International Journal of Pediatric Otorhinolaryngology

Editorial Board

2012-02-01

Lingual thyroglossal duct cysts—A review

K.S. Muhammed Sameer, Suravi Mohanty, Marjorie Mariam Ann Correa, Kanishka Das — 2012-02-01

Abstract: Objectives: Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors’ series and review existing literature on the entity.Methods: A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management.Results: Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported.Conclusions: In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.

Pediatric exposure to choking hazards is associated with parental knowledge of choking hazards

2012-02-01

Abstract: Objective: To evaluate parental knowledge regarding household food and non-food choking hazards.Design: Cross Sectional Survey.Setting: Tertiary Care Children's Hospital.Participants: Parents presenting to a Pediatric Otolaryngology Clinic with a child <4 years old.Methods: Parental survey asking which choking hazard foods (CHF) they allow their child to eat, previous instruction of CHF, knowledge of non-food choking hazards, and their knowledge sources. Statistics: adjusted odds ratios (AOR) and logistic regressions.Results: 492 respondents. Adjusted for significant covariates associations between correct knowledge of CHF and correct parents actions of disallowing CHF: fruit chunks (prior instruction=42%; correct action=25%; AOR=3.51; P<0.0001), hot dogs (59%; 28%; 1.75; 0.0178), raw vegetables (41%; 47%; 1.28; 0.198) popcorn (67%; 49% 2.64; <0.0001), whole grapes (68%; 51%; 2.2; <0.0001), nuts (73%; 66%; 2.47; <0.0001), chunks of peanut butter (45%; 79%; 2.55; 0.0003), sticky candy (79%; 80%; 2.16; <0.0033), gum (72%; 84%; 1.75; 0.028), seeds (65%; 87%; 1.4; 0.247), 76% always supervise meals, 57% always cut food, 62% know CPR.Knowledge of non-food hazards: Coins (97%), marbles (94%), small batteries (93%), small toy parts (93%), dice (92%), pen caps (92%), safety pins (85%), balloons (84%), syringes (40%). Sources of choking hazard knowledge: physicians (67%), family/friends (52%), books/magazines (40%), and the Internet (25%).Conclusions: Parental knowledge of CHF is incomplete. The consumption of CHF in children under 4 is significantly associated with decreased parental knowledge. Therefore, more parental education is needed.

Random Gap Detection Test (RGDT) performance of individuals with central auditory processing disorders from 5 to 25 years of age

2012-02-01

Abstract: Objective: The aim of the present study was to assess the auditory temporal resolution ability in individuals with central auditory processing disorders, to examine the maturation effect and to investigate the relationship between the performance on a temporal resolution test with the performance on other central auditory tests.Methods: Participants were divided in two groups: 131 with Central Auditory Processing Disorder and 94 with normal auditory processing. They had pure-tone air-conduction thresholds no poorer than 15dB HL bilaterally, normal admittance measures and presence of acoustic reflexes. Also, they were assessed with a central auditory test battery. Participants who failed at least one or more tests were included in the Central Auditory Processing Disorder group and those in the control group obtained normal performance on all tests. Following the auditory processing assessment, the Random Gap Detection Test was administered to the participants. A three-way ANOVA was performed. Correlation analyses were also done between the four Random Gap Detection Test subtests data as well as between Random Gap Detection Test data and the other auditory processing test results.Results: There was a significant difference between the age-group performances in children with and without Central Auditory Processing Disorder. Also, 48% of children with Central Auditory Processing Disorder failed the Random Gap Detection Test and the percentage decreased as a function of age. The highest percentage (86%) was found in the 5–6 year-old children. Furthermore, results revealed a strong significant correlation between the four Random Gap Detection Test subtests. There was a modest correlation between the Random Gap Detection Test results and the dichotic listening tests. No significant correlation was observed between the Random Gap Detection Test data and the results of the other tests in the battery.Conclusion: Random Gap Detection Test should not be administered to children younger than 7 years old because other reduced capacities might influence their performance. Also, Random Gap Detection Test assesses a specific auditory ability, different than the one evaluated with the other auditory tests. Finally, it is suggested to test individuals at only one frequency of the Random Gap Detection Test because results provide similar information than when assessing them on all subtests.

Novel rat model of tympanostomy tube otorrhea

Rodrigo C. Silva, Joseph E. Dohar, Patricia A. Hebda — 2012-02-01

Abstract: Objective: Tympanostomy tube otorrhea (TTO), caused by the presence of pathogenic bacteria in the middle ear, is the most common complication of TT insertion. No studies have described a reproducible animal model of TTO. We aimed to develop a rat model of TTO which, in turn, could be used to assay the levels of TNF-α and IL-1β through the course of the infection.Methods: The left Eustachian tubes of 55 male Sprague-Dawley albino rats were occluded with gutta-percha (ETO=Eustachian Tube Occlusion). Middle ear (ME) effusion was ascertained by weekly otomicroscopy. At 3weeks tympanostomy tubes were placed bilaterally and the MEs were inoculated bilaterally with Streptococcus pneumoniae through the tubes. The rats were randomly assigned to one of two daily ototopical treatments: ciprofloxacin/dexamethasone (CDX) or placebo. The animals in each of the two treatment groups were further divided to receive 1, 2, 5 or 7days of treatment. The rats were sacrificed after treatment was finished. The rates of otorrhea, positive middle ear (ME) cultures, and levels of TNF-α and IL-1β in the ME fluid were measured.Results: Left ETO followed by ME inoculation with S. pneumoniae and treatment with placebo resulted in persistent infection (100% culture-positive ME fluid at 10days) and otorrhea (85.7%). Persistent infection of the left ear was accompanied by significantly elevated the levels of IL-1β and TNF-α. Ears treated with CDX had lower rates of otorrhea at all time points and lower levels of IL-1β and TNF-α.Conclusions: This study is the first to describe a reproducible animal model of acute TTO. Surgical obstruction of the ET, followed by TT placement and ME inoculation with S. pneumoniae induced persistent otorrhea and infection. Both IL-1β and TNF-α appear to be potential markers of persistent middle ear infection. This novel model may be used in future studies of the pathogenesis and therapy of TTO.

A model of canine tracheal stenosis induced by radiofrequency cauterization

Zhifeng Chen, Jiasheng Luo, Li Xu, Ruina Ma, Ni Zhang, Pengcheng Cui — 2012-02-01

Abstract: Objective: The current methods of management of tracheal stenosis have disadvantages and are controversial, therefore ideal experimental animal models for the further studies are required. The aim of this study was to establish a new model of canine tracheal stenosis by radiofrequency cauterization.Methods: The tracheal cartilage ring was injured by radiofrequency at the level of the sixth tracheal ring in 12 mongrel dogs. A fibrolaryngoscope was used to guide the procedure. The animals were observed after operation and examined after euthanasia. Endoscopic and histological examinations were undertaken to evaluate the progress of stenosis. The degree of stenosis was calculated using the formula: degree of stenosis=(initial lumen area−final lumen area)/initial lumen area×100%.Results: Tracheal stenosis had developed in all dogs by the 21st day post operation. Costal retraction was observed in all dogs after the 18th day post operation. At the end of the study, gross and endoscopic examinations showed that stenosis had been induced to a satisfactory degree and without any complications. The median of the degree of stenosis was 92%, with a range of 84–94%. Histological examination showed that cartilage was damaged and that granulation tissue and collagen fibres had formed.Conclusions: The model of canine tracheal stenosis induced by radiofrequency cauterization is a relatively simple, reliable, and reproducible animal model. This model may be useful in the development of new methods of treatment for tracheal stenosis.

Prevalence of inhaled antigen sensitization and nasal eosinophils in Japanese children under two years old

2012-02-01

Abstract: Objective: The increasingly younger age of onset of allergic rhinitis (AR) has recently become a problem. This study examined the prevalence of inhaled antigen sensitization and nasal eosinophils in children younger than two years old, with measurement of the serum concentrations of aeroallergen-specific IgE antibodies to house dust mites, cat fur, and Japanese cedar pollen, measurement of nasal eosinophil counts, and a questionnaire administered to the children's parents.Methods: The subjects were a group of healthy children undergoing 18-month infant health checks provided by the local government, and sick children younger than two years old at the pediatric hospital.Results: Among 408 healthy infants, 44 (10.7%) had antigen-specific IgE antibodies, 29 (7.1%) had nasal eosinophils, and eight (2.0%) had both specific IgE antibodies and nasal eosinophils. Nasal assessment revealed that 125 children had rhinorrhea. Of the infants who showed both sensitization to antigens and nasal eosinophils, six (1.5%) had confirmed rhinorrhea. Among 186 sick children younger than two years old at the pediatric hospital, aeroallergen-specific IgE antibodies were detected in five (2.6%). The presence of nasal eosinophils was confirmed in six children (3.2%), which percentage was smaller than that of the healthy group. No infant had either sensitization to antigens or nasal eosinophils.Conclusion: The findings described above indicate that the minimum prevalence of AR might be 1.5% in 18-month-old children and that around 10% of affected children have aeroallergen-specific IgE antibodies in Japan. The incidence of AR in young children might increase further.

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

Oren Cavel, Mathieu Bergeron, Laurent Garel, Pierre Arcand, Patrick Froehlich — 2012-02-01

Abstract: Objectives: Rigid bronchoscopy (RB) is the principal method used for the extraction of a tracheo-bronchial foreign body (FB), but its use as a diagnostic tool implies a certain rate of negative exams, exposing the child to the risk of procedure and anesthesia-related complications. Technological progress has improved the accuracy and availability of non-invasive modalities, such as CT scan and fluoroscopy. Our aim is to review our experience in the routine use of bronchoscopy for a suspected FB aspiration, and evaluate the adequacy of our current attitude in light of these alternatives.Methods: We performed a retrospective review of cases where bronchoscopy was used in the management of a suspected airway FB, and analysis of the correlation between the clinical and radiological data and the bronchoscopy's results. In addition we reviewed the literature concerning the use of RB and alternative means of diagnosis such as CT scan, fluoroscopy and flexible bronchoscopy.Results: Thirty-two patients underwent bronchoscopy to rule out a FB aspiration under general anesthesia. No FB was found in 8 cases (25%). Cough and a history of choking were the most sensitive parameters (sensitivity 100% and 80% respectively), but had a low specificity. Stridor was the most specific sign (88% specificity), but was not sensitive. Chest radiography had 25% sensitivity, and 62.5% specificity. Flexible bronchoscopy changed the management in 22% of cases, sparing RB.Conclusions: Basing the decision to perform RB solely on the clinical findings and chest radiography entails a 25% rate or more of negative exams. CT scan appears to be the most accurate non-invasive tool for ruling out the presence of a FB but its use cannot be systematic due to its complexity and the risks of exposure to radiation. Digital substraction fluoroscopy is a safe and simple mean to confirm the presence of air trapping generated by a bronchial obstruction, but it is not sensitive enough to definitively rule out a FB. We propose a stepwise approach using fluoroscopy or possibly flexible bronchoscopy under sedation, in order to reduce the number of negative RBs while restricting the use of the CT scan.

Pediatric all-terrain vehicle related temporal bone fractures

Anthony Anfuso, Paul M. Weinberger, Brian J. McKinnon — 2012-02-01

Abstract: Objectives: To determine the prevalence of helmet use in children involved in all-terrain vehicles (ATV) accidents.Study design: Retrospective chart review.Setting: Tertiary Academic Medical Center.Subjects and methods: Retrospective review was performed using the trauma registry of an academic tertiary medical center identifying ATV injured patients under 13 years of age between 2003–2008. Data regarding age, gender, ethnicity, driver/passenger status, helmet status, length of hospital stay, Glascow Coma Scale, Injury Severity Score, Abbreviated Injury Score, and presence of temporal bone fracture were analyzed.Results: Seventy-four ATV injured pediatric subjects were identified. Average age was 8.6 years, 62% male, 38 were drivers, 32 were passengers. Helmet use data were available on 47 (64%) subjects, of these 9 (19%) wore helmets, and 38 (81%) were not wearing helmets. There was no observed statistical difference between helmeted and unhelmeted riders when comparing age, gender, ethnicity, driver/passenger status, length of hospital stay, Glascow Coma Scale (GCS), Injury Severity Score, Abbreviated Injury Score, or presence of temporal bone fracture.Conclusions: This review found that documented helmet use in pediatric ATV injuries to be profoundly low (19%). Within our cohort no protective benefit from helmet use was identified, suggesting the inherent and potentially unalterable dangers of pediatric ATV recreation.

Human bocavirus in the nasopharynx of otitis-prone children

2012-02-01

Abstract: Objectives: Human bocavirus (HBoV) is frequently identified in children with respiratory tract infections, and its role in acute otitis media (AOM) has been suggested. The disease associations for the closely related bocaviruses HBoV2-4 remain unknown. Increasing evidence shows that probiotics may reduce the risk of AOM of viral origin. Objectives of the study was to examine the prevalence and persistence of bocaviruses in consecutive nasopharyngeal samples (NPS) of otitis-prone children, and whether an association exists between HBoV and the child's characteristics, respiratory symptoms, and AOM pathogens, and whether probiotics reduce the occurrence of HBoV.Methods: In a double-blind, placebo-controlled, randomized, 6-month intervention study, 269 otitis-prone children (aged 9 months to 5.6 years), consumed daily either one capsule of probiotics (Lactobacillus rhamnosus GG, L. rhamnosus Lc705, Bifidobacterium breve 99 and Propionibacterium freudenreichii JS) or placebo. After a clinical examination and NPS collected at three-time points, the presence and persistence of HBoV1-4 DNA in NPS was determined by RT-qPCR at the baseline, after 3, and 6 months.Results: A high load (>10,000copies/ml) of HBoV DNA was detected in 26 (17.1%) of 152 children, and 16 (10.5%) showed a prolonged presence of HBoV for at least 3 months. None had DNA of HBoV2-4. Higher number of siblings associated with increased HBoV prevalence (p=0.029). Prevalence or persistence of HBoV was not significantly associated with other characteristics, respiratory symptoms, or AOM pathogens. Probiotic intervention significantly reduced the number of HBoV DNA-positive samples (probiotic vs. placebo: 6.4% vs. 19.0%, OR=0.25, CI 95%=0.07–0.94, p=0.039).Conclusions: HBoV, but not HBoV2-4, DNA occurs often in the nasopharynx of otitis-prone children, and may persist for 3–6 months. Probiotic treatment possibly reduced the presence of HBoV.

The economics of screening infants at risk of hearing impairment: An international analysis

Martyn J. Burke, Ruth C. Shenton, Matthew J. Taylor — 2012-02-01

Abstract: Objective: Hearing impairment in children across the world constitutes a particularly serious obstacle to their optimal development and education, including language acquisition. Around 0.5–6 in every 1000 neonates and infants have congenital or early childhood onset sensorineural deafness or severe-to-profound hearing impairment, with significant consequences. Therefore, early detection is a vitally important element in providing appropriate support for deaf and hearing-impaired babies that will help them enjoy equal opportunities in society alongside all other children. This analysis estimates the costs and effectiveness of various interventions to screen infants at risk of hearing impairment.Methods: The economic analysis used a decision tree approach to determine the cost-effectiveness of newborn hearing screening strategies. Two unique models were built to capture different strategic screening decisions. Firstly, the cost-effectiveness of universal newborn hearing screening (UNHS) was compared to selective screening of newborns with risk factors. Secondly, the cost-effectiveness of providing a one-stage screening process vs. a two-stage screening process was investigated.Results: Two countries, the United Kingdom and India, were used as case studies to illustrate the likely cost outcomes associated with the various strategies to diagnose hearing loss in infants. In the UK, the universal strategy incurs a further cost of approximately £2.3 million but detected an extra 63 cases. An incremental cost per case detected of £36,181 was estimated. The estimated economic burden was substantially higher in India when adopting a universal strategy due to the higher baseline prevalence of hearing loss. The one-stage screening strategy accumulated an additional 13,480 and 13,432 extra cases of false-positives, in the UK and India respectively when compared to a two-stage screening strategy. This represented increased costs by approximately £1.3 million and INR 34.6 million.Conclusions: The cost-effectiveness of a screening intervention was largely dependent upon two key factors. As would be expected, the cost (per patient) of the intervention drives the model substantially, with higher costs leading to higher cost-effectiveness ratios. Likewise, the baseline prevalence (risk) of hearing impairment also affected the results. In scenarios where the baseline risk was low, the intervention was less likely to be cost-effective compared to when the baseline risk was high.

Internationalization of pediatric sleep apnea research

Mario Milkov — 2012-02-01

Abstract: Objective: Recently, the socio-medical importance of obstructive sleep apnea in infancy and childhood increases worldwide. The present investigation aims at analyzing the dynamic science internationalization in this narrow field as reflected in three data-bases and at outlining the most significant scientists, institutions and primary information sources.Methods: A scientometric study of data from a retrospective problem-oriented search on pediatric sleep apnea in three data-bases such as Web of Science, MEDLINE and Scopus was carried out. A set of parameters of publication output and citations was followed-up. Several scientometric distributions were created and enabled the identification of some essential peculiarities of the international scientific communications.Results: There was a steady world publication output increase. In 1972–2010, 4192 publications from 874 journals were abstracted in MEDLINE. In 1985–2010, more than 8100 authors from 64 countries published 3213 papers in 626 journals and 256 conference proceedings abstracted in Web of Science. In 1973–2010, 152 authors published 687 papers in 144 journals in 19 languages abstracted in Scopus. USA authors dominated followed by those from Australia and Canada. Sleep, Int. J. Pediatr. Otorhinolaryngol., Pediatr. Pulmonol. and Pediatrics belonged to ‘core’ journals concerning Web of Science and MEDLINE while Arch. Dis. Childh. and Eur. Respir. J. dominated in Scopus. Nine journals being currently published in 5 countries contained the terms of ‘sleep’ or ‘sleeping’ in their titles. David Gozal, Carole L. Marcus and Christian Guilleminault presented with most publications and citations to them. W.H. Dietz’ paper published in Pediatrics in 1998 received 764 citations. Eighty-four authors from 11 countries participated in 16 scientific events held in 12 countries which were immediately devoted to sleep research. Their 13 articles were cited 170 times in Web of Science. Authors from the University of Louisville, Stanford University, and University of Pennsylvania published most papers on pediatric sleep apnea abstracted in these data-bases.Conclusions: The newly created data-base with the researchers’ names, addresses and publications could be used by scientists from smaller countries for further improvement of their international collaboration.

The nasopharynx in infants with cleft lip and palate

2012-02-01

Abstract: Objective: The purpose of this study was to use three-dimensional computed tomography data and computer imaging technology to assess the skeletal components of the naso-pharyngeal area in patients with cleft lip and palate and to quantify anatomical variations.Methods: CT scans were obtained from 29 patients of Malay origin with cleft lip and palate aged between 0 and 12 months and 12 noncleft patients in the same age group, using a GE Lightspeed Plus Scanner housed in Hospital Universiti Sains Malaysia. Measurements were obtained using the ‘Persona’ three-dimensional software package, developed at Australian Craniofacial Unit, Adelaide.Results: The results of the present study show that there is an increased nasopharyngeal space in cleft lip and palate that may lead to compression of the nasopharyngeal structures, including the Eustachian tube. Alterations of the medial pterygoid plate and the hamulus may lead to an alteration in the origin and orientation of the tensor veli palatini muscle leading to alteration in its function.Conclusions: These anatomical variations may compromise the dilatory mechanism of the Eustachian tube, thus leading to recurrent middle ear infections in cleft children and subsequent loss of hearing.

Microarray-based mutation detection of pediatric sporadic nonsyndromic hearing loss in China

2012-02-01

Abstract: Objective: To investigate the molecular etiologic causes of sporadic nonsyndromic hearing loss in Chinese children.Methods: 179 sporadic nonsyndromic hearing loss children were subjected to microarray-based mutation detection for nine hot spot mutations in four of the most common deafness-related genes, including GJB2, SLC26A4, GJB3, and 12s rRNA.Results: The incidence of positive genetic errors was 43.58% with the current set of target genes in sporadic nonsyndromic hearing loss children. Among them, 25.14% of cases had genetic defects in GJB2, 16.76% of cases had pathogenic mutations in SLC26A4, 1.12% of cases were caused by 12s rRNA mutations, and GJB3 mutation was detected in 0.56% of this group of patients.Conclusions: Our results demonstrated that genetic factors were important causes for sporadic nonsyndromic hearing loss in Chinese pediatric cases. Mutations of GJB2 and SLC26A4 are two major genetic causes, whereas mutations of GJB3 and 12s rRNA result in the development of hearing loss in a small percentage of sporadic nonsyndromic hearing loss cases. Microarray testing is a helpful and instrumental screening method in the diagnosis of genetic hearing loss.

Evaluation of pediatric subglottic cysts

Elif Ayanoglu Aksoy, Cagdas Elsürer, Gediz Murat Serin, Ömer Faruk Ünal — 2012-02-01

Abstract: Introduction: Subglottic cysts (SGCs) are increasingly recognized as a cause of upper airway obstruction in previously intubated infants. Endoscopic marsupialization with cold steel instruments or CO2 laser has been reported to be the standardised treatment method for SGCs. SGC case series of 9 patients who were treated with endoscopic marsupialization with cold steel instruments or CO2 laser and mechanical decompression with balloon dilatation are presented.Patients and methods: Retrospective study of 9 cases of subglottic cysts treated between 2003 and 2010 was done. Diagnoses were made by performing flexible nasopharyngolaryngoscopy and surgical treatment was done through endoscopic marsupialization with cold steel instruments or CO2 laser.Results: The age range of SGC patients were between 3 months and 36 months (average 12, 11 months). Two of the patients were female (2/9), 7 of them were male (7/9). SGC diagnoses were made by flexible nasopharyngolaryngoscopy. History of intubation was noted in 3 of the patients (3/9). Duration of intubation was 28 days, 6 days, and 8 days respectively. Cysts were multiple in all cases, and located posteriorly and laterally at the subglottic area and upper trachea. The patients presented with were stridor, fail to thrive, and recurrent croup attacks. Treatment methods preferred for these patients were endoscopic marsupialization with cold steel instruments or CO2 laser and mechanical decompression with balloon dilatation. The follow-up period after treatment ranged between 8 months and 3 years. Recurrence of the SGCs did not happen and re-evaluation under general anesthesia was reserved for the symptomatic patients.Conclusion: Diagnostic laryngoscopy and bronchoscopy are important in diagnosing SGC. History of premature birth and intubation are not ‘sine qua non’ of SGC as SGC may be congenital as well. Symptoms of SGCs may mimic the characteristic features of chronic obstructive lung disease, so evaluation of the airway should be considered in such infants if they have stridor or hoarseness not responding to routine treatment. Laryngoscopy and bronchoscopy are routinely indicated for airway evaluation in at-risk infants.

Cochlear involvement in Familial Mediterranean Fever: A new feature of an old disease

Serap Koybasi, Halil İbrahim Atasoy, Yusuf Ozgur Bicer, Esra Tug — 2012-02-01

Abstract: Objectives: In this study we first aimed to assess the cochlear functions in children with Familial Mediterranean Fever. The second aim was to investigate the correlation between the hearing levels and some clinical features of Familial Mediterranean Fever including the duration of the disease, age at onset, genetic analysis and colchicine use.Methods: Thirty-four children with Familial Mediterranean Fever and 27 age matched children were included in the study. Following otologic examination, all children underwent audiometric evaluation, including Pure Tone Average measurements and Distortion Product Otoaoustic Emission testing. Audiological results of the two groups were compared and correlation between the audiologic status and clinical parameters of the disease like the duration of disease, age at onset, mutations and colchicine treatment were studied.Results: Pure tone audiometry hearing levels were within normal levels in both groups. Hearing thresholds of Familial Mediterranean Fever patients were found to be increased at frequencies 8000, 10,000, 12,500 and 16,000 (p<0.05). In otoacoustic emission evaluation, distortion products and signal–noise ratio of FMF children were lower in the tested frequencies, from 1400Hz to 4000Hz (p<0.05). Interaction of the disease duration and age of disease onset was found to predict hearing levels, distortion products and signal–noise ratios of children with Familial Mediterranean Fever (F value=2.034; p=0.033).Conclusions: To our knowledge this is the first study demonstrating cochlear involvement in children with Familial Mediterranean Fever which showed increased hearing thresholds at higher frequencies in audiometry together with decreased distortion products and signal–noise ratios demonstrated by distortion product otoacoustic emission testing. Similar studies must be carried out on adult patients to see if a clinical hearing impairment develops. The possible mechanisms that cause cochlear involvement and the effect of colchicine treatment on cochlear functions must be enlightened.

The effect of adenotonsillectomy on serum insulin like growth factors and the adenoid/nasopharynx ratio in pediatric patients: A blind, prospective clinical study

2012-02-01

Abstract: Objectives: Obstructive adenoid and tonsillar hyperplasia may present with retardation of growth. An adenoid–nasopharynx (A/N) ratio determined by means of lateral cephalometric radiographs has long been used as a diagnostic tool in the assessment of adenoid size. This study was designed to investigate the effect of adenotonsillectomy on insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels and correlation between A/N ratio and IGF-I and IGFBP-3 levels.Methods: Patients (n=48) that had been operated on our clinic with a diagnosis of adenotonsillar hypertrophy between July 2009 and January 2010 were included in the study. The routine ear–nose and throat examination was done in all patients. Blood samples were taken, and lateral cephalometric radiographs were obtained preoperatively and repeated at 6–9 months (mean 7.2±1.0mo) following tonsillectomy and adenoidectomy. The chemiluminescent enzyme-linked immunosorbent method was used to IGF-I and IGFBP-3 levels. Each cephalometric radiograph was evaluated by a blinded radiologist. The A/N ratio was calculated using the Fujioka method.Results: When the preoperative and postoperative results were compared, a statistically significant increase in serum IGF-I and IGFBP-3 and a decreased A/N ratio were found. However, although correlation between the Δ(preoperative−postoperative difference) IGFBP-3 and ΔA/N ratio was 40%, it was not statistically significant. Additionally, no statistically significant correlation between the ΔIGF-I and ΔA/N ratio was found.Conclusions: The results of the present study indicate that adenotonsillectomy could result in the relief of nasopharyngeal obstruction and have a positive effect on growth in children by decreasing the A/N ratio and increasing IGF-I and IGFBP-3. There was no correlation between the ΔA/N ratio and ΔIGF-I and ΔIGFBP-3 levels.

Socio-demographic factors associated with caustic substance ingestion in children and adolescents

2012-02-01

Abstract: Objective: Caustic substance ingestion is a public health issue in some underdeveloped countries. Published information on socio-demographic factors related to this problem is scarce. The aim of this study was to evaluate the association of socio-demographic factors with caustic ingestion in children.Methods: Design: case-control study. Cases were children with caustic substance ingestion who were attended to during 2006 (n=94) at a pediatric referral hospital in Guadalajara, Mexico; the controls were a random sample of children who were hospitalized or seen as outpatients in the same pediatric referral hospital (n=641). The socio-demographic variables were studied using a validated questionnaire (Children Nutrition Organization Survey). Statistics: OR, 95% CI and logistic regression.Results: Mean age of the cases was 3.2 years (SD 2.4) and 37.2% of cases were girls. Caustic ingestion occurred at home in 63.8% of cases and at a relative's home in 23.4% of cases. Alkaline products were ingested by 85.1%; containers had no warning labels in 72.3% of cases and no childproof safety caps in 92.6% of cases. The socio-demographic variables associated with caustic ingestion included higher family income, lower educational level of the mother, higher proportion of fathers working as independent professionals, extended family, mother's age <30 years, and mother working outside the home.Conclusions: The observed family risk profile for caustic ingestion was higher family income, young working mother with low educational level, father working as independent professional, and extended family.

Auditory brainstem implant outcomes and MAP parameters: Report of experiences in adults and children

2012-02-01

Abstract: The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (CI). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention.Objective: The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center.Methods: Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate.Results: The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300μs. Free-field thresholds with warble tones varied from very soft auditory sensation of 70dBHL at 250Hz to a pure tone average of 45dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores.Conclusion: We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist.

Prevalence of GJB6 mutations in Chinese patients with non-syndromic hearing loss

Peiwei Chen, Hui Chen, Siqing Fu, Guanming Chen, Jiashu Dong — 2012-02-01

Abstract: Objective: To investigate the distribution of GJB6 mutations in Central Chinese population with non-syndromic hearing loss.Method: Totally 655 hearing impaired patients in Hubei province of China were screened for del(GJB6-D13S1830) deletions by using multiplex PCR and sequencing of GJB6 whole coding region.Result: The del(GJB6-D13S1830) and other mutations in GJB6 gene were not observed in our study cohort.Conclusion: The results suggest that GJB6 mutations is not a common cause among Central Chinese population and screening for the mutations of GJB6 can be ranked as unconventional deaf gene test for this population.

Spectrum of GJB2 (Cx26) gene mutations in Iranian Azeri patients with nonsyndromic autosomal recessive hearing loss

2012-02-01

Abstract: Objective: Hereditary hearing impairment is a genetically heterogeneous disorder. In spite of this, mutations in the GJB2 gene, encoding connexin 26 (Cx26), are a major cause of nonsyndromic recessive hearing loss in many countries and are largely dependent on ethnic groups. The purpose of our study was to characterize the type and prevalence of GJB2 mutations among Azeri population of Iran.Methods: Fifty families presenting autosomal recessive nonsyndromic hearing loss from Ardabil province of Iran were studied for mutations in GJB2 gene. All DNA samples were screened for c.35delG mutation by ARMS PCR. Samples from patients who were normal for c.35delG were analyzed for the other variations in GJB2 by direct sequencing. In the absence of mutation detection, GJB6 was screened for the del(GJB6-D13S1830) and del(GJB6-D13S1854).Result: Thirteen families demonstrated alteration in the Cx26 (26%). The 35delG mutation was the most common one, accounting for 69.2% (9 out of 13 families). All the detected families were homozygous for this mutation. Two families were homozygous for delE120 and 299–300delAT mutations. We also identified a novel mutation: c.463–464 delTA in 2 families resulting in a frame shift mutation.Conclusion: Our results suggest that c.35delG mutation in the GJB2 gene is the most important cause of GJB2 related deafness in Iranian Azeri population.

Congenital aural atresia: Bone-anchored hearing aid vs. external auditory canal reconstruction

Sarah Bouhabel, Pierre Arcand, Issam Saliba — 2012-02-01

Abstract: Objective: To compare the audiologic outcome and feasibility of bone-anchored hearing aid (BAHA) and external auditory canal reconstruction (EACR) surgeries in pediatric patients presenting a congenital aural atresia (CAA).Methods: A retrospective chart review of 40 patients operated in our tertiary pediatric care center between 2002 and 2010 was performed. 20 patients underwent EACR, whereas another 20 patients were implanted with a BAHA device. Air conduction (AC), bone conduction (BC), pure tone average (PTA) and speech discrimination score (SDS) were compared preoperatively, and hearing gain (HG) postoperatively at 6 and at 12 months at frequencies of 500, 1000, 2000 and 4000Hz. Operative time, complications and associated microtia were documented as well. EACR patients were graded retrospectively upon Jahrsdoerfer's classification.Results: Preoperative AC were significantly different between groups, at 500, 1000 and 2000Hz but not at 4000Hz. BAHA group compared postoperatively to EACR group showed significantly a superior HG of 46.9±7.0dB (p<0.001) and of 39.8(7)±7.2(6.9)dB (p<0.001) at 6 months and at 1 year, respectively.Moreover, aided air thresholds from the EACR group revealed an audiologic status similar to those of the BAHA group patients, at 6 months and one year postoperatively. Both groups had a similar evolution of their BC, as well as of the incidence of complications. We report one case of transient facial paralysis in the EACR group. Total operative time is significantly lower (p<0.001) for a BAHA implantation (56±21min) than for EACR surgery (216±174min). No preoperative or postoperative correlation (Pearson correlation test; p>0.05) was found between patient's Jahrsdoerfer's score and their audiologic outcome. HG does not seem to be influenced by the presence of microtia.Conclusion: EACR, although constituting an attractive option, does not give acceptable results alone. It can however, when combined to conventional air conduction hearing aids, provide excellent audiologic outcomes comparable to BAHA. BAHA implantation is a reliable, safe and efficient therapeutic option that allows a significantly better audiologic outcome when compared to unaided EACR for patients with CAA.

Myringoplasty in children with cleft palate and craniofacial anomaly

Monika Knapik, Issam Saliba — 2012-02-01

Abstract: Objectives: Analyze the anatomical and audiological success rates of myringoplasty in children with craniofacial anomaly, cleft palate and compare them to a control group.Methods: Retrospective review of medical records for all children who underwent myringoplasty between 1997 and 2007. The following data was recorded: sex, age, perforation side, size, location and etiology, surgical approach, type of myringoplasty, graft material, season of surgery, preoperative status of the operated and contralateral ear, history of previous otologic surgery, and adenoidectomy or tonsillectomy.Results: Myringoplasty outcomes of 22 craniofacial anomaly patients (15/22 were cleft palate patients) were compared to 144 controls. Children in the craniofacial anomaly group demonstrated a tendency towards surgery at an older age. Children in the craniofacial anomaly and cleft palate groups had a significant positive history of previous otologic procedures to both operated and contralateral ears. Peroperative subannular ventilation T-tubes were more frequently recorded in patients with craniofacial anomaly than patients in the control group. The craniofacial anomaly, cleft palate and control group had comparable mean preoperative and postoperative ABG and their ABG improvement was statistically significant. Children with craniofacial anomaly, cleft palate and control group shared similar anatomical and audiological success rates (ABG<20dB) at 6, 12 and 24 months.Conclusions: Although children in the craniofacial anomaly and cleft palate groups are predisposed to middle ear disease, their disease responds well to surgical intervention. Their audiological and anatomical success rates were equivalent to the ones observed in the control group. In light of our results, we recommend that myringoplasty in children with craniofacial anomaly and cleft palate be performed after the age of 12.

The laryngeal mask in infants and children: What is the cuff pressure?

Bryan Schloss, Julie Rice, Joseph D. Tobias — 2012-02-01

Abstract: Background: Unintended hyperinflation of the cuff of a laryngeal mask airway (LMA) has been associated with increased airway morbidity and postoperative pain. While the manufacturers recommend a cuff pressure of less than 60cmH2O, in usual clinical practice, there is no method used to determine intracuff pressure of an LMA. The purpose of this prospective quality assurance study is to evaluate the incidence of LMA hyperinflation and excessive intracuff pressure in a busy tertiary care pediatric hospital.Methods: There was no change dictated in clinical practice for these patients. Per our usual practice, the LMA was removed from the package and inserted with the cuff partially inflated. The cuff was further inflated as needed to ensure a seal during positive pressure ventilation to a peak inflating pressure of 20–25cmH2O. During the first 30min of the case, the pressure in the cuff of the LMA was measured using a hand held manometer. Additional data collected included the patient's demographic data (age, weight, and gender), the size of the ETT, and whether nitrous oxide was in use.Results: Of the 200 subjects in the current study, 106 had an LMA cuff pressure ≥60cmH2O (53%). Patients who were greater than 8 years of age had significantly higher average cuff pressures and significantly more LMAs with an intracuff pressure ≥60cmH2O when compared to patients younger than 4 years of age and patients 4–8 years of age. Similarly, larger LMAs were found to have significantly higher intracuff pressures.Conclusions: Using current clinical practice to inflate the cuff of the LMA, a significant percentage of pediatric patients have an intracuff pressure greater than the generally recommended upper limit of 60cmH2O. Risk factors identified in our study included age of the patient and the size of the LMA.

Prevalence of the 35delG mutation in deaf South Brazilian infants submitted to cochlear implantation

2012-02-01

Abstract: Objective: Determine the prevalence of 35delG mutation in GJB2 gene in patients with prelingual deafness of no defined etiology whose underwent cochlear implant in the Otolaryngology Department at the Hospital de Clínicas de Porto Alegre and compare the speech recognition index using an open-set of sentences according to the presence or absence of the 35delG mutation.Methods: Cross-sectional study nested in a cohort. Were analyzed 37 patients with indeterminate etiology for deafness that underwent to cochlear implant. DNA was extracted and the mutations were studied using Polymerase Chain Reaction followed by gene sequencing.Results: The prevalence of 35delG mutation was 11%. The speech recognition index was 72% in the group with 35delG mutation, and 30% in the group without this mutation (p>0.05).Conclusions: Prevalence of 35delG mutation in this study confirmed findings in the Brazilian literature. There was a clinically significant difference in hearing performance in patients with 35delG. Absence of statistical significance in this result might be attributed to the small number of patients with 35delG in our sample.

Management of children with inherited mild bleeding disorders undergoing adenotonsillar procedures

2012-02-01

Abstract: Objective: To evaluate the incidence of perioperative bleeding among children with mild bleeding disorders who underwent adenotonsillar surgery in our hospital and were treated with our perioperative bleeding prophylaxis protocol.Methods: Retrospective chart review was aimed at determining the perioperative bleeding rate in children with mild bleeding disorders subjected to our prophylactic protocol while undergoing adenotonsillar procedures. Low von Willebrand factor (LVWF), unspecific platelet function disorders (UPFD) and mild factor VII deficiency were considered as mild bleeding disorders. The protocol utilizes intravenous desmopressin, tranexamic acid, NSAID avoidance, and overnight observation.Results: Between 2004 and 2009, 44 children with mild bleeding disorders underwent adenotonsillar procedures in our hospital and were treated with the protocol. One patient (LVWF+UPFD) developed perioperative bleeding (2.3%).Conclusions: It is possible to obtain low rates of perioperative bleeding in children with mild bleeding disorders undergoing adenotonsillar procedures, provided there is a well-timed diagnosis and an adequate prophylaxis protocol. We believe that further efforts must be directed at preoperative diagnosis of mild bleeding disorders to ensure safer surgeries.

Nonlipidized juvenile xanthogranuloma: An unusual variant with a potential diagnostic pitfall

2012-02-01

Abstract: Juvenile xanthogranuloma (JXG) is a histiocytic inflammatory disorder that can present different histologic patterns. Classic JXG consists of sheets of foamy histiocytes and numerous multinucleated Touton giant cells. Nonlipidized JXG (NJXG) is one of the unusual variants of JXG, consisting of a diffuse monomorphic infiltrate of mononuclear histiocytes, suggesting an aggressive or malignant tumor due the high mitotic index. However, NJXG behaves clinically as classic JXG. We present an unusual case of a 6-year-old boy who presented an exophytic ulcerated nodule on the lower lip diagnosed as NJXG. The boy is currently well without recurrence three years after surgical excision.

Acoustic brainstem implant in a post-meningitis deafened child—Lessons learned

Vanessa Y.J. Tan, Vishal Deepak D'Souza, Wong Kein Low — 2012-02-01

Abstract: We report a case of a deafened child with advanced labyrinthitis ossificans resulting from meningo-encephalitis. She received a cochlear implant in the right ear, following a drill-out procedure. Post-implant hearing outcomes were satisfactory initially, but deteriorated over time as a result of partial electrode migration. The child subsequently received a left auditory brainstem implantation with improvement of hearing outcomes. Post-operatively, a sub-dural hematoma developed not on the side of the operation but on the opposite side. Simultaneous use of the cochlear implant on one side and the acoustic brainstem on the other, aggravated the non-auditory side effects of the ABI and compromised its potential for optimal hearing results.

Is there any correlation between allergy and adenotonsillar tissue hypertrophy?

Dong-Hee Lee — 2012-02-01

I read with great interest the article titled “Is there any correlation between allergy and adenotonsillar tissue hypertrophy?” by Sadeghi-Shabestari et al. . They concluded that allergy is an important risk factor for pediatric adenotonsillar hypertrophy (ATH). Their evidence was that 70% of children with ATH had positive skin prick test (SPT) but only 10% of children without ATH had positive skin prick test. They also reviewed some literature presenting that adenoid hypertrophy is more prevalent in children with allergic rhinitis.

Re: Is there any correlation between allergy and adenostonsillar tissue hypertrophy?

Yalda Jabbari Moghaddam, Mahnaz Sadeghi Shabestari — 2012-02-01

With thanks for your comments about the our article titled “Is there any correlation between allergy and adenostonsillar tissue hypertrophy?” If you notice to our method, our inclusion criteria was children with adenotonsillar hypertrophy, but we matched age in both case and control groups. So children in the range of 1–14 years who had adenotonsillar hypertrophy (Randomly) included in our case and control group and there is not any age selection biase.

Erratum to “Activity of soluble aminopeptidase A and dipeptidyl peptidase IV and membrane-bound aminopeptidase B and pyroglutamyl peptidase I in adenoid hyperplasia, tonsillar hyperplasia and chronic tonsillitis” [Int. J. Pediatr. Otorhinolaryngol. 75 (November (11)) (2011) 1399–1403]

2012-02-01

We have detected a major mistake, surely provocated by ourself: In the list of authors,

Calendar of Events

2012-02-01

Guide for Authors

2012-02-01