Influence of size and site of perforation on fat graft myringoplasty

Objectives

In this retrospective study, we investigated the outcomes of fat graft myringoplasty (FGM) in different perforation sizes and locations. The outcomes were evaluated in terms of closure rates and audiological test results.

Methods

The study population included 172 patients who were operated between 2007 and 2012. 161 had unilateral and 11 had bilateral chronic otitis media; and 183 ears were operated by FGM. The patients were divided into two groups based on size as small and larger (size of ≤30 of TM was defined as small perforations, and size of >30% TM was defined as a medium–large perforations); and two groups based on location of perforation [anterior and other (non-anteriorly located)]. Patients’ follow-ups were performed between 1 and 5 years; and follow-up examinations were performed with otoendoscopy. Air conduction (AC) thresholds and air-bone gap (ABG) were evaluated both preoperative year and postoperative 1st year.

Results

The total perforation closure rate was 84.7%. In this study, we found out that FGM is effective closing medium–large perforations just as small perforations with the success rate of 79.1% and 86.4% respectively (p > 0.05). When audiological outcomes were evaluated in both groups, AC values got lower and ABG values improved postoperatively, whereas regarding AC thresholds and ABG improvement among the size groups, patients with small perforations had significantly better postoperative results (p < 0.05). In terms of perforation location, closure rates were 85.2% in anteriorly perforations and 84.5% in the other located perforations. Audiological outcomes demonstrated that in both groups, AC values got lower and ABG values improved postoperatively; and hearing results were not different in anteriorly located perforations and other locations.

Conclusion

Fat graft myringoplasty (FGM) may be used in all small and medium–large, and anteriorly and other located perforations. Although hearing improvement was detected in each of the small; and medium–large perforations; patients with small perforations had more satisfied audiological outcome than medium–large perforations.     

Low-tone air-bone gaps after endolymphatic sac surgery

Objectives

We detected chronic low-tone air-bone gaps (LTABGs) in some patients with Meniere's disease after endolymphatic sac surgery. The aim of the present study was to elucidate the mechanism of LTABGs after endolymphatic sac surgery.

Methods

We investigated 50 patients with Meniere's disease, who underwent surgery more than two years prior. LTABGs were defined as the three-tone-average = 20 dB formulated by (a + b + c)/3, where a, b, and c are ABGs at 0.25, 0.5, and 1 kHz, respectively (ABG ±). The intra-operative finding was focused on identifying operculum (OPC ±).

Results

The ratio of post-operative ABG(+) was 50.0% (25/50). The ratio of intra-operative OPC(+) was 72.0% (36/50). The surgery results were as follows: the ratio of complete vertigo suppression (VS(+)) was 84.0% (42/50), air-conduction hearing gain (aHG(+)) was 40% (20/50), bone-conduction hearing gain (bHG(+)) was 64% (32/50), and speech discrimination gain (SDG(+)) was 28% (14/50). The post-operative ABG(+) was commonly observed in patients with intra-operative OPC(+) (chi-square test, p = 0.013). aHG(+) and SDG(+) results were related to the post-operative ABG(+) (chi-square test, p = 0.021 and p = 0.0018, respectively).

Conclusions

These data suggest that intra-operative OPC(+) may be causative for post-operative ABG(+), resulting in post-operative aHG(+) and SDG(+). Thus, as enlarged vestibular aqueduct syndrome and superior semicircular canal deficiency syndrome exhibit LTABGs due to the third mobile inner ear window, endolymphatic sac surgery with adequate endolymphatic sac decompression and exposure to high doses of steroids, might induce LTABGs and the beneficial results of endolymphatic sac surgery.     

Tympanoplasty in children: A review of 91 cases

Objectives

There is a marked diversity in the reported success rates for achieving an intact tympanic membrane following tympanoplasty. Controversy exists about the factors thought to influence surgical outcome. These facts have important implications for the selection of patients who would benefit the most. This study reviews the factors thought to determine the anatomical and functional success of tympanoplasty in children.

Materials and methods

Retrospective study of the anatomical and functional results of 91 tympanoplasties performed in children. Age, gender, size and site of perforation, status of operated and contralateral ear, underlying cause of the perforations, surgical technique, pre-operative and post-operative hearing levels, post-operative follow-up time and post-operative complications were recorded. We divided our population into two groups according to the expected eustachian tube maturity (younger group (N = 24): ≤10 years old, older group (N = 67): >10 years old). All patients were evaluated in terms of anatomical and functional outcome and complications.

Results

Anatomical success was achieved in 85.7% and functional success was 76.9% after a mean follow-up of 25.6 ± 17.1 months. Anatomical success (intact tympanic membrane) was achieved in 83% of younger vs 87% of older patients (p = n.s.). Functional (air bone gap closure) success was 75% in the younger group vs 78% in the older group (p = n.s.). There were no significant differences in post-operative gain at different frequencies (500, 1000, 2000 and 3000 Hz) between the two groups. A previous adenoidectomy in children older than 10 years seems to be an independent predictor of functional success The incidence of minor and major complications were 29% in patients aged ≤10 and 21% in those older than 10 (p = n.s.). We report 12.9% minor post-operative complications in successful cases: injury to the chorda tympani nerve (5.7%), wound infection (2.9%), otitis externa (2.9%) and transient vertigo (1.4%). Among the 21 reperforations observed, 92.3% occurred before 1 year.

Conclusions

This study shows that tympanoplasty is a valid treatment modality for tympanic membrane perforation in the pediatric population. A tympanic membrane perforation can be closed at any age. There is no age limit below which perforation should not be closed. A previous adenoidectomy in children older than 10 years seems to be an independent predictor of functional success.     

Results of revision tympanoplasty for chronic non-cholesteatomatous otitis media

Objective

To evaluate the success rate for revision tympanoplasty using different graft materials, to compare results of primary and re-tympanoplasty using the same technique and to analyse the effect of potential influencing factors on closure of tympanic membrane (TM) and hearing outcome.

Methods

Study included all patients, who underwent tympanoplasty (n = 617) and re-tympanoplasty (n = 94) for chronic otitis media without cholesteatoma in the period between September 1998 and 2007. The data of all patients on preoperative disease, perforation size and localization, middle ear status, surgical approach, graft material, adjunctive procedures, pre- and postoperative morphological (otomicroscopy) and functional (hearing examination evaluating pure-tone audiogram) results were analyzed. All operations were performed using an underlay technique and either the retroauricular or transcanal approach. The temporal fascia, perichondrium or cartilage-perichondrium composite grafts were used for the reconstruction of TM. Ossiculoplasty was performed as needed. The interrelation between multiple pre-operative parameters and post-operative morphological (closure of the perforation) and functional (hearing level) outcomes was analysed.

Results

Successful closure rates of the TM perforation were 93.6% and 90.2% of the patients in the primary and revision tympanoplasty groups, respectively. Graft take rate and hearing results did not depend on graft material. Structural changes were found more frequently in the re-tympanoplasty group (63.4% comparing to 29.5% of primary cases). Ossiculoplasty was performed more often in revision cases (24.4% comparing to 11.4% of primary cases). Successful hearing (ABG within 20 dB) for primary tympanoplasties was achieved in 81.1%, and for retympanoplasty - in 69.5% of the cases. (p < 0.01). There were no interrelation between any estimated parameters and the graft take rate for either primary or revision tympanoplasty.

Conclusions

There is no evidence of increased risk of graft failure in re-tympanoplasty cases when compared to primary tympanoplasty operations. Hearing results depend on structural changes in the middle ear (ossicular abnormalities and tympanoscerosis) which in revision cases are found more often. No differences were found between fascia, perichondrum or cartilage-perichondrium grafts in terms of graft healing and hearing results.     

l-Epinephrine and dexamethasone in postextubation airway obstruction: A prospective, randomized, double-blind placebo-controlled study

Purpose

This prospective randomized double-blind placebo-controlled study paired trial groups to investigate the effect of intravenous dexamethasone and nebulized l-epinephrine on the clinical development of postextubation laryngeal edema.

Material and methods

Sixty-four patients aged 1 day to 12 years who needed intubation from August/1997 to February/1999 in the Pediatric Intensive Care Unit (PICU) of Santa Casa de São Paulo School of Medicine were paired according to age, height and weight, anthropometric z-scores, duration of tracheal intubation and number of intubation attempts. Patients received intravenous dexamethasone (0.2 mg/kg every 6 h), with or without nebulized l-epinephrine (0.5 mg/kg every 4 h) in the study groups; in the control groups, they received nebulized or intravenous isotonic saline solution, or both. Dependent variables: frequency and severity of the laryngeal edema (according to Westley Clinical Scoring System), as well as the time interval (min) between extubation and the first postextubation laryngeal edema scores. Postextubation respiratory rate and transcutaneous oxygen saturation were employed as indicators of the clinical conditions for extubation.

Results

Laryngeal edema frequencies did not change according to treatments, χ² (3, N = 64) = 0.58, p > 0.05, and the highest scores were not reached in the 24 h after extubation, (3, N = 16) = 1.03, p > 0.05.

Conclusions

Dexamethasone and l-epinephrine did not reduce the clinical progression of airway obstruction due to laryngeal edema in the early postextubation period.     

The clinical status of the eardrum: An inclusion criterion for the treatment of chronic secretory otitis media in children

Objective

To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion.

Methods

161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum.

Results

The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z = 1.565; p = 0.0587).There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t = 2.173; p = 0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower.Sequelae: scars of the eardrum (chi-square = 28.107; ss = 1; p < 0.001) and attic retractions (chi-square = 4.592; ss = 1; p = 0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on.

Conclusion

A criterion that could influence the approach to the therapy of CSOM in children.     

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

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 1400 Hz to 4000 Hz (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.     

Is there any developmental relationship between mastoid pneumatization and adenoid tissue volume?

Objective

The aim of this study was to investigate the developmental relationship between adenoid tissue volume and mastoid air cell volume, using a 3D reconstruction technique.

Study design

Cross-sectional retrospective study.

Subjects and methods

Multislice computed tomography (MSCT) images were obtained using three-dimensional (3D) reconstruction and volume-rendering techniques (VRT). The subjects were 63 boys and 37 girls, 3-16 years of age. The volumes of bilateral mastoid air cells and adenoids marked in axial-coronal-sagittal planes were calculated. The patients were grouped into three categories according to adenoid tissue volume, total mastoid volume (TMV), and age.

Results

No significant difference was noted between the right mastoid volume (RMV) and the left mastoid volume (LMV) or between age and sex (p = 0.368; p = 0.549; p = 0.454). The incremental increase in adenoid tissue volume did not correlate with TMV (r = −0.161, r = −0.279, r = 0.015). The incremental increase in TMV did not correlate with the volume of adenoid tissue (r = 0.024, r = 0.148, r = 0.017).

Conclusions

No significant correlation was obtained between the incremental increase in adenoid tissue volume and TMV or the incremental increase in TMV and adenoid tissue volume. There does not seem to be a developmental relationship between adenoid tissue volume and TMV.     

Nasality evaluation of Turkish phonemes in vowel-consonant combinations

Objectives

The purpose of this study is to find average nasalance values of Turkish syllables with the nasometer.

Methods

This study is done at Hacettepe University Department of Otolaryngology Audiology and Speech Pathology Unit with 50 participating children.

Results

The normative nasalance values of Turkish phonemes are determined. It is found that nasalance scores of syllables that is combined with/i/phoneme is statistically have higher nasalance scores than/a/and/e/phonemes (p < 0.05). There is no difference find statistically between age and nasalance value (p > 0.05). Statistical difference between age and nasalance score is found in “iki, ?e, e?e, i?i, aç, eç, çi, içi, iç, al, yi, iy, iyi, yiy, ana, ne” syllables (p < 0.05). These phonemes have positive relation with the age. There is no statistical difference between sex and nasalance scores (p < 0.05). Statistical difference is only found in “tat- te- li- lil- aya” syllables (p < 0.05). On these phonemes it is found that girls have higher nasalance score than boys.

Conclusion

As a result, it is thought that gathered nasalance values of Turkish phonemes will be useful for resonance disorder diagnosis and follow ups on treatment.     

Suction cautery adenoidectomy (SCA): is the additional cost justified?

Objectives

Adenoidectomy is one of the oldest and most frequent ENT procedures. This study aimed to compare adenoidectomy using suction-cautery adenoidectomy (SCA) to curettage with respect to operative time, postoperative complications, and cost-effectiveness.

Methods

The data for this retrospective case control study were retrieved from the Medical Records Department at one of the few medical centers that perform this technique in the Kingdom of Saudi Arabia. The data for each case included the following: patient demographic features, type of procedure, time of operation, occurrence of any postoperative complications, length of hospital stay and cost of the procedure. To minimize the sources of variance in our data, all adenoidectomies were performed by the same consultant otolaryngologist, using either SCA or curettage.

Result

Of the 86 patients who underwent adenoidectomy in this study, SCA was performed in half of them (43) and curettage in the other half. The two groups were well matched with no significant group differences in either age or gender (p = 0.2 and p = 0.19, respectively). There was a significant reduction in operative time (p < 0.001) in the SCA group. There were no cases of postoperative hemorrhage after SCA, but there was one case of hemorrhage in the curette group that required a 2nd surgery to control the bleeding. Regarding cost, there were additional profits of more than 700,000 SR (US$180,000) each month with SCA as compared to curettage.

Conclusions

The suction cautery technique was superior at reducing operative time, increasing cost-effectiveness and decreasing the risk of postoperative complications. Therefore, we suggest suction cautery as the most appropriate method for adenoidectomy.     

Infants versus older children fitted with cochlear implants: performance over 10 years

Objectives

To investigate the efficacy of cochlear implants (CIs) in infants versus children operated at later age in term of spoken language skills and cognitive performances.

Method

The present prospective cohort study focuses on 19 children fitted with CIs between 2 and 11 months (X = 6.4 months; SD = 2.8 months). The results were compared with two groups of children implanted at 12-23 and 24-35 months. Auditory abilities were evaluated up to 10 years of CI use with: Category of Auditory Performance (CAP); Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS); Peabody Picture Vocabulary Test (PPVT-R); Test of Reception of Grammar (TROG) and Speech Intelligibility Rating (SIR). Cognitive evaluation was performed using selected subclasses from the Griffiths Mental Development Scale (GMDS, 0-8 years of age) and Leiter International Performance Scale-Revised (LIPS-R, 8-13 years of age).

Results

The infant group showed significantly better results at the CAP than the older children from 12 months to 36 months after surgery (p < .05). Infants PPVT-R outcomes did not differ significantly from normal hearing children, whereas the older age groups never reached the values of normal hearing peers even after 10 years of CI use. TROG outcomes showed that infants developed significantly better grammar skills at 5 and 10 years of follow up (p < .001). Scores for the more complex subtests of the GMDS and LIPS-R were significantly higher in youngest age group (p < .05).

Conclusion

This study demonstrates improved auditory, speech language and cognitive performances in children implanted below 12 months of age compared to children implanted later.     

Adenotonsillar hypertrophy: Does it correlate with obstructive symptoms in children?

Objective

The goal of this study is to determine the correlation of clinical symptoms of UAO (upper airway obstruction) with radiographic evaluation of adenoidal obstruction and tonsil size in children with adenotonsillar hypertrophy and to evaluate the usefullness of lateral neck radiography.

Study design

Prospective study.

Setting

Haydarpa?a Numune Research and Education Hospital, Istanbul, Turkey.

Subjects and methods

This study analyses 95 children with one or more of the symptoms of UAO. Clinical symptoms were assessed by a standardized questionnaire evaluating the severity of symptoms. All patients underwent otolaryngologic examination and their tonsil sizes were graded. 74 of 95 patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods.

Results

We did not find statistically siginificant correlation between symptom scores and radiologic measurements according to Johanneson (r = 0.072, p = 0.544, p > 0.05) and Crepeau (r = 0.034, p = 0.773, p > 0.05). The correlations between OSA score and Cohen and Konak's method and AN ratio were weak and not statistically siginificant (p = 0.133, r = 0.176; p = 0.290, r = 0.125 respectively; p > 0.05). But, we found a statistically siginificant correlation between the tonsil grade and symptom scores (r = 0.216, p = 0.036, p < 0.05).

Conclusion

Our results have demonstrated that radiologic measurements of the nasopharyngeal obstruction do not correlate with clinical symptoms of UAO, but clinical assessment of tonsil size does.     

Increased expression of VEGF, iNOS, IL-1β, and IL-17 in a rabbit model of gastric content-induced middle ear inflammation

Objective

To investigate the histopathological changes and the expression of vascular endothelial growth factor (VEGF), inducible NO-synthase (iNOS), endothelial NO-synthase (eNOS), interleukin (IL)-1β, and IL-17 in the rabbit middle ear mucosa after direct gastric content exposure.

Methods

Exploratory controlled study in which histological and immunochemical features were studied after gastric content-induced inflammation was established in rabbits. Sixteen healthy rabbits were divided into two equal groups. Gastric contents of an animal were injected into the middle ear of the same animal for 20 days. Saline was injected into the middle ear of the animals in the control group. The rabbits were humanely killed on day 27. Inflammation was assayed by light microscopy. Immunochemical staining was performed for VEGF, iNOS, eNOS, IL-1β, and IL-17 expression. Experimental and control animals were examined using the same protocol.

Results

The expression levels of VEGF, iNOS, IL-1β, and IL-17 differed significantly between the experimental and control groups (p = 0.018, p = 0.010, p = 0.002, and p = 0.002, respectively). The expression level of eNOS was not significantly different between the two groups (p = 0.132).

Conclusion

This study demonstrates that gastroesophagial reflux induced middle ear inflammation is associated with increased expression of VEGF, IL-1β, IL-17, and iNOS.     

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.     

Kurz titanium prosthesis ossiculoplasty—Follow-up statistical analysis of factors affecting one year hearing results

Objective

Analysis of the one year results of Kurz titanium ossicular prosthesis and the factors affecting the outcome from this prosthesis. The hearing results of titanium partial ossicular replacement prosthesis (PORP) and total ossicular replacement prosthesis (TORP) were compared.

Methods

This is prospective study of 97 Kurz prosthesis ossiculoplasties, performed by the same senior author (VVR) between 2004 and 2006. All patients undergoing ossiculoplasty using Kurz prosthesis between 2004 and 2006 were included. All patients had minimum follow-up period of one year. There were 97 patients in total. 65 patients had PORP's and 32 had TORP's. The mean preoperative and postoperative air-bone gaps for the frequencies (500, 1000, 2000, and 3000 Hz) were calculated. The improvement of the mean air-bone gap (ABG) and air conduction over the same frequencies were measured. A postoperative ABG less than or equal to 20 dB was considered a successful result. Statistical analysis was used to identify the factors which affect the postoperative results.

Results

The mean preoperative ABG was 27.89 dB (SD = 11.71). The mean postoperative ABG for the entire series was 11.39 dB (SD = 10.47). The mean improvement in ABG was 16.50 dB (SD = 14.00). 81.4% (79 patients) had postoperative ABG ≤ 20 dB. 56.7% (55 patients) of the patients had postoperative ABG ≤ 10 dB. The mean postoperative ABG for all PORP patients was 10.6 dB (SD = 9.7). The mean postoperative ABG of TORP was higher in this study (14.84 dB, SD = 12.86) but it was not statistically significant (p = 0.10, 2-tailed t-test, 95% CI −9.35 to 0.924). There was no significant effect of age, presence or absence of cholesteatoma or retraction pocket, type of mastoid surgery and thickness of the cartilage graft used on the results. The effect of the preoperative ossicular condition on the postoperative hearing results was also analysed.

Conclusion

Titanium ossicular reconstruction gives stable short-term results. There was no statistically significant difference between the total and partial replacement prostheses. The preoperative status of the stapes superstructure did influence the mean postoperative ABG.     

Assessment of adenoid size: A comparison of lateral radiographic measurements, radiologist assessment, and nasal endoscopy

Objectives

Correlate adenoid size as determined by lateral neck radiographs and intra-operative mirror exam. Determine if a radiologist's assessment of the lateral neck X-ray correlates with adenoid size. Assess the correlation of endoscopic findings to the degree of adenoid hypertrophy seen on intra-operative mirror exam. To perform a cost analysis of radiographic and endoscopic evaluations of the adenoids.

Study design

Retrospective study.

Methods

Patients who underwent adenoidectomy were reviewed. The adenoid size as determined by the adenoid-to-nasopharyngeal (A/N) ratio, radiology report, and flexible nasal endoscopy were compared to the adenoid size as determined by intra-operative mirror nasopharyngeal exam. Compensation rates for each modality were compared.

Results

Sixty-one children had pre-operative airway radiography. Ninety-nine patients underwent flexible nasopharyngoscopy. When the A/N ratio was compared to the intra-operative mirror exam, the Pearson Correlation coefficient was 0.64 (p < 0.0001). The radiology reading was compared to intra-operative mirror exam and the Spearman Correlation coefficient was 0.29 (p = 0.0258). When endoscopic nasopharyngoscopy was compared to intra-operative mirror exam, the Pearson Correlation coefficient was 0.62 (p < 0.0001). The cost of nasal endoscopy was $654. Lateral airway radiography plus radiology interpretation cost $605.

Conclusion

Children who undergo lateral radiographs to assess adenoid size are younger than those who undergo awake flexible endoscopic nasopharyngoscopy. Both the A/N ratio and endoscopic nasopharyngoscopy correlate well with the findings of the intra-operative mirror exam. The radiologist interpretations that do not utilize the A/N ratio measurement do not correlate well with intra-operative mirror exam findings. Both modalities are comparable in cost.     

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.     

Vitamin D and tonsil disease--preliminary observations

Objective

To estimate the prevalence of 25(OH) vitamin D deficiency in children undergoing (adeno)tonsillectomy.

Methods

From 1st November 2008 to 20th December 2008, 33 children aged from 4 to 16 and resident in Auckland, New Zealand (latitude 36° 52′ S) undergoing (adeno)tonsillectomy for difficulty breathing/sleep apnoea and/or recurrent tonsillitis had 25(OH) vitamin D, iron and zinc levels measured.

Results

Of the 32 patients who had 25(OH) vitamin D levels measured, 15.6% were vitamin D deficient (25(OH) vitamin D < 50 nmol/L), and 78% had levels, <75 nmol/L. 25(OH) vitamin D level was inversely correlated with Fitzpatrick skin type (Spearman's rho = −0.713, p < 0.01), body mass index (BMI) (Spearman's rho = −0.434, p = 0.013) and tonsil size (Spearman's rho = −0.417, p = 0.017). However regression modeling demonstrated that only Fitzpatrick skin type (β = −0.687, p = 0.001) and BMI (β = −0.256, p = 0.044) were significant predictors of vitamin D levels (R² = 0.572).

Conclusions

Seventy-eight percent of Auckland children undergoing (adeno)tonsillectomy had a 25(OH) vitamin D level < 75 nmol/L, a level which is associated with an increased incidence of upper respiratory tract infection. Low 25(OH) vitamin D levels were related to a darker skin, increased BMI and larger assessed tonsil size. The association of larger tonsil size with lower 25(OH) vitamin D status needs further evaluation but offers a potential explanation why black and Hispanic children are more likely than white children to have (adeno)tonsillectomy for snoring or obstructive sleep apnoea.     

Effect of different treatments in young children with language problems

Objective

Analysis of the relationship between treatment and improvement on language scores in children with language problems.

Design

Observational longitudinal study.

Materials and methods

123 children between 2 and 5 years of age, diagnosed as having a language problem were followed for 1 year. By means of monthly questionnaires, the form of intervention received was recorded. Language abilities were measured at baseline and after 1 year. Mixed model analysis was used to determine the relationship between improvement and language scores.

Results

During the year 119 parents returned the monthly questionnaires and four treatment groups were subsequently able to be categorized: language treatment (n = 21, 18%), surgical hearing improvement (n = 16, 13%), language treatment and surgical hearing improvement (n = 42, 35%) and a three-combination group (language treatment, surgical hearing improvement and developmental guidance, n = 40, 34%).For the four treatment groups there were no significant differences at baseline for the Language Comprehension Quotient (LCQ) (p = 0.07) and Sentence Development Quotient (SDQ) (p = 0.09). In all treatment groups the mean Sentence Development Quotient improved significantly (p = 0.001). The mean Language Comprehension Quotient did not improve in the surgical hearing improvement group (p = 0.42), but improved significantly in the language treatment group, in the language treatment and surgical hearing improvement group and in the three-combination group (p = 0.002, 0.040, 0.001).From all included children 38 children (32%) moved from an inadequate to an adequate language score.

Conclusion

All distinguished forms of treatment were effective. However, only for a proportion of the children this meant a clinical relevant improvement. For the improvement of language comprehension targeted language therapy seems essential, as children without this (children receiving surgical hearing impairment) did not improve their LCQ.