeal embryology and possible timing of the pathogenesis of this rare occurrence are reviewed as well. PMID: 21726906 [PubMed - indexed for MEDLINE]

The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma (JNA).

The site of origin and expansive routes of juvenile nasopharyngeal angiofibroma (JNA). Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1088-92 Authors: Liu ZF, Wang DH, Sun XC, Wang JJ, Hu L, Li H, Dai PD Abstract OBJECTIVE: Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular tumor of the nasopharynx occurring in young males. The aim of this study was attempt to find out the site of origin and the common expansion routes of JNA. METHODS: The CT examinations of 46 untreated patients with histologically proven JNA were retrospectively analyzed. Evidence of tumor spreading of the locations are those following CT characteristics: (a) expansion and/or erosion of bony wall; (b) obliteration of normal fatty planes. In addition, three dimensional reconstruction technology was used to make further study. RESULTS: The pterygoid canal was affected in all untreated cases and therefore was considered as the origin of JNA. Nineteen patients' tumors (41.3%) originated from the front part of pterygoid canal and the other 27 ones (58.7%) from the post part of pterygoid canal. Pterygoid canal, choanae and nasal cavity are the three most common sites of JNA. CONCLUSION: The possible site of origin is pterygoid canal. After originating from this point, the tumor will invade sphenopalatine foramen, sphenoid sinus and pterygopalatine fossa first, and then into adjacent structure through aforementioned three sites. PMID: 21719122 [PubMed - indexed for MEDLINE]

Maternal smoking during pregnancy: impact on otoacoustic emissions in neonates.

Maternal smoking during pregnancy: impact on otoacoustic emissions in neonates. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1093-8 Authors: Durante AS, Ibidi SM, Lotufo JP, Carvallo RM Abstract OBJECTIVES: To determine the effect of maternal smoking during pregnancy on transient evoked otoacoustic emissions levels in neonates. METHODS: This was a cross-sectional study investigating neonates in the maternity ward of a university hospital in the city of São Paulo, Brazil. A total of 418 term neonates without prenatal or perinatal complications were evaluated. The neonates were divided into two groups: a study group, which comprised 98 neonates born to mothers who had smoked during pregnancy; and a control group, which comprised 320 neonates born to mothers who had not. In order to compare the two ears and the two groups in terms of the mean overall response and the mean transient evoked otoacoustic emissions in response to acoustic stimuli delivered at different frequencies, we used analysis of variance with repeated measures. RESULTS: The mean overall response and the mean frequency-specific response levels were lower in the neonates in the study group (p<0.001). The mean difference between the groups was 2.47 dB sound pressure level (95% confidence interval: 1.47-3.48). CONCLUSIONS: Maternal smoking during pregnancy had a negative effect on cochlear function, as determined by otoacoustic emissions testing. Therefore, pregnant women should be warned of this additional hazard of smoking. It is important that smoking control be viewed as a public health priority and that strategies for treating tobacco dependence be devised. PMID: 21719121 [PubMed - indexed for MEDLINE]

Prognostic validity of dichotic multiple frequencies auditory steady-state responses versus distortion product otoacoustic emissions in hearing screening of high risk neonates.

Prognostic validity of dichotic multiple frequencies auditory steady-state responses versus distortion product otoacoustic emissions in hearing screening of high risk neonates. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1109-16 Authors: Mahmoudian S, Farhadi M, Kadivar M, Ghalehbaghi B, Rahimi F, Hemami MR, Kamrava SK, Asghari A, Amintehran E, Mohagheghi P Abstract OBJECTIVE: To determine the validity of dichotic multiple frequencies auditory steady-state responses (ASSR) as a hearing screening technique versus using distortion product otoacoustic emissions (DPOAEs) among high-risk neonates. METHODS: A cross sectional study was performed on 118 high-risk neonates by means of dichotic multiple frequencies ASSR and DPOAE for hearing screening. DPOAE results were used as the standard for hearing screening in parallel with ASSR. Dichotic multiple frequencies ASSR results were analyzed by means of F-value of less or greater than 0.05 criteria as a pass-fail for the responses. Dichotic multiple ASSR hearing screening technique was considered in two intensity levels at 40 and 70 dB HL. The ASSRs thresholds were measured in high risk neonates with and without hearing deficits as determined by DPOAES. The results of ASSR and DPOAE were compared to be gathered by contingency table in order to obtain sensitivity, specificity and other different statistical values. Average performing times for the tests were analyzed. RESULTS: The specificity of dichotic multiple ASSR was 92.6%, 93.8% and the sensitivity was 71.6%, 62.2% at the 70 and 40 dB hearing levels, respectively. Mean ASSR thresholds for normal-hearing infants at an average corrected age of 6 days were 32.2 ± 12.2, 29.8 ± 10.2, 26.2 ± 11.4 and 30.4 ± 10.8 dB HL for 0.5, 1, 2 and 4 kHz, respectively. The average times for performing the tests were 18.7 and 32.9 min respectively. CONCLUSIONS: ASSR with this special paradigm is a fairly desirable method for hearing screening of high-risk neonates. There is good concordance between ASSRs and DOPAEs results among high risk neonates referred for hearing screening. The sensitivity and specificity of this test is sufficient for hearing screening in high risk neonates. This test could be valuable for rapid confirmation of normal thresholds. As long as further research have not been conducted on ASSR, great caution should be made to interpret the results of ASSR as a hearing screening technique in young infants and also additional techniques such as the tone-evoked ABRs should be used to cross-check results. It's still too soon to recommend ASSRs as a standalone electrophysiologic measure of hearing thresholds in infants. PMID: 21719120 [PubMed - indexed for MEDLINE]

Relation between language, audio-vocal psycholinguistic abilities and P300 in children having specific language impairment.

Relation between language, audio-vocal psycholinguistic abilities and P300 in children having specific language impairment. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1117-22 Authors: Shaheen EA, Shohdy SS, Abd Al Raouf M, Mohamed El Abd S, Abd Elhamid A Abstract Specific language impairment is a relatively common developmental condition in which a child fails to develop language at the typical rate despite normal general intellectual abilities, adequate exposure to language, and in the absence of hearing impairments, or neurological or psychiatric disorders. There is much controversy about the extent to which the auditory processing deficits are important in the genesis specific language impairment. The objective of this paper is to assess the higher cortical functions in children with specific language impairment, through assessing neurophysiological changes in order to correlate the results with the clinical picture of the patients to choose the proper rehabilitation training program. SUBJECTS AND METHOD: This study was carried out on 40 children diagnosed to have specific language impairment and 20 normal children as a control group. All children were subjected to the assessment protocol applied in Kasr El-Aini hospital. They were also subjected to a language test (receptive, expressive and total language items), the audio-vocal items of Illinois test of psycholinguistic (auditory reception, auditory association, verbal expression, grammatical closure, auditory sequential memory and sound blending) as well as audiological assessment that included peripheral audiological and P300 amplitude and latency assessment. The results revealed a highly significant difference in P300 amplitude and latency between specific language impairment group and control group. There is also strong correlations between P300 latency and the grammatical closure, auditory sequential memory and sound blending, while significant correlation between the P300 amplitude and auditory association and verbal expression. CONCLUSION: Children with specific language impairment, in spite of the normal peripheral hearing, have evidence of cognitive and central auditory processing defects as evidenced by P300 auditory event related potential in the form of prolonged latency which indicate a slow rate of processing and defective memory as evidenced by small amplitude. These findings affect cognitive and language development in specific language impairment children and should be considered during planning the intervention program. PMID: 21719119 [PubMed - indexed for MEDLINE]

Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children.

Microbiological profile with antibiotic sensitivity pattern of cholesteatomatous chronic suppurative otitis media among children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1104-8 Authors: Madana J, Yolmo D, Kalaiarasi R, Gopalakrishnan S, Sujatha S Abstract INTRODUCTION: Chronic suppurative otitis media (CSOM) is the most common cause of childhood hearing impairment in the developing countries and atticoantral type is associated with increased incidence of intracranial and extracranial complications. This study was undertaken to define the microbiology of atticoantral type of chronic otitis media and the antibiotic sensitivity pattern, thereby reducing the potential risks of complications. MATERIALS AND METHODS: A retrospective study was done in the Department of Otolaryngology, JIPMER, Puducherry from the year August 2003 to October 2009 using the medical record department database to retrieve the patient details. During this study period, 223 children with atticoantral type CSOM consisting of 126 males and 97 females with an age range of 1-14 years were assessed. Patients with persistent otorrhea for more than 3 months with atticoantral type of chronic otitis media were selected. The exudates were collected under sterile conditions and inoculated onto culture media; bacterial growth and antibiotic sensitivity pattern were studied. RESULTS: Nine species of micro organisms were isolated from the middle ear aspirate, Pseudomonas aeruginosa being the most predominant isolate constituting about 32% (72 discharging ears) of the total isolates followed by Proteus mirabilis (20% of isolates) and Staphylococcus aureus (19% of isolates). Gram negative organisms accounted 58% of total isolates and gram positive organisms constituted 22% isolates. Candida albicans and methicillin resistant S. aureus were identified in 4% and 2% of isolates, respectively. 100% of Pseudomonas isolates showed susceptibility to ceftazidime and a high sensitivity (92% of isolates) to ciprofloxacin and 88% isolates were sensitive to amikacin. 100% of P. mirabilis isolated from inoculates showed sensitivity to ceftazidime and ciprofloxacin. It also showed 87-97% sensitivity to ceftriaxone, amikacin and ampicillin. All (100%) of the Staphylococcus isolates were sensitive to vancomycin and 84-86% were sensitive to ciprofloxacin and erythromycin. In general, gram negative organisms showed increased sensitivity to ceftazidime, ciprofloxacin and amikacin, while gram positive organisms to vancomycin, erythromycin and ciprofoxacin. CONCLUSION: Continuous and periodic evaluation of microbiological pattern and antibiotic sensitivity of cholesteatomatous CSOM is necessary to decrease the potential risks of complications by early institution of appropriate systemic and topical antibiotic alongside mastoid exploration. We believe that our data may contribute to an effective medical management of chronic suppurative otitis media with cholesteatoma. Since the most common organisms in our clinical set up being P. aeruginosa, P. mirabilis and S. aureus, which showed a percentage susceptibility of 100% to ceftazidime and vancomycin, thus making it an empirical antibiotic combination therapy of choice in the recent times. PMID: 21715027 [PubMed - indexed for MEDLINE]

Retropharyngeal infections in children. Treatment strategies and outcomes.

Retropharyngeal infections in children. Treatment strategies and outcomes. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1099-103 Authors: Hoffmann C, Pierrot S, Contencin P, Morisseau-Durand MP, Manach Y, Couloigner V Abstract OBJECTIVE: To optimize the treatment of retropharyngeal infections in children. METHODS: Retrospective chart review of 101 consecutive pediatric cases of retropharyngeal infections referred to our center from January 2006 to July 2009. RESULTS: Two-thirds of patients were males. Their mean age was 52 months (range: 6-163). Upper airway obstruction was observed in three patients. In another child, the infection evolved towards a diffuse cervical cellulitis. Medical treatment was initially planned in 44% of patients. Failures requiring surgical drainage occurred in 18% of them. In 56% of cases, surgical treatment was immediately instigated. It failed in 16% of patients, requiring a second surgical drainage. There was no difference in the duration of fever and of hospital stay between patients initially treated medically or surgically. Both medical and surgical treatment failures were associated with longer durations of fever (p=0.002, and p<0.0001, respectively) and of hospital stay (p=0.0006, and p=0.0005, respectively). Some characteristics of CT-scan anomalies were correlated with treatment failure. A hypodense core surrounded by rim enhancement, with a largest long axis ≥ 20 mm, was more frequent in case of medical failure (p=0.02). Surgical failure was associated with the same feature, but with a largest long axis ≥ 30 mm (p=0.05). CONCLUSIONS: The present study suggests that severe complications are rare in pediatric retropharyngeal adenitis, and that CT-scan is a useful tool to choose between medical and surgical treatment. PMID: 21705095 [PubMed - indexed for MEDLINE]

Exploring factors that affect the age of cochlear implantation in children.

Exploring factors that affect the age of cochlear implantation in children. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1082-7 Authors: Fitzpatrick EM, Johnson E, Durieux-Smith A Abstract OBJECTIVE: Early access to sound through early cochlear implantation has been widely advocated for children who do not derive sufficient benefit from acoustic amplification. Early identification through newborn hearing screening should lead to earlier intervention including earlier cochlear implantation when appropriate. Despite earlier diagnosis and the trend towards early implantation, many children are still implanted well into their preschool years. The purpose of this study was to examine the factors that affected late cochlear implantation in children with early onset permanent sensorineural hearing loss. METHODS: Data were examined for 43 children with cochlear implants who were part of a group of 71 children with hearing loss enrolled in a Canadian outcomes study. Eighteen (41.9%) of the 43 children were identified through newborn screening and 25 (58.1%) through medical referral to audiology. Medical chart data were examined to determine age of hearing loss diagnosis, age at cochlear implant candidacy, and age at cochlear implantation. Detailed reviews were conducted to identify the factors that resulted in implantation more than 12 months after hearing loss confirmation. RESULTS: The median age of diagnosis of hearing loss for all 43 children was 9.0 (IQR: 5.1, 15.8) months and a median of 9.1 (IQR: 5.6, 26.8) months elapsed between diagnosis and unilateral cochlear implantation. The median age at identification for the screened groups was 3.3 months (IQR: 1.4, 7.1) but age at implantation (median 15.8 months: IQR: 5.6, 37.1) was highly variable. Eighteen of 43 children (41.9%) received a cochlear implant more than 12 months after initial hearing loss diagnosis. For many children, diagnosis of hearing loss was not equivalent to the determination of cochlear implant candidacy. Detailed reviews of audiologic profiles and study data indicated that late implantation could be accounted for primarily by progressive hearing loss (11 children), complex medical conditions (4 children) and other miscellaneous factors (3 children). CONCLUSIONS: This study suggests that a substantial number of children will continue to receive cochlear implants well beyond their first birthday primarily due to progressive hearing loss. In addition, other medical conditions may contribute to delayed decisions in pediatric cochlear implantation. PMID: 21703694 [PubMed - indexed for MEDLINE]

Epidemiology of acute otitis media in children of Latin America and the Caribbean: a systematic review and meta-analysis.

Epidemiology of acute otitis media in children of Latin America and the Caribbean: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1062-70 Authors: Bardach A, Ciapponi A, Garcia-Marti S, Glujovsky D, Mazzoni A, Fayad A, Colindres RE, Gentile A Abstract BACKGROUND: Acute otitis media (AOM) is one of the most common childhood diseases requiring antimicrobial prescription in pre-school children. This systematic review aimed to estimate the AOM incidence, bacterial etiology and use of resources in children aged <6 years in Latin America and the Caribbean (LA&C). METHODS: A systematic search using keywords otitis or middle ear and inflammation was performed for articles published during 1988-2008 in MEDLINE, Cochrane Library, EMBASE, LILACS, generic and academic internet searches, Ministries of Health, PAHO, regional proceedings, reference lists and consulting experts. Pairs of reviewers independently selected articles and assessed their methodological quality with a checklist of essential items from the STROBE statement according to pre-specified criteria. Studies involving immune-competent children with AOM were considered. Arcsine transformations were used for proportion meta-analyses. RESULTS: Annual AOM incidence in four studies in children aged <5 years ranged from 1,171-36,000 episodes/100,000 children. Meta-analysis on etiology and pneumococcal serotypes included 18 studies and 125, 519 children with AOM from six LA&C countries. Meta-analysis per serotype showed that Streptococcus pneumoniae (32.4%; 95%CI=27.1-38.0%) and Haemophilus influenzae (26%; 95%CI=19.5-33.1%), including non-typeable H. influenzae (18.3%; 95%CI=9.5-33.1%) were the most prevalent. The most commonly observed pneumococcal serotype was 19F (24.0%; 95% CI 17.0-32.0%). Data on use of health resources were scarce. CONCLUSIONS: Streptococcus pneumoniae and H. influenzae were the most frequent AOM bacterial pathogens, consistent with the international literature from other regions. Future studies on AOM incidence and health resources usage will help better define the impact of this disease. PMID: 21665297 [PubMed - indexed for MEDLINE]

A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media.

A systematic review of the effect of tympanostomy tubes in children with recurrent acute otitis media. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1058-61 Authors: Lous J, Ryborg CT, Thomsen JL Abstract OBJECTIVE: Documentation of the effect of tympanostomy tubes in children with recurrent acute otitis media (RAOM) is limited. A recently published Cochrane review on the effect of tympanostomy tubes in children with RAOM was based on only two studies. Could the documentation be increased by including other randomized studies? METHODS: A MEDLINE and EMBASE search for randomized controlled trials was performed and 143 eligible papers were found. Only five studies could be included. All five were randomized studies with a total of 519 children, four randomized by children and one by ears. All five studies had different designs and control groups, making a proper meta-analysis impossible. Three studies had an antibiotic treated group, two studies a placebo group, and two studies a no treatment group as comparison group. Outcome measures were rates of AOM or fraction free of AOM in six or 12 months. RESULTS: Between two and five children have to be treated with tympanostomy tubes to prevent one child from attacks of acute otitis media (AOM) in six months. Tube treatment could reduce AOM with about one attack in six months after operation. Six months treatment with antibiotics was not different from treatment with tubes. No study reported quality of life for child and family or parental absence from day care or work. CONCLUSION: Insertion of tympanostomy tubes or long-term treatment with antibiotics seems to prevent one attack of AOM or keep one child out of three free from AOM in six months. PMID: 21636136 [PubMed - indexed for MEDLINE]

Urgent maxillectomy in infants for rare infantile maxillary tumors.

Urgent maxillectomy in infants for rare infantile maxillary tumors. Int J Pediatr Otorhinolaryngol. 2011 Sep;75(9):1071-4 Authors: Amer HE, Sharkawy AA, Musad A, Tawfik A, Kamal A Abstract OBJECTIVE: The purpose of this study was to present our experience with definitive surgical management of infants with Melanotic neuroectodermal tumor of infant (MNTI) and epithelioid hemangioendothelioma (EHE). PATIENTS AND METHODS: This study included four male infants with histologically proven MNTI (three infants) and EHE (one infant). CT scan and MRI were for taken for the patients preoperatively. Surgical intervention was used in all infants. RESULTS: This study is a retrospective study that reflects our experience in the last 20 years in maxillectomy in infants. All infants were male with mean age 6 months (2-9 months). Complete resection of the tumor was achieved all infants with no residual or recurrence. Neither chemotherapy nor radiation was used in this study. CONCLUSIONS: MNTI and EHE are rare tumor of infant. They present as a slow painless hard swelling of the maxilla. Imaging is an essential before surgical treatment. Complete excision is curative. PMID: 21247639 [PubMed - indexed for MEDLINE]