Rate of eradication of group A beta-hemolytic streptococci in children with pharyngo-tonsillitis by amoxicillin and cefdinir

Background

Cephalosporins were found to be more effective than penicillins in the eradication of group A β-hemolytic streptococcal (GABHS) from tonsillar tissues. This study investigated the effect of amoxicillin and cefdinir therapies on the rate of eradication of GABHS from the tonsils of children with acute pharyngo-tonsillitis (PT).

Patients and methods

Of 50 children suffering from PT 25 were treated with amoxicillin (40 mg/(kg d) or 250 mg every 8 h) and 25 with cefdinir (14 mg/(kg d) or 600 mg once a day) for 10 days. Pharyngo-tonsillar cultures were obtained from all children before treatment and on the 1st, 2nd, 3rd, 4th, 7th, and 12th days.

Results

GABHS was eradicated more rapidly from children treated with cefdinir as compared to those receiving amoxicillin. A smaller number of patients with GABHS were found in those treated with cefdinir as compared to amoxicillin throughout the treatment period. Eradication of GABHS from 68% (8 of 25 patients) was noted in those treated with cefdinir after 2 days and those treated with amoxicillin after 4 days. The differences between the number of patients who had a bacteriological cure between those receiving cefdinir to those getting amoxicillin was statistical significant at day 4 (32% vs. 8%). At the end of therapy GABHS was recovered from 5 (20%) and 2 (8%) of the patients. The group that received cefdinir, had a more rapid reduction in fever on the first after initiation of therapy as compared to those receiving amoxicillin. The fever reduction in those receiving cefdinir occurred a day earlier than in those getting amoxicillin.

Conclusions

Fever was reduced and GABHS was eradicated more rapidly from children treated with cefdinir as compared to amoxicillin.     

Congenital external auditory canal stenosis and partial atretic plate

Objectives

To report outcomes of surgery for severe congenital external auditory canal (EAC) stenosis with or without partial atretic plate (PAP).

Design

Retrospective review.

Subjects

Thirteen patients (18 ears) had surgery for severe EAC stenosis with (n = 10, 56%) or without PAP (n = 8, 44%). Indications included severe stenosis with hearing loss, cerumen impactions, and/or canal cholesteatoma. Mean age = 7.8 years (range 0.4-19.9 years). Mean follow up = 5.2 years (range 0.4-10.0 years).

Setting

Tertiary care children's hospital.

Interventions

Nineteen endaural canaloplasties were performed in 17 ears (2 revisions). There was one post-auricular approach. Fifteen tympanoplasties were performed in 13 ears (2 revisions). PAP was reconstructed with drilling to enlarge the bony annulus and fascia grafting to enlarge the tympanic membrane in 10 (56%) ears.

Outcome measures

Patency of EACs; otologic findings; pure tone averages (PTA); complications.

Results

All (100%) EACs had improved patency (≥4 mm). Findings included canal cholesteatoma (2/18, 11%), ossicular fixation (4/18, 22%), stapes abnormality (2/18, 11%), and incudostapedial discontinuity from cholesteatoma (1/18, 6%). Mean preoperative PTA = 38.7 dB HL (range 60-20 dB HL). Mean post-operative PTA = 23.6 dB HL (range 50-6.7 dB HL). Audiologic results were significantly better for cases without PAP (p < .01) and without ossicular fixation (p < .01). There were seven minor and no major complications.

Conclusions

Endaural canaloplasty is safe and effective for providing patent EACs and hearing improvement for severe congenital EAC stenosis. However, since hearing outcomes were worse for cases with PAP and ossicular fixation, alternatives such as hearing aids or BAHA^® may be considered.     

Plain radiographic evaluation of the nasopharynx: Do raters agree?

Background

Subjective plain radiographic evaluation of the nasopharynx has been a widely adopted technique. Although it has its own limitations, its ease of interpretation and simplicity are some of its advantages.

Aim

To investigate the reliability, using kappa, in subjectively reporting plain nasopharyngeal radiographs in children with symptoms suggestive of enlarged adenoids.

Methods

This was a retrospective study of the clinical records, and plain X-rays of the nasopharynx of paediatric patients with clinical features of adenoid hypertrophy in a Nigerian Tertiary Health Institution from January 2008 to December 2008.

Results

Fifty-one children with a mean age of 3.4 years; standard deviation of 2.772 was studied. They had an age range of 2 months to 12 years. Most (66.6%) of the children studied were in the age bracket 0-4 years. The inter-rater reliability between the two Otolaryngologists, and that between an Otolaryngologist and a Radiologist using kappa statistics were 0.6696, 95% CI (0.5035-0.8357; p < 0.05) and 0.8182, 95% CI (0.7073-0.9291; p < 0.05) respectively. While the kappa intra-rater reliabilities for the two Otolaryngologists were 0.6931, 95% CI (0.5473-0.8389) and 0.9591, 95% CI (0.9033-1.000).

Conclusion

There was a high level of agreement among trained raters, in subjectively interpreting plain nasopharyngeal radiographs in children with suspected adenoidal obstruction.     

Impact of oseltamivir treatment on the incidence and course of acute otitis media in children with influenza

Objective

Acute otitis media (AOM) is the most common complication of pediatric influenza, and imposes a substantial health care burden. We examined the influence of oseltamivir treatment on the incidence and course of AOM in children with influenza.

Methods

In the original study, 695 children 1-12 years who presented within 48 h of the onset of influenza-like symptoms were randomized to oseltamivir (2 mg/kg) or placebo given twice daily for 5 days. AOM was assessed at enrollment and days 3, 6 (±1), 10 (±2) and 28 (±7). AOM was clinically diagnosed by the participating primary care provider, supported by tympanometry when possible. We performed a retrospective analysis of those participants with laboratory-confirmed influenza (LCI). Assessments included the incidence and clinical course of new AOM cases.

Results

In all, 452 children had LCI; 217 received oseltamivir and 235 placebo. AOM was diagnosed on or after study day 3 at a significantly lower frequency in the oseltamivir versus placebo group (12.4% versus 21.7%; relative risk [RR]: 0.57 [95% CI: 0.37, 0.88], respectively). Treatment effects were greatest for children 1-2 years (RR = 0.42 [95% CI: 0.20, 0.89]) and 3-5 years (RR = 0.45 [95% CI: 0.19, 1.04]), in whom the incidence of AOM was highest.

Conclusions

Oseltamivir treatment significantly reduces the emergence of new AOM infections in children with LCI; effects are most pronounced in those <5 years. Clinical trial number: WV15758.     

Supraglottoplasty outcomes in relation to age and comorbid conditions

Objective

To determine if age and comorbid conditions effect outcomes in children undergoing supraglottoplasty for severe laryngomalacia.

Design

Retrospective study.

Setting

Urban tertiary-care children's hospital.

Patients

Children undergoing supraglottoplasty for severe laryngomalacia between February 2004 and July 2008. 56 patients were identified.

Outcome measures

Persistence of upper airway obstruction, revision surgery (supraglottoplasty), and additional surgery (tracheostomy).

Results

33/56 (58.9%) patients had no comorbid conditions and 23/56 (41.1%) patients had comorbid conditions. In noncomorbid patients, 36.4% of those less than 2 months of age at the time of surgery required revision supraglottoplasty, compared to 5.3% of patients between 2 and 10 months (p < 0.05). Compared to the 2-10-month age group, there was a significantly higher percentage of patients with comorbid conditions in the >10-month group (32.1% vs. 79%, p < 0.01). Patients with comorbid conditions were diagnosed at a significantly later age than those without (6 mo vs. 2 mo, respectively), and had significantly higher rates of revision supraglottoplasty (47.8% vs. 18.2%) and tracheostomy (39.1% vs. 0.0%). 70% of children with neurological conditions required revision surgery, with 60% requiring tracheostomy. The revision surgery and tracheostomy rates were significantly higher compared to the noncomorbid group (p < 0.01 and p < 0.0001). Children with cardiac conditions had a higher rate of tracheostomy than noncomorbid children (30% vs. 0%, p < 0.01). 16.7% of children with genetic conditions required supraglottoplasty, and none required tracheostomy.

Conclusions

In noncomorbid patients, those undergoing supraglottoplasty less than 2 months of age had a significantly higher rate of revision supraglottoplasty. Patients with neurologic and cardiac comorbidities require tracheostomy at a significantly higher rate than noncomorbid patients.     

Diagnosis and treatment of pediatric vallecular cysts and pseudocysts

Objective

To review the experience at a children's hospital diagnosing and treating vallecular cysts.

Secondary objectives

To determine if cyst type, operative mode, or ages are risk factor(s) for recurrence.

Methods

Chart review of eleven children with vallecular cysts and pseudocysts from 1997 to 2009.

Results

The most common presenting symptoms were stridor (8/12, 67%), respiratory distress (7/12, 58%), and feeding difficulties (4/12, 33%). Symptoms of gastroesophageal reflux disease were present in 67% of patients and 17% carried a concurrent diagnosis of laryngomalacia. Eleven of twelve patients required operative intervention, the majority of which were transoral endoscopic procedures. Three patients (3/11, 27%) had recurrences. Two of these patients required only a second procedure, but one patient required multiple procedures. Fifty percent (2/4) of the patients 2 years or older experienced a recurrence, whereas only 14% (1/7) of the patients less than 2 years old had a recurrence, a difference which was not statistically significant (p = 0.49). Pseudocysts tended to recur more frequently than vallecular cysts. (p = 0.13). Surgical approach (marsupialization versus total excision) did not affect recurrence rate. One patient with a small, asymptomatic cyst was observed and continues to be symptom-free. There were no surgical complications.

Conclusions

Vallecular cysts and pseudocysts are rare congenital lesions of the upper aerodigestive tract. Vallecular pseudocysts tended to recur more than vallecular cysts in our series. Surgery is the treatment of choice for symptomatic patients; smaller cysts may be followed closely.     

Post-operative bleeding is less after partial intracapsular tonsillectomy than bipolar total procedure

Objective

To compare bleeding after partial intracapsular tonsillectomy (PIT) and bipolar diathermy tonsillectomy (BDT).

Design

Retrospective chart review.

Setting

Stollery Children's Hospital, tertiary pediatric referral centre.

Patients

All children (≤17 years of age) who had tonsillectomy. Patients who had incomplete information or less than 2-weeks follow-up were excluded.

Main outcome measure

(1) Post-tonsillectomy bleeding, (2) other data collected included demographics, length of follow-up, indication(s) for surgery, other procedures performed, and co-morbidities.

Results

Over a 4.5-year period 677 patients (333 BDT, 344 PIT) were identified in our search, and 77 (38 BDT, 39 PIT) were excluded. The mean age was 7.7 ± 3.8 years in the BDT group and 6.5 ± 3.2 years in the PIT group. Sex distribution was similar in the 2 groups (chi square p = 0.61). Twenty (6.8%) BDT patients experienced post-tonsillectomy bleeding, compared to three (0.98%) of PIT patients (p = 0.0001, 95% CI 1.52-2.18, OR = 7.32). Over 3 times as many PIT patients (153) had co-morbid conditions than BDT patients (44); this was statistically significant (chi square p < 0.00001, 95% CI 1.78-2.38).

Conclusion

PIT results in significantly less post-tonsillectomy bleeding than BDT. These findings favor partial over total techniques with respect to reducing this important complication.     

The role of matrix metalloproteinases in recurrent tonsillitis

Objective

The aim of this study was to investigate the status of matrix metalloproteinases (MMP-2, MMP-7, MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) due to dysregulated turnover of connective tissue matrices in children with recurrent tonsillitis (RT).

Methods

Forty-four patients with RT were enrolled in the study. All patients with RT were graded according to the hypertrophy degree of the tonsillar tissue from grade I to grade IV. Patients with grade I tonsillar hypertrophy and grade II tonsillar hypertrophy were accepted as group A, patients with grade III tonsillar hypertrophy and grade IV tonsillar hypertrophy were accepted as group B Tonsillectomy was performed via the usual dissection-snare method. Tonsillar specimens of superficial and core region were evaluated for MMP-2, MMP-7, MMP-9 and TIMP-1 analysis.

Results

There was no statistical significance according to the MMP-2, MMP-7, MMP-9 and TIMP-1 activity of superficial part and core regions in both groups individually, MMP-9 level of both the superficial and core regions in group B had statistical significant higher results than group A (p = 0.026, p = 0.06 respectively). MMP-7 level of the superficial part in group B patients also had statistical significant higher results than group A (p = 0.025). However, there was no statistical difference found between superficial and core region MMP-2 and TIMP-1 levels of group A and group B. Related to this, balance between MMP-7-9 and TIMP-1 activities tended to slip MMP-7 and MMP-9 sides with increased tonsillar grade.

Conclusions

Results from this study suggest that the presence of MMPs in tonsil tissue consolidates the involvement of degraded extracellular matrix proteins in the pathophysiology of chronic tonsillitis. MMPs activity showed diffuse dissemination in the tonsillar tissue and especially MMP-9 and MMP-7 are the main promoters of the extracellular matrix that responded to inflammatory changes in the tonsillar tissue. Further studies are needed concerning the possible efficiency of selective MMP inhibitors on tonsillar tissue.     

Functional endoscopic sinus surgery—A retrospective analysis of 115 children and adolescents with chronic rhinosinusitis

Objective

Functional endoscopic sinus surgery (FESS) is not frequently performed in children. The aim of our retrospective analysis was to determine symptoms, surgical extent, complications and outcome of operated children.

Methods

For a period from 1994 to 2004 the clinical records of the Department of Otorhinolaryngology, LMU Munich, Germany, were screened for pediatric FESS procedures. Subsequently, a retrospective chart review was performed in all cases. For assessment of outcome, symptom- and quality of life-related questionnaires were sent out to all patients.

Results

115 children had a FESS procedure due to CRS, 77 were boys and 38 girls. The response rate of the questionnaires was 64% (73 of 115); the mean follow up of these was 5.4 (±1.8) years. 76% of the patients reported an improvement of their chief symptoms and 71% of their general quality of life. The overall quality of life had improved significantly (p < 0.01) on VAS. In CRS patients nasal obstruction was completely relieved in 62.3%, facial pain in 65.5% and postnasal drip in 72.5%. Improvement of primary nasal symptoms (PNS) of CRS in patients with CF, asthma or allergies as well as in youngsters who had started or continued to smoke 35 out of 73 (48%) was significantly less.

Conclusions

Self-assessment after FESS showed in 76% improvement of chief symptoms in children with CRS. Besides known negative prognostic factors for long-term outcome as CF, asthma, nasal polyps, allergies and previous surgery, smoking was correlated with less favourable improvement.     

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

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.     

Microdebrider resection of acquired subglottic cysts: Case series and review of the literature

Objective

Pediatric subglottic cysts (SGC) are a rare but curable cause of respiratory distress. Previous studies have described microsurgical marsupialization and carbon dioxide laser ablation to treat SGC. In this report we describe our experience performing endoscopic resection of SGC with a laryngeal microdebrider.

Methods

A retrospective review of all patients who underwent endoscopic resection of SGC with a laryngeal microdebrider between January 2004 and October 2008 at a tertiary care children's hospital was performed.

Results

Eight patients with one or more SGC were treated with microdebrider resection. All patients presented with stridor or respiratory distress, were born prematurely (mean gestational age 27 weeks), and had been intubated for between 1 and 91 days (mean 33 days). In all cases, suspension laryngoscopy was performed under general anesthesia. The SGC was visualized using a 4.0-mm Hopkins rod telescope and excised using a 2.9-mm diameter laryngeal microdebrider (skimmer blade). No patient experienced significant bleeding following excision. Mean surgical time was 36 min (range 26-59 min). Seven of eight patients (87.5%) were extubated by post-operative day 1. All patients had a follow-up bronchoscopy within 10 weeks. Six of eight patients (75%) had a single treatment, while two patients (25%) required a second resection. One patient had a symptomatic recurrence (12.5%). All eight patients are now free of disease with a mean follow-up of 21 months. No patient developed clinically significant scarring or subglottic stenosis.

Conclusions

The laryngeal microdebrider offers a safe and effective way to remove SGC with a low recurrence rate.     

The effects of desflurane and sevoflurane on the peri- and postoperative bleeding of adenotonsillectomy patients

Objective

To compare the effects of, volatile anesthetics, desflurane and sevoflurane on intra-operative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy.

Material and method

Totally 40 children (14 girl and 26 boys) aged between 2 and 16 years were included in this prospective randomized double-blind clinical trial. The patients underwent conventional cold tonsillectomy and curettage adenoidectomy under general anesthesia. For the maintenance of anesthesia, the patients were randomized into two groups; desflurane group and sevoflurane group, each including 20 subjects. Desflurane concentration was set between 4% and 6% (0.7-0.9 MAC), whereas sevoflurane concentration was set between 2% and 2.5% (0.7-0.9 MAC). The amount of perioperative bleeding in milliliters was measured by using separate aspirator bags for each patient.

Results

Desflurane caused significantly lower amount of perioperative bleeding compared to sevoflurane (p = 0.03). No significant difference was observed between the two groups in terms of age, body mass index and operation duration, respectively (p = 0.20, p = 0.49, p = 0.07).

Conclusion

Desflurane, which is one of the volatile anesthetics, leads to a lower amount of intraoperative bleeding than sevoflurane during tonsillectomy and adenoidectomy operations.     

Endoscopic transsphenoidal approach versus microscopic approach in children

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.     

Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children

Objective

To analyse the efficacy of CO₂ laser arytenoidectomy in the management of bilateral vocal cord paralysis in children.

Methods

Retrospective series of 17 patients who underwent laser arytenoidectomy for bilateral vocal cord between 1995 and 2008 in a tertiary care institution. All patients had bilateral laryngeal paralysis, in isolation (n = 5) or associated with concomitant airway conditions (n = 12). All cases had anterior prolapse of the arytenoids with partial obstruction of the airway on inspiration. 12/17 patients (70.5%) were tracheotomy-dependant, 2/17 were in-extubatable, and 3/17 had severe airway limitation, effort dyspnea and poor sleep pattern. Main outcome measures were decannulation rate for patients with tracheotomy, occurrence of aspiration and quality of voice.

Results

The mean age was 2.8 years old. 9/12 patients with tracheotomy (75%) were decannulated with a median delay of 2 months (2 days to 18 months). Both of the intubated patients were extubated with a median delay of 36 h. One of the decannulated patients who re-presented with a residual dyspnea after the arytenoidectomy was improved by a further laser cordotomy. 2/17 patients (11.7%) had post-operative persistent aspirations (with pneumopathies in one case), 5/17 patients were dysphonic, 3 improved with speech therapy and 2 with intracordal lipoinjection.

Conclusions

Laser arytenoidectomy is effective for improving the breathing in children presenting with a bilateral vocal fold paralysis associated with obstructive arytenoid prolapse. Results are good as a first-line surgery or following laryngo-tracheal surgery. Voice outcomes are satisfactory. However, aspiration is a rare complication.     

Use of endocanalicular dacryocystorhinostomy with multidiode laser in children

Objective

To evaluate the clinical outcome and efficacy of endocanalicular laser dacryocystorhinostomy using a multidiode laser in cases unresponsive to medical therapy, probing or intubation of pediatric nasolacrimal duct obstruction.

Methods

Eight children with nasolacrimal duct obstruction were treated with a multidiode laser. The study was prospective, non-randomized, and noncomparative. The patients, 2 (25%) males and 6 (75%) females, ranged in age from 8 to 13 years (mean 11.25 ± 2.43). Surgery was performed under general anesthesia. All procedures were performed using a multidiode laser. The nasal passage was visualized with a 30° nasal video endoscope. In all cases, silicone stents were inserted. The main outcome measure was resolution or improvement of the epiphora and no major laser damage intranasally. Patients were followed for at least 6 months.

Results

The endocanalicular laser dacryocystorhinostomy failed in one of the 8 (12.5%) cases, which had been secondary to trauma. The others were due to primary nasolacrimal duct obstruction. External dacryocystorhinostomy was performed on the failed case. None of the cases with primary nasolacrimal duct obstruction had obstruction after the endocanalicular laser dacryocystorhinostomy operation.

Conclusions

Endocanalicular laser dacryocystorhinostomy using a multidiode laser appears to be an effective technique in cases unresponsive to medical therapy, probing or intubation of primary nasolacrimal duct obstruction.     

Endoscopic balloon dilatation of esophageal strictures in children

Aim of the study

To assess the efficacy and safety of endoscopic balloon dilatation of esophageal strictures in children.

Material and methods

Design: retrospective case series; population: 49 patients under 18 years of age referred to our center for esophageal strictures; treatment: endoscopic balloon dilatation; outcome parameters: residual dysphagia, weight gain, iatrogenic esophageal perforation, assessment of the esophageal lumen by endoscopy or esophagogram.

Results

The three main etiologies were esophageal atresia (49%; n = 24), corrosive injury (25%; n = 12), and epidermolysis bullosa (14%; n = 7), followed by a heterogeneous group of rarer causes (12%; n = 6). The number of dilatations ranged from 1 to 8 sessions per patient (median ± SEM: 2 ± 0.3). The length of the follow-up period ranged from 20 to 109 months (median ± SEM: 40 ± 4 months). Treatment was successful in 86% of cases (n = 42). Twelve percent of patients (n = 6) had a residual stenosis requiring surgery, and a further one still experienced swallowing difficulties requiring enteral nutrition via gastrostomy in spite of the absence of significant residual stricture. Results were less satisfactory in cases of corrosive injury than with other etiologies. Three esophageal perforations were observed (6% of patients; 2% of procedures). All were medically treated.

Conclusions

Endoscopic balloon dilatation is a simple, safe and efficacious treatment of esophageal strictures in children.     

Prolonged recovery after out-patient pediatric adenotonsillectomy

Objective

To determine variables predictive of recovery room times in pediatric outpatient adenotonsillectomy.

Study design

Retrospective case-control.

Methods

One-hundred ninety consecutive patients undergoing outpatient adenotonsillectomy at an ambulatory surgery center of a tertiary-care free standing pediatric hospital were grouped into upper and lower deciles of recovery room times. Twenty-one variables were analyzed to determine which variables are predictive of prolonged recovery time. Univariate and multivariate analyses were performed.

Results

Of the 190 patients, mean recovery room time was 103 min (SD 53.1), 22 patients were in the lower decile (mean recovery room time of 63 ± 6 min) and 17 patients were in the upper decile (155 ± 40 min, P < 0.0001). Of the 21 variables analyzed, post-anesthesia care unit (PACU) nursing staff was the only significant predictor of prolonged recovery room time. Compared with one PACU nurse, other nurses (N = 5) predicted a longer recovery time (OR = 10.8, 95% CI 2.0-59.5, P = 0.0017). This association remained significant when controlling for anesthesiologist and surgeon (OR = 8.8, 95% CI 1.5-50.9, P = 0.0072). There were no complications in any patients.

Conclusions

Recovery room times after outpatient adenotonsillectomy vary significantly (mean 103 min (SD 53.1), range 50-241 min). Of potential predictors, only the human factor (PACU nursing staff) was associated with prolonged recovery room times, independent of surgeon and anesthesiologist. Development of standardized protocols for nurses to use for discharge has the potential to increase throughput for adenotonsillectomy patients in an outpatient surgery center setting.     

The role of vascular endothelial growth factor in pediatric otitis media with effusion

Objectives

Vascular endothelial growth factor (VEGF) is a potent and critical inducer of angiogenesis and vascular permeability, and has been shown to play an important role in inflammatory events, together with hypoxia and inflammatory cytokines. VEGF messenger ribonucleic acid (mRNA) is expressed in the middle ear in an experimental animal model of otitis media with effusion (OME) and in patients with OME. However, the protein levels of VEGF in middle ear effusions (MEEs) are unknown and the role of VEGF in the pathogenesis of OME is unclear. The goals of this study were to determine the VEGF levels in MEEs and to investigate the role of VEGF in production of MEEs by comparing these levels with those of interleukin-8 (IL-8), endotoxin, and albumin.

Methods

Forty-six MEEs obtained from 33 children (24 boys, 9 girls) were used in the study. The mean age of the subjects was 6.3 years old (range, 1-12 years old). The patients underwent myringotomy and/or insertion of a ventilation tube for treatment of OME. After myringotomy, MEEs were collected with a Juhn Tym-Tap. The samples were divided into serous and mucoid types based on observation by the naked eye. After measuring the weight of the MEE, the sample was diluted with phosphate-buffered saline and frozen until use. The concentrations of VEGF and IL-8 in the MEEs were determined by enzyme-linked immunosorbent assays, endotoxin concentrations were measured by the Limulus Amebocyte Lysate test, and albumin levels were determined using an immunoturbidimetric assay.

Results

VEGF, endotoxin, IL-8, and albumin were detected in 100%, 89%, 98%, and 100% of the 46 MEEs, respectively. The concentrations of VEGF, endotoxin, and IL-8 were significantly higher in mucoid MEEs than in serous MEEs (p < 0.01), whereas there was no significant difference in the albumin concentration between mucoid and serous MEEs. The VEGF levels were positively correlated with those of endotoxin (R² = 0.17, p < 0.05) and albumin (R² = 0.65, p < 0.01) in mucoid MEEs, but not in serous MEEs.

Conclusions

Our results suggest that VEGF is produced in response to bacterial components such as endotoxin in the middle ear cavity and is associated with production of mucoid MEEs by increasing serum exudation and mucosal secretion.     

Eustachian tube function in patients with Meniere's disease

Objective

The aim of the present study was to clarify the relationship between Eustachian tube function and inner ear function, especially with respect to the hearing ability of patients with Meniere's disease.

Methods

Patients with Meniere's disease underwent nystagmic examinations and audiometric measurements, including hearing tests, tympanometry, and Eustachian tube function tests (sonotubometry). We compared the audiometric examination results of normal subjects to those of patients with Meniere's disease.

Results

Twenty-five percent of patients with Meniere's disease exhibited Eustachian tube dysfunction, but 92% displayed normal tympanometry findings. Their sonotubometry durations and amplitudes were not significantly different from those of normal subjects. However, the patients’ hearing level was significantly correlated to sonotubometry duration and amplitude. Our patients were classified according to the four stages of Meniere's disease: stage 1 (n = 9); stage 2 (n = 5); stage 3 (n = 8); and stage 4 (n = 2). The incidence of Eustachian tube dysfunction in these four groups of patients were 0% (0/9); 40% (2/5); 38% (3/8); and 50% (1/2), respectively.

Conclusion

Our study provides evidence demonstrating that treatment of Eustachian tube dysfunction may be useful in preventing the hearing of Meniere's patients from becoming worse.     

Aerodynamic and acoustic assessment in children following airway reconstruction: An assessment of feasibility

Objective

The purpose of this study was to examine the feasibility of conducting aerodynamic and acoustic assessment in children following airway reconstruction. Underlying etiologies, co-morbidities and age related factors can present challenges for meaningful instrumental data collection in this population.

Methods

A chart review of 100 children who were seen for a complete voice evaluation at the Center for Pediatric Voice Disorders at the Cincinnati Children's Hospital Medical Center was conducted. Children who completed full or partial aerodynamic and acoustic protocols were identified. Data regarding the ability to participate in the assessment was tabulated, and vowel samples taken from the acoustic data were subjected to signal type classifications (e.g., Type I, II, III).

Results

Fifty-three children met the inclusion/exclusion criteria of the chart review. Of those children, 58% (n = 31/53) were able to complete the full acoustic and aerodynamic protocols without any modification. In regards to the aerodynamic protocol alone, 64% (n = 34/53) could complete protocol. In regards to the acoustic protocol alone, 75% (n = 40/53) could complete the entire acoustic protocol without any modification. There were 32% (n = 17) who provided a Type I acoustic signal which was appropriate for measurement of F₀. There was a significant correlation between age and ability to complete the protocol for both the aerodynamic (p = .007) and acoustic (p = .004) protocols.

Conclusions

This study demonstrated that a majority of children were capable of completing aerodynamic and acoustic protocols. A significant proportion of children in this study had severe dysphonia, precluding the ability to extract fundamental frequency. Although aerodynamic and acoustic measures are feasible for many patients in this population, the severity of dysphonias observed in these patients causes the use of these measures to be limited in some cases for documenting behavioral and surgical outcomes measures.