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.     

Place of birth and characteristics of infants with congenital and early-onset hearing loss in a developing country

Objective

To determine the characteristics of infants with sensorineural hearing loss (SNHL) and the relationship with place of birth.

Methods

Subjects were drawn from hospital-based and community-based universal infant hearing screening programs concurrently conducted from May 2005 to April 2008 in Lagos, Nigeria. Maternal and infant characteristics of children born in hospitals and detected with SNHL were compared with those born outside hospitals. Each program consisted of a first-stage screening with transient-evoked otoacoustic emissions (TEOAE) followed by second-stage automated auditory brainstem response (AABR). Hearing status was confirmed by diagnostic auditory brainstem response, tympanometry and visual response audiometry.

Results

A total of 4718 infants were screened under the hospital-based program out of which 12 (0.3%) infants were confirmed with SNHL whereas 71 (1.0%) of the 7179 infants screened under the community-based program were confirmed with SNHL. Of all infants with SNHL 39 (47.0%) were born in hospitals suggesting that 27 (38.0%) of infants under the community-based program were born in hospitals. Prevalence of SNHL ranged from 4.0 per 1000 among infants born in government hospitals to 23 per 1000 among those born in family homes. Mothers of those born outside hospitals were significantly likely to belong to the Yoruba tribe (p < 0.001), use herbal medications in pregnancy (p < 0.001), deliver vaginally (p = 0.004) but without skilled attendants at delivery (p < 0.001). There were no significant differences among the infants themselves except that those born outside hospitals were significantly likely to be detected in the first 3 months of life compared to those born in hospitals (p < 0.001).

Conclusions

A significant proportion of infants with SNHL in many developing countries are likely to be born outside hospitals thus underscoring the need for community-oriented UNHS to facilitate early detection and intervention. Conventional risk factors for SNHL are unlikely to discriminate across places of birth. Pediatricians and otolaryngologists should consider a more active role in fostering community-oriented delivery of primary ear care services in this and similar settings in the developing world.     

Investigating child raising attitudes of fathers having or not having a child with hearing loss

Aim

The main goal of this study is investigating child raising attitudes of fathers having or not having a child with hearing loss.

Material and method

The fathers of 20 children with hearing loss who attend the Training Unit of Hearing and Speaking Abilities in Hacettepe University Department of Audiology and Speech Defects and 20 fathers having children who have a normal hearing have participated in this study. Demographic Information Form and P.A.R.I (Parental Attitude Research Instrument) have been used as devices for data collecting.

Results

Sub dimension of overprotection scores (42.76 ± 5.59) of the fathers having a child with hearing loss are found higher on a statistically meaningful level than the scores (40.16 ± 6.55) of fathers who do not have a handicapped child (p < 0.01). Together with this, the fathers having a child with hearing loss get lower scores from the democratic/equality and strict discipline sub dimensions as compared to the fathers who do not have a handicapped child, and this situation is found meaningful statistically (p < 0.01).

Conclusion

It is very important that the father's having enough information and support help the father to be encouraged and feel himself enough for this issue. Moreover, the wrong attitudes and behaviors towards the child can be corrected upon noticing them.     

Evaluation of cochlear involvement by transient evoked otoacoustic emission test in children with Crimean-Congo hemorrhagic fever

Objective

The aim of this study was to investigate cochlear involvement in child patients with Crimean-Congo hemorrhagic fever (CCHF) disease.

Methods

Twenty-eight CCHF disease patients (56 ears) and 26 sex- and age-matched healthy control subjects (52 ears) were included in the study. Pure-tone audiometry at frequencies 0.25, 0.5, 1, 2, 4, and 6 kHz, immittance measures including tympanometry and acoustic reflex testing, and transient evoked otoacoustic emission (TEOAE) testing were performed in the patients and controls.

Results

The proportion with a result of ‘fail’ for the TEOAE test in the CCHF patients was not statistically significant from the control group (p > 0.05).

Conclusions

CCHF disease does not impair cochlear function in children. The clinical course of CCHF among children seems to be milder than in adults.     

Comparison between symptoms and endoscopy in children with nasal obstruction

Objective

Nasal obstruction is a common symptom in childhood. It may be frequently observed in children with allergic rhinitis and/or adenoidal hypertrophy. However, its assessment is very difficult. The aim of the study was to compare the use of both a Face Related Scale (FRS), recorded by children and their parents, and a simplified Visual Analogue Scales (sVAS) with nasal endoscopy in children complaining nasal obstruction.

Methods

121 children (75 males, mean age 7.5 years) were studied. FRS and sVAS for nasal obstruction and endoscopy were performed in all patients.

Results

A moderate correlation has been observed between FRS and sVAS and obstruction of nasal anterior segment (r = 0.51 for FRS; r = 0.52 for sVAS), a strong correlation was observed with nasal posterior segment (r = 0.60 for FRS; r = 0.61 for sVAS) assessed by endoscopy. However, parents’ perception did not relate with objective parameters.

Conclusions

This study suggests that assessment of FRS and sVAS for nasal obstruction may be used in clinical practice to approximately quantify this symptom in children.     

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.     

Children with hearing impairment--living with cochlear implants or hearing aids

Objective

The aim of this study was to enhance knowledge about the life circumstances of children with cochlear implants or hearing aids, regarding daily functioning and attitude to the impairment.

Methods

Data were obtained from 36 children with cochlear implants and 38 children with hearing aids via study-specific questionnaires with fixed answer alternatives. The questions covered (1) usage of aids and related factors, (2) hearing in different everyday situations, (3) thoughts about the children's own hearing and others’ attitudes to it, and (4) choice of language. The data were analyzed using SPSS, and presented via the theoretical frame of the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY).

Results

Children with CI and HA functioned equally well in daily life, but there were also certain differences. Symptoms from neck and shoulders were more common among children with hearing aids than among children with cochlear implants (p < .001). Children with hearing aids used their aids significantly less often than those with cochlear implants (p < .001). The participation variables showed that children with hearing aids had significantly more hearing problems in team sports (p = .033) and outdoor activities (p = .019), in comparison to children with cochlear implants. The two groups had similar thoughts regarding their own hearing, mostly considering it not to be a problem. They also did not generally think that other people found their hearing to be a problem.

Conclusions

Children with cochlear implants and children with hearing aids have, in some aspects, equally good functioning in everyday life situations. However, certain differences were found in dimensions of functioning, regarding neck and shoulder pain, usage of aids and sign language, and hearing problems in some activities.     

Quantification of vocal tract configuration of older children with Down syndrome: A pilot study

Objective

To quantify the vocal tract (VT) lumen of older children with Down syndrome using acoustic reflection (AR) technology.

Design

Comparative study.

Setting

Vocal tract lab with sound-proof booth.

Participants

Ten children (4 males and 6 females), aged 9-17 years old diagnosed with Down syndrome. Ten typically developing children (4 males and 6 females) matched for age, gender, and race.

Intervention

Each participant's vocal tract measurements were obtained by using an Eccovision Acoustic Pharyngometer.

Main outcome measures

Six vocal tract dimensional parameters (oral length, oral volume, pharyngeal length, pharyngeal volume, total vocal tract length, and total vocal tract volume) from children with Down syndrome and the typically developing children were measured and compared.

Results

Children with Down syndrome exhibited small oral cavities when compared to control group (F(1, 18) = 6.55, p = 0.02). They also demonstrated a smaller vocal tract volumes (F(1, 18) = 2.58, p = 0.13), although the results were not statistically significant at the 0.05 level. Pharyngeal length, pharyngeal volume, and vocal tract length were not significantly different between the two groups.

Conclusion

Children with Down syndrome had smaller oral cavities, and smaller vocal tract volumes. No significant differences were found for pharyngeal length, pharyngeal volume, and vocal tract length between these two groups.     

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

Objectives

The aim of this study was to assess the pharyngeal airway space (PAS) in nasal and mouth-breathing children using cone beam computed tomography (CBCT).

Methods

Volume, area, minimum axial area and linear measurements (PAS-NL, PAS-UP, PAS-OccL, PAS-UT, PAS-Bgo, PAS-ML, PAS-TP) of the pharyngeal airway of 50 children (mean age 9.16 years) were obtained from the CBCT images. The means and standard deviations were compared according to sexes (28 male and 22 female) and breathers patterns (25 nasal breathers and 25 mouth breathers).

Results

There were no statistically significant differences (p > 0.05) between all variables when compared by sexes. Comparisons between nasal and mouth breathers showed significant differences only in two linear measurements: PAS-OccL (p < 0.001) and PAS-UP (P < 0.05). Airway volume (p < 0.001), area (p < 0.001) and minimum axial area (p < 0.01) had significant differences between the groups.

Conclusions

The CBCT evaluation showed that pharyngeal airway dimensions were significantly greater in nasal-breathers than in mouth-breathers.     

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.     

Prenatal risk factors and occurrence of allergic rhinitis among elementary school children in an urban city

Objectives

To investigate the incidence and prenatal risk factors for allergic rhinitis among elementary school children in an urban city.

Study design

Risk factor data were collected by questionnaire and direct physical examination. Multiple logistic regression analysis was used to calculate the odds ratios of developing allergic rhinitis among children 6-13 years of age.

Methods

From January 2006 to December 2006, we enrolled 1368 elementary school children in the study. Sampling was done by a multi-stage clustered-stratified random method to determine the study subject. All the children studied attended 12 elementary schools located in the six districts in Taipei, with two schools in each district. Odds ratios were adjusted for the confounding effects of gender, parity, maternal age at childbirth, maternal education, gestational complications, tobacco smokers in the residence, pets, carpets, molds, and air pollution.

Results

The incidence of allergic rhinitis in the study was 50.1% (685/1368). Factors like gender (p < .001), parity (p < .05), carpets (p < .025), and air pollution (p < .001) increased risk, while the other factors did not (p > .05 for all).

Conclusion

Gender, parity, carpets, and air pollution increased the risk of developing allergic rhinitis among elementary school children. Other potential factors such as low birth weight, maternal age at childbirth, parental education, gestational complications, presence of tobacco smokers, and exposure to pets and molds did not significantly increase risk of developing allergic rhinitis.     

Hearing status in children with congenital cytomegalovirus: up-to-6-years audiological follow-up

Objective

To evaluate the audiological outcome of children with congenital cytomegalovirus infection.

Methods

In a prospective study, the hearing of ninety seven congenitally cytomegalovirus-infected children, born between January 2003 and July 2009, was systematically evaluated until the age of six, applying the Flemish CMV protocol. Depending on the age of the child, the protocol provides hearing evaluation by objective-, play- or conventional audiometry. Symptomatic children with hearing loss at birth were treated with ganciclovir, if parents consented.

Results

Seventy children had a pass on initial screening, 27 had unilateral or bilateral hearing loss. Within the normal hearing group, one asymptomatic and two symptomatic children developed late-onset hearing loss. Within the group with hearing loss, 8 children received ganciclovir, while 8 symptomatic and 11 asymptomatic children did not receive ganciclovir. As for the treated group, 37.5% of the children had stable hearing loss, one child had progressive and one child had fluctuating hearing loss. Improvement of hearing threshold occurred in 37.5% of the children. Among the untreated symptomatic children, hearing loss remained stable in 50%, while progression occurred in 37.5%. In the group of asymptomatic children with hearing loss, hearing loss was most commonly stable (72.7%).Within the group of normal hearing ears at birth (n = 156), there is a significant better progression in pure tone average for ears of asymptomatic subjects in comparison to ears of symptomatic subjects (p ≤ 0.0001). As for the group of ears with hearing loss at birth (n = 38), analysis shows no evidence for a difference in pure tone average progression between the different groups (p = 0.38).

Conclusions

Cytomegalovirus infection may cause hearing loss, in both symptomatic and asymptomatic children. Our data show a significant difference, between both groups, in the progression of pure tone average of normal hearing ears at birth, in favor of the asymptomatic children. This is not the case for ears with hearing loss at birth. However, this may be due to the small number of ears in this group. Our data show the tendency that treatment with ganciclovir increases the likelihood of improvement and reduces the likelihood of deterioration of the hearing.     

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.     

Human bocavirus in the nasopharynx of otitis-prone children

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 (>10,000 copies/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.     

Sleep quality and effects of position on sleep apnea in East Asian children

Objectives

To assess whether obstructive sleep apnea syndrome (OSAS) affects sleep architecture and quality in East Asian children, and also to assess the effects of body position during sleep on respiratory disturbance during sleep.

Materials and methods

We enrolled 50 consecutive East Asian children with habitual snoring between 2007 and 2009. Nineteen children had OSAS (apnea-hypopnea index, AHI ≥ 5; OSAS group) and 31 children were simple snorers (control group). They underwent polysomnography and physical examination of their nasal and oral cavities with a roentgenogram of the nasopharynx. Sleep architecture and other polysomnographic variables were compared between the OSAS and control groups. The effect of body position during sleep on respiratory disturbance was examined, and also in relation to obesity and adeno-tonsillar size.

Results

There was a decrease in total sleep time and in sleep efficiency, as well as increased arousal and heart rate (P < 0.05) in the OSAS group. Sub-analysis of AHI according to sleep posture showed that AHI is higher when the patient is in the supine position than in the non-supine position (P = 0.032). The presence of OSAS and kissing tonsils were contributing factors to the positional difference in AHI (P < 0.05). Obesity and adenoid hypertrophy did not affect the positional difference of AHI.

Conclusions

OSAS may have a greater influence on the sleep architecture of East Asian children, and East Asian children may have a higher AHI when sleeping in the supine position. Tonsillar hypertrophy and the presence of OSAS are possible contributing factors for positional difference of AHI in East Asian children.     

Expanded protocol of orofacial myofunctional evaluation with scores: Validity and reliability

Objective

Clinical evaluation of the stomatognathic system is indispensable for the diagnosis of orofacial myofunctional disorders. In order to obtain a more precise diagnosis, the protocol of orofacial myofunctional evaluation with scores (OMES protocol) (Int. J. Pediatr. Otorhinolaryngol. 72 (2008) 367-375) was expanded in terms of number of items and scale amplitude. The proposal of this study is to describe the expanded OMES protocol (OMES-E) for the evaluation of children. Validity of the protocol, reliability of the examiners and agreement between them were analyzed, as also were the sensitivity, specificity and predictive values of the instrument.

Methods

The sample consisted of videorecorded images of 50 children, 25 boys (mean age = 8.4 years, SD = 1.8) and 25 girls (mean age = 8.2 years, SD = 1.7) selected at random from 200 samples. Three speech therapists prepared for orofacial myofunctional evaluation participated as examiners (E). The OMES and OMES-E protocols were used for evaluation on different days. E1 evaluated all images, E2 analyzed children with recordings from 1 to 25 and E3 analyzed children with recordings from 26 to 50. The validity of OMES-E was analyzed by comparing the instrument to the OMES protocol using the Pearson correlation test complemented with the split-half reliability test (p < 0.05). The linear weighted Kappa coefficient of agreement (Kw′), the sensitivity, specificity and predictive values and the prevalence of OMD were calculated.

Results

There was a statistically significant correlation between the OMES and OMES-E protocols (0.79 > r < 0.94, p < 0.01) and a significant test-retest correlation with the OMES-E (0.75 > r < 0.86, p < 0.01), with a reliability range of 0.86-0.93. The correlation and reliability coefficients between examiners were: E1 × E2 (r = 0.74, 0.84), E1 × E3 (r = 0.70, 0.83) (p < 0.01). Kw′ coefficients with moderate and good strength predominated. The OMES-E protocol presented mean sensitivity = 0.91, specificity = 0.77, positive predictive value = 0.87 and negative predictive value = 0.85. The mean prevalence of OMD was 0.58.

Conclusion

The OMES-E protocol is valid and reliable for orofacial myofunctional evaluation.     

Psychological stress and family functioning in mothers of children with allergic rhinitis

Objective

Psychiatric symptoms are observed more commonly in mothers of children with allergic disease compared to the general population. In our study, we aimed to compare family functioning and anxiety parameters in mothers of children diagnosed allergic rhinitis and healthy controls.

Methods

Study group consisted of 82 mothers of 7-15 years old children with allergic rhinitis. Control group consisted of 70 mothers of children with no chronic diseases. State-Trait Anxiety Inventory (STAI) and McMaster Family Assessment Device (FAD) scales was obtained from participants.

Results

Anxiety scores in mother of children with allergic rhinitis were significantly higher than the ones in the control group (50 ± 7.54, 32 ± 5.44, p = 0.02, respectively). Family assessment scores were higher in mother of children with allergic rhinitis when compared to the control group but did not reach statistical significance (1.89 ± 0.12, 1.87 ± 0.95, p = 0.19, respectively). Smoking status at home and jobless father were found to have a significant impact on the evaluation scale in mothers in the case group.

Conclusion

Psychiatric symptoms observed in mothers of children with allergic rhinitis might be associated with child disease and the functioning of the entire family rather than features of the mother alone. Having a child with allergic rhinitis does not affect family functions according to the mother's aspect.     

Ghrelin levels in children with adenoid or chronic tonsil hypertrophies before and after surgery

Objective

We aimed to evaluate the ghrelin levels in the children with adenoid or tonsil hyperthrophies.

Methods

The study included 27 children (17 boys and 10 girls). Mean age was 6.9 ± 3.5 years, ranging from 3 to 16. Ghrelin levels in the patients and their weight and height measurements were evaluated before surgery and after 3 months later of the operation.

Results

While 18 (67%) children were operated for adenoid hypertrophy, 9 (33%) children were operated for adenoid and tonsil hypertrophy. It was found that postoperative ghrelin levels were significantly decreased whereas weight and BMI scores were significantly increased (p < 0.01). A weak correlation was observed between preoperative ghrelin and weight (r = −0.29). This negative correlation became more profound at the postoperative 3rd month examination (r = 0.85) (p < 0.01).

Conclusions

The present study showed that the surgical treatment provides positive contributions on the growing of children with adenoid and tonsil hypertrophies. The ghrelin levels were significantly decreased at the postoperative period in the children, and a negative relationship was observed between the ghrelin levels and the weight. These findings suggest that blood ghrelin levels may be useful as a parameter for following the development of the children.     

Communicative abilities in toddlers and in early school age children with cleft palate

Objectives

Evaluation of improvement in communicative abilities in children with nonsyndromic cleft palate.

Methods

Longitudinal retrospective case history study. Out of 117 children with cleft lip and/or cleft palate born in 1998, 1999 and 2000 and enrolled in the cleft palate team of the University Medical Centre Groningen (UMCG), 63 children were included in the study; 29 (46%) boys and 34 (54%) girls. From these 63 Dutch speaking children communicative abilities were measured when toddlers and at early school age. Cleft types were cleft lip with or without cleft alveolus (CL ± A; n = 10, 5%), unilateral cleft lip and palate (UCLP; n = 23, 37%), bilateral cleft lip and palate (BCLP; n = 9, 14%) and isolated cleft palate (CP; n = 21, 33%). The percentage of problems in language comprehension, language production, articulation, hearing and hypernasality, present when toddlers, were compared with the percentage of problems found at early school age. The treatments executed were also analysed.

Results

Except for hearing problems, problems in all other communicative fields improved significantly. In the total group language comprehension problems decreased from 23% to 2% (p = 0.00), language production problems from 21% to 6% (p = 0.01), articulation problems from 57% to 25% (p = 0.00) and hypernasality from 38% to 10% (p = 0.04). Hearing problems appeared more difficult to treat effectively, they decreased from 42% to 31% (p = 0.29). Children with BCLP appeared to have the most problems, followed by children with UCLP and then children with CP. Children with CL ± A show the least problems. In the intervening period, often a combination of treatments was performed. Pharyngoplasty appeared to be very successful in treating hypernasality, with a success rate of 86%.

Conclusions

At early school age, in children with clefts, speech and language problems were significantly improved following a multidisciplinary approach to treatment and resemble their peers without clefts. Hearing problems were more difficult to treat.     

Fiberoptic Endoscopic Evaluation of Swallowing in children: feeding outcomes related to diagnostic groups and endoscopic findings

Objective

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is used as an adjunct to assess swallowing function in children with complex feeding disorders. We report the feeding outcomes of patients who underwent FEES to determine whether associations exist between clinical diagnoses or FEES findings and feeding outcomes.

Methods

Retrospective review of children who underwent FEES for dysphagia or aspiration from 2003 to 2009. The clinical diagnoses and initial FEES findings were compared to follow up feeding status for associations.

Results

79 patients were included (44 males and 35 females). The change from initial to final status: total oral feeding (42-67%), NPO ± minimal tastes (39-21%) and oral feeding with tube feeding (19-12%). Of the clinical diagnoses, tonsillar hypertrophy was associated with ultimately obtaining total oral feeding status (p = 0.046) while the inability to obtain total oral feeding status was associated with neurologic (p < 0.001). The initial FEES findings showed no significant associations with long-term feeding status.

Conclusion

Many children overcome their dysphagia but those with neurologic disorders are less likely to achieve total oral feeding status. In children with dysphagia evaluated by FEES, the long-term feeding status is not significantly associated with the initial FEES findings.