Role of allergy in children with adenotonsillar hypertrophy.

OBJECTIVE: The goal of this prospective study is to investigate the correlation between allergen sensitivity and radiographic evaluation of adenoidal obstruction and tonsil size. SUBJECTS AND METHODS: A total of 82 children with upper airway obstructive symptoms were evaluated for their tonsil size. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to the Cohen and Konak method. Skin prick tests with multitest applicator including 14 allergens were carried out to investigate their allergic background. RESULTS: All children reacted positive to at least one of the 14 allergens tested. We found a statistically significant correlation between tonsil size and skin prick tests (P < 0.01). However, there was no statistically significant correlation between the adenoid size and skin prick test results (P > 0.05). CONCLUSIONS: Although the degree of nasopharyngeal obstruction caused by adenoid hypertrophy does not increase with the degree of positivity to specific allergens in skin prick tests, allergic sensitivity may play an important role in children with tonsillar hypertrophy.

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 usefulness of lateral neck radiography. STUDY DESIGN: Prospective study. SETTING: Haydarpasa 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.

Is there a relation between mastoid aeration and Körner's septum?

The purpose of this study is to investigate the prevalence of Körner's septum (KS) in temporal bones with varying degrees of pneumatization and to evaluate any relationship between the degree of pneumatization and the presence of KS. Data were obtained retrospectively from 356 temporal bone high-resolution computed tomography of 178 patients who underwent tympanoplasty. Mastoid bone pneumatization was classified as aerated, diploic and sclerotic. The presence of Körner's septum was also investigated. The relationship between the presence of Körner's septum and the type of mastoid pneumatization was assessed. KS was encountered in 98 out of total 356 ears. Prevalence of KS was not statistically different between aerated (31%, n = 36), diploic (24.7%, n = 27) and sclerotic mastoids (26.9%, n = 35; p > 0.05). In conclusion, there is no relationship between the presence of KS and the degree of pneumatization. The presence of KS does not necessarily corroborate the presence of poor pneumatization.

Does adenoid hypertrophy really have effect on tympanometry?

OBJECTIVE: The goal of this study is to determine the correlation between the radiographic measurements of adenoid size and tympanometric findings. STUDY DESIGN: Prospective study. SETTING: Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. SUBJECTS AND METHODS: Nine five consecutive children complaining of one or more of the symptoms of upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were included in the study. Symptom severity was assessed by a standardized questionnaire. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. Tympanometry was used to evaluate the middle ear. RESULTS: Of 190 ears, 79 were type A, 49 were type B and 62 were type C tympanograms. The symptom severity of 14 patients was graded as mild, 56 patients as moderate and 25 patients as severe. There was no statistically significant difference between UAO symptom severity groups and tympanogram types (p>0,05). Each one of the four methods of radiologic measurements of the adenoid enlargement showed no statistically significant difference between the tympanogram types (p>0,05). CONCLUSION: The adenoid hypertrophy in both means of radiologic measurements and symptom severity does not correlate with the changes in tympanograms. These findings do not support the hypothesis that adenoidal size plays a major role in the etiopathogenesis of middle ear effusion (MEE).

Bilateral aberrant internal carotid arteries: a case report presenting with pulsatile middle ear discharge.

An aberrant internal carotid artery (AICA) is a rare vascular anomaly. Misdiagnosis may lead to massive hemorrhage or other life threatening complications during even a minor surgical procedure of the tympanic membrane or middle ear. Knowledge of this rare entity is essential to any surgeon who undertakes myringotomy and middle ear surgery. Only 14 cases of bilateral AICA were reported in literature. We present a very rare case with bilateral AICA presenting with pulsatile middle ear discharge from his left ear and left sided conductive hearing loss. Tympanic membrane perforation and middle ear discharge were evaluated inaccurately as chronic otitis media on otoscopic appearance. The definitive diagnosis made after CT (computed tomography) and MRA (MR angiography). Otolaryngologists should keep in mind that the diagnosis of AICA may be obscured by chronic otitis media without radiologic examination. In this report, clinical presentation, relevant radiologic findings and management of AICA were discussed with the literature knowledge.

Salivary gland choristoma of the middle ear in a child with situs inversus totalis.

Salivary gland choristoma of the middle ear cavity is an extremely rare entity. It is thought to be a developmental abnormality and may be associated with abnormalities of adjacent structures. We report a case of salivary gland choristoma of the middle ear with prominent Körner's septum in a 7-year-old girl with situs inversus totalis. Situs inversus totalis is the mirror image reversal of the normal position of the internal organs and frequently associated with other congenital anomalies. This patient is the first reported case with situs inversus totalis, having middle ear salivary gland choristoma and prominent bilateral Körner's septae. The management and the differential diagnosis of this condition are discussed with the review of the literature.

Effect of ototopical ciprofloxacin-dexamethasone on myringotomy in a rat model.

OBJECTIVE: To examine the potential of ototopical ciprofloxacin-dexamethasone (CDX) to delay the closure of myringotomy perforation and to evaluate its effect on inflammation. STUDY DESIGN: Prospective, randomized, and controlled. METHODS: Effusion is obtained in the right middle ear of 24 rats by blocking nasopharyngeal opening of eustachian tube by fibrin glue. Left middle ears of 30 rats remained healthy. Animals were randomly classified into three groups; each containing eight right ears with effusion and 10 rats with healthy left ear. Bilateral myringotomy was applied to all rats and randomly divided into three groups. First group received CDX, second group received serum physiologic (SF) for 14 days. Third group served as control. Otomicroscopy was performed by days 7, 14 and 28 to assess wound healing. On day of 28, all animals were humanly euthanized in order to pathological examination of the tympanic bullas. RESULT: CDX group showed lesser perforation closure ratios both in healthy and diseased ears. Inflammation was found to be lesser at CDX group in comparison to other groups. CONCLUSION: Closure of the myringotomy perforation can be modulated by ototopical CDX treatment. This delaying of wound healing may be attributed to antiinflammatory action of dexamethasone.

Intraductal papilloma of the parotid gland in a child.

Intraductal papillomas are rare benign tumors, most commonly encountered in minor salivary glands and rarely in major salivary glands. They are cystic, solitary neoplasm that arise from ductal epithelium and produce painless swelling. We report a case of intraductal papilloma of the parotid gland in a child.