A comparison of ultrasound-guided aspiration with open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis.

OBJECTIVES: Image-guided aspiration has been proposed as an alternative to the traditional open drainage in acute suppurative cervical lymphadenitis, although little evidence comparing these approaches exists. The aim of this study was to compare ultrasound-guided aspiration and open surgical drainage in the management of pediatric acute suppurative cervical lymphadenitis. METHODS: Patients treated for acute suppurative cervical lymphadenitis at a tertiary referral pediatric hospital over a three-year period were retrospectively analyzed. RESULTS: Of eighteen patients included, 9 (50 %) underwent aspiration and 9 (50 %) underwent open surgical drainage. None required repeat intervention or readmission over a median follow up of 10.5 weeks. Those undergoing aspiration had a shorter post-operative length of stay (1.67 vs 4.33 days, p = 0.001) compared with open surgical drainage. CONCLUSION: Ultrasound-guided aspiration of pediatric acute suppurative cervical lymphadenitis is a safe and effective alternative to open drainage.

Allergic rhinitis facts from an Irish pediatric population.

Objective: Assessing the main allergens in the pediatric population from the largest urban area in the country. Methods: Clinical letters of patients referred with possible allergic rhinitis (AR) were retrospectively reviewed over the past 5 years. Results: Five hundred and fifty-five patients were included. Males suffer twice as often with AR than females and have high titers of allergens. House dust mites (44.7%) and grass pollen (29%) were the main allergens in our area, with 48% of patients sensitized to both allergens. Half of the patients had the diagnosis of AR confirmed with positive allergen-specific tests. For the other half, the diagnosis was based on a clinical assessment performed by a pediatric otolaryngologist. Conclusions: Half of suspected AR children have environmental allergen sensitivity confirmed by testing, and a large number had a clinical diagnosis of AR after an otolaryngology consultation. Our findings can help clinicians to initiate AR treatment considering the most problematic allergens in the area.

A prospective study of parents' compliance with their child's prescribed analgesia following tonsillectomy.

We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg/kg/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study-35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg/kg/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg/kg/day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.

Investigation of a glottal related harmonics-to-noise ratio and spectral tilt as indicators of glottal noise in synthesized and human voice signals.

The harmonics-to-noise ratio (HNR) of the voiced speech signal has implicitly been used to infer information regarding the turbulent noise level at the glottis. However, two problems exist for inferring glottal noise attributes from the HNR of the speech wave form: (i) the measure is fundamental frequency (f0) dependent for equal levels of glottal noise, and (ii) any deviation from signal periodicity affects the ratio, not just turbulent noise. An alternative harmonics-to-noise ratio formulation [glottal related HNR (GHNR')] is proposed to overcome the former problem. In GHNR' a mean over the spectral range of interest of the HNRs at specific harmonic/between-harmonic frequencies (expressed in linear scale) is calculated. For the latter issue [(ii)] two spectral tilt measures are shown, using synthesis data, to be sensitive to glottal noise while at the same time being comparatively insensitive to other glottal aperiodicities. The theoretical development predicts that the spectral tilt measures reduce as noise levels increase. A conventional HNR estimator, GHNR' and two spectral tilt measures are applied to a data set of 13 pathological and 12 normal voice samples. One of the tilt measures and GHNR' are shown to provide statistically significant differentiating power over a conventional HNR estimator.

Infarcted angiomatous nasal polyps.

Angiomatous nasal polyps are a rarely reported subtype of inflammatory sinonasal polyps that are characterized by extensive vascular proliferation and ectasia. Compromise of their vascular supply may occasionally lead to infarction, resulting in clinical, radiological and pathological features that simulate a neoplastic process. In the present paper, the salient characteristics of this unusual entity are described. The clinical, radiological and pathological features of two patients with infarcted angiomatous nasal polyps are presented. Grossly, the polyps had an unusual inhomogenous appearance and texture and were associated with a foul odor. CT findings included bony expansion and destruction. MRI findings included markedly inhomogenous contrast enhancement on T1-weighted images. Histopathologically, both cases showed abundant vascular ectasia, with widespread intraluminal thrombosis and necrosis. Recanalization and reparative changes were also present. Angiomatous nasal polyps are poorly documented in the literature. Although entirely benign, they may simulate neoplastic processes, thus awareness of their existence is of considerable importance.

Role of CO2 laser in the management of obstructive ectopic lingual thyroids.

Ectopic lingual thyroid glands may occasionally undergo massive hypertrophy and be a source of airway obstruction. Securing the airway prior to surgery in such cases may be difficult. In the present paper, we report on two cases of obstructive ectopic lingual thyroids which were successfully managed endoscopically using CO(2) laser. The use of CO(2) laser for removal of ectopic lingual thyroid tissue offers advantages over traditional surgical techniques. In our opinion, removal of an appropriate amount of gland to secure an adequate airway is all that is required in most cases.

Tracheal juvenile xanthogranuloma in a child.

Juvenile xanthogranuloma is the most common form of non-Langerhans cell histiocytosis in children. It usually presents in the form of cutaneous lesions. Occasionally, the disease may affect other organs. Visceral forms are usually associated with cutaneous lesions, and are easily diagnosed. In isolated visceral occurrence, however diagnosis may prove difficult. Having the same spontaneous remission as cutaneous lesions, visceral lesions require treatment only in the case of serious dysfunction. We describe a case of isolated juvenile xanthogranuloma of the trachea, which has not previously been reported in children. The patient presented with serious respiratory symptoms that required immediate intervention.

Surface microstructure of the perilymphatic space: implications for cochlear implants and cell- or drug-based therapies.

OBJECTIVE: To study the surface microstructure of the scala tympani and scala vestibuli in humans and cats using scanning electron microscopy. DESIGN: Cochleas from 8 humans and 4 cats were harvested and the otic capsule and soft tissue removed before the cochleas were prepared for scanning electron microscopy. Micrographs were taken of the bony surface of both the scala tympani and scala vestibuli in each cochlear turn. The diameter and density of the micropores (canaliculi perforantes) and the thickness of the osseous spiral lamina (OSL) adjacent to Rosenthal's canal was measured. RESULTS: The human cochlea exhibits numerous canaliculi on the surface of the scala tympani, particularly associated with the OSL. There was a large range of diameters in the modiolar region of the OSL (0.2-23.0 micro m). The OSL was also very thin, with a mean thickness of 26.8 micro m in the base, tapering to 8.4 micro m in the apical turn. Far fewer canaliculi were evident in the scala vestibuli. Examination of the cat cochleas showed a similar distribution of canaliculi to that seen in the human; however, they were smaller in diameter and the OSL was thicker than in the human cochleas. CONCLUSIONS: The OSL is a thin and highly porous bony lamina that would appear to provide an open and extensive fluid communication channel between the scala tympani and Rosenthal's canal. These findings have important implications for the design and application of perimodiolar cochlear implant electrode arrays and may provide a potential route for drug- and cell-based cochlear therapies delivered via the scala tympani.

Facial node involvement in head and neck cancer.

BACKGROUND: Facial node involvement in head and neck cancer is rarely documented. Furthermore, facial node removal may increase the risk of damage to the marginal mandibular nerve. Thus, although they may receive afferent lymphatic drainage from the oral cavity, facial nodes are rarely removed during neck dissection. METHODS: We retrospectively reviewed the records of 29 patients with oral cavity or oropharyngeal carcinomas who underwent facial node sampling in 32 heminecks during neck dissection for oral cavity or oropharyngeal cancer. RESULTS: Facial node metastases were present in seven patients. Facial node involvement was much more common among patients with palpable cervical lymphadenopathy. Positive facial nodes were associated with an increased risk of treatment failure and a poorer survival. CONCLUSIONS: In patients with oral cavity/oropharyngeal primary tumors and palpable cervical lymphadenopathy, consideration should be given to removal of facial nodes during neck dissection; however, further data are awaited before any benefits can be quantified.

A post-traumatic nasal epidermoid: an endoscopic approach.

BACKGROUND: Epidermoid cysts are thought to arise as a result of implantation of epidermal cells into the deeper dermal elements. These cysts have previously been described postsurgery but not after accidental nasal trauma. METHODS: We outline a case of a nasal epidermoid occurring post-blunt nasal trauma and its subsequent excision. RESULTS: The lesion was excised successfully endoscopically without recourse to an open technique. CONCLUSION: We describe, for the first time, the successful intranasal removal of a post-traumatic epidermoid cyst via an endoscopic approach.

Argon plasma coagulation in the treatment of tonsil remnants.

Tonsil remnants are a problematic outcome in a subset of patients undergoing tonsillectomy. Treatment options are rarely discussed in the literature. This is the first description of the use of argon plasma coagulation (APC) in this setting. APC is based on the principle of ionised argon gas creating a conductive plasma between an activating electrode and a tissue surface. We describe the usability and clinical efficacy of this modality in a group of six patients.

Randomized controlled trial comparing argon plasma coagulation tonsillectomy with conventional techniques.

Argon plasma coagulation (APC) is based on the principle of ionized argon creating a conductive plasma between an activating electrode and a tissue surface. To date, its use in tonsillectomy has not been extensively examined. The purpose of this randomized controlled trial was to assess the clinical efficacy of APC as a tool for this common surgical procedure. Forty patients were randomized into two groups--treatment A (conventional tonsillectomy, n = 20) and treatment B (APC tonsillectomy, n = 20). Trial end-points included a) operative time, b) intra-operative blood loss, and c) objective assessment of post-operative pain, by completion of a visual analogue pain score chart, over a two-week period. Thirty-one patients were available for analysis. There was a statistically significant reduction in the intra-operative blood loss with treatment B (p = 0.02). There was no statistical difference between both groups for the other outcome measures. First clinical experience with this treatment modality shows that it is an attractive alternative to conventional tonsillectomy and may offer possible benefits.

An unusual case of external ear inflammation caused by sarcoidosis.

Inflammation of the pinna can occur in conjunction with polychondritis and otitis externa. We describe a case of pinneal inflammation that proved to be sarcoidosis, and we discuss the otolaryngologic manifestations of sarcoidosis.