Young Children Allergic Rhinitis Questionnaire is a novel tool for allergy screening in children.

BACKGROUND: There are a limited number of validated questionnaires available for use in the clinical screening for allergic rhinitis (AR) in children ≤3 years old. We developed a novel self-reported questionnaire and assessed its accuracy and reliability. METHODS: After establishing a pool of items, which were screened by experts, the Young Children Allergic Rhinitis Questionnaire (YCAR-Q) was administered to a birth cohort in the Shunyi District (Beijing, China). The electronic version of the YCAR-Q was distributed through the online community. Children were invited to visit a physician for examination. The diagnostic criteria included symptoms, physical examination findings, and specific serum immunoglobulin E tests. Each item on the questionnaire was evaluated, and the questionnaire's internal consistency, content validity, criterion-related validity, and diagnostic accuracy were assessed. RESULTS: The six-item YCAR-Q was distributed to 7423 parents, and 3037 valid questionnaires were recovered. In total, 1521 children visited a physician for examination, of which 82 were found to have AR. In terms of internal consistency, Cronbach's coefficient was 0.777 and all six questionnaire items were retained. The average scale-level content validity index value was 1. The area under the curve was 0.759. The total scores ranged from 0 to 6, and the cutoff value for diagnosing AR was 3, with a sensitivity of 68.29% and a specificity of 76.58%. CONCLUSIONS: This cross-sectional study indicated that the YCAR-Q could detect AR in children ≤3 years old. This brief and simple test may be used effectively in clinical practice.

A case report of proboscis lateralis: emphasis on the reconstruction of the lacrimal drainage system.

Background: Proboscis lateralis (PL) is a rare congenital malformation of the craniofacial structure. On the basis of 34 reported cases, Boo-Chai developed the first classification system in 1985 based on commonly associated anomalies of the eyes, palate, and lips. Sinonasal deformity is the most prevalent systemic abnormality associated with PL, accounting for 87.9%, and concomitant ocular anomalies account for 44-70%. Case Description: We report a case of PL in a 20-month-old female patient with a mass in the left medial canthal area, and ipsilateral symptomatic epiphora. The removal of the proboscis at 4 months without the reconstruction of the nasolacrimal duct resulted in secondary sequelae that lasted 16 months. A second operation by a multidisciplinary team released the pressure on the lacrimal sac and reconstructed the lacrimal system. External dacryocystorhinostomy (DCR) is performed through the original external incision aided by nasal endoscopic examination. The bony passage between the nasal cavity and the lacrimal sac was reconstructed, and nasal endoscopy revealed a wide opening in the nasal cavity of at least 6 mm. Follow ups ensured a patent nasal airway, without complications. Conclusions: It is instructive to learn from this case that treatment plans for PL should consider associated ocular anomalies and lacrimal drainage reconstruction, following a comprehensive and multidisciplinary approach.

Increased prevalence of CFTR variants and susceptibility to CRS: A real-world study based on Chinese children.

Background: Chronic Rhinosinusitis is a common disease in children. The main function of CFTR is to maintain the thickness of the mucous layer on the surface of the nasal mucosa. CFTR disease-causing variant can cause CFTR protein dysfunction and induce or aggravate chronic infection. However, the carrying status of the CFTR variants in the Chinese population is not clear. Objective: To study the frequency and variants of CFTR in Chinese children with CRS and to analyze the CFTR variants and the clinical characteristics and susceptibility to CRS. Methods: Whole Exome Sequencing was performed to analyze the CFTR genes in a total of 106 CRS children from the Chinese mainland area. The CFTR variants, frequency and clinical data were summarized and analyzed. Results: A total of 31 CFTR variants were detected, of which the carrying rate of 7 sites was significantly higher than that of the population database. 88 patients carried more than 2 variants. 37 people carried variants (MAF < 0.05), of which 91.89% had a history of recurrent upper respiratory infections, 16 had nasal polyps, 5 had bronchiectasis, and 1 was diagnosed with CF-related disorders. Conclusion: The carrying rate of CFTR variants in Chinese CRS children increased, and the highest rates of variants (MAF < 0.05) are p.I556V, p. E217G, c.1210-12[T]. Carrying multiple CFTR variants, especially p.E217G, p.I807 M, p.V920L and c.1210-12[T] may lead to increased susceptibility to CRS. There are CF-related disorders in patients with CRS.

Bath-plug technique for the endoscopic management of cerebrospinal fluid leaks in children.

Importance: The safety and efficacy of the bath-plug technique for the closure of cerebrospinal fluid (CSF) leaks in children remain unknown. Objective: We undertook this study to ascertain whether the bath-plug technique was safe and effective for the repair of CSF leaks. Methods: We retrospectively reviewed patients who underwent endoscopic repair of CSF leaks with the fat graft as a plug-in at Beijing Children's Hospital from March 2016 to May 2020. Demographic data, medical history, defect sites and sizes, interventions, and clinical outcomes were analyzed. One representative clinical case was additionally selected to highlight the procedure and the healing process. Results: A total of 18 pediatric patients were included in this study. The group was composed of 11 boys and seven girls, aged from 5 to 123 months. The etiologies included congenital CSF leaks (n = 9) and head trauma (n = 9). Among all patients, 12 fistulas (66.7%) were located at the cribriform plate area, two (11.1%) at the roof of the ethmoid sinuses, two (11.1%) in the sphenoid sinus, and two (11.1%) at the frontal sinus. The maximum diameters of fistulas ranged from 5 to 20 mm, with a median value of 8 mm. Encephaloceles were identified in 14 (77.8%) patients. No hydrocephalus was recognized. All CSF leaks were successfully repaired with a bath-plug technique. Follow-up ranged from 50 to 70 months. No surgical complications were encountered in any patient. Interpretation: Bath-plug technique is safe and reliable for the endoscopic management of CSF leaks in children. Meticulous peri-operative preparations are important for pediatric patients.

Primary Aneurysmal Bone Cyst of Nasal Cavity and Sinuses in a Child: Case Report and Literature Review.

INTRODUCTION: Aneurysmal bone cysts (ABCs) are a rare benign bone lesion, which are divided into primary and secondary categories, and occur mainly in the vertebra and the long tubular bones. Primary ABCs in the nasal cavity and the sinuses are rare. CASE PRESENTATION: We reported on a one-year-old boy who suffered from progressive nasal obstruction and intermittent nosebleeds over a period of approximately 1 month. The patient had no history of trauma or surgery. Physical examination showed a red tumor in his right nasal cavity. A magnetic resonance imaging scan showed a multicystic lesion arising from the ethmoid sinus. The lesion was resected under a nasal endoscope without any complications. Histological evaluation confirmed that the lesion was an aneurysmal bone cyst. Because an osteoma was found during the surgery on the cyst, the lesion was considered secondary clinically. However, fluorescence in situ hybridization testing showed a rearrangement of the USP6 (ubiquitin-specific protease 6) oncogene on chromosome 17. No recurrence was observed after 1 year. CONCLUSION: An ABC of the nasal cavity and sinuses in such a young child is very rare and needs to be further analyzed according to postoperative pathology and combined with a genetic examination to make a diagnosis. Endoscopic sinus surgery is an effective method of treatment for this kind of disease.

Changes in Pre- and Post-adenoidectomy Bacterial Profile in Children With Chronic Rhinosinusitis.

OBJECTIVE: We aimed to investigate the difference between the bacterial profiles of the nasal cavities and adenoid surfaces of children with chronic rhinosinusitis (CRS). We also intended to determine and analyze the potential correlation between the pre- and post-adenoidectomy differences in the nasal bacterial profile and clinical prognosis. METHODS: The clinical information of pediatric patients was collected. All the children underwent adenoidectomy (with or without tonsillectomy), and swab samples were collected during the operation. Visual analog scales (VAS) were used at 3, 6, and 12 months postoperatively. At the 12-month follow-up examination, swab samples were collected again. PCR amplification was performed of the v3-v4 variable regions of 16S rRNA of the collected specimens, as well as high-throughput sequencing using the Illumina platform. The species information was obtained by OTUs clustering, species annotation, and α-diversity analysis. RESULTS: Twenty-two male and eight female pediatric patients were included in the investigation The most abundant genus level bacterial representatives on the nasal surface before adenoidectomy were Moraxella catarrh, Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus, whereas on the surface of adenoids, they were Streptococcus pneumonia, Haemophilus influenza, Nucleobacter, and Moraxella catarrhalis. One year postoperatively, the bacteria with the highest abundance on the nasal surface at the genus level were Moraxella catarrhalis, Streptococcus pneumonia, Staphylococcus aureus, and non-culturable Dolosigranulum. One year postoperatively, the bacterial richness in the nasal cavity was significantly higher than at baseline (P < .05). Furthermore, the subjective nasal score of all children significantly decreased at 3, 6, and 12 months postoperatively (P < .01). CONCLUSION: The preoperative bacterial abundance of the nasal cavity and the adenoid surfaces was similar, showing a clear correlation. No single specific bacterium was established to be a dominant species associated with the development of CRS in children. The post-adenoidectomy bacterial richness in the nasal cavity was significantly increased, which may be closely related to the relief of postoperative sinusitis symptoms.

[Clinical analysis of 59 cases of pediatric nasal dermal sinus cysts with midfacial infection as the first symptom].

Objective:To review the clinical and radiological presentation and management of infected nasal dermal sinus cysts（NDSC） in children. Methods:Clinical data were collected from 59 NDSC children with secondary fronto-orbital area infection who presented to Beijing Children's Hospital from January 2007 to December 2021. All patients underwent preoperative imaging workup, including MRI and CT. All patients underwent endoscopic excision of a NDSC under general anesthesia. Results:A total of 59 patients were included in the study,while 58 presented with a sinus, 1 presented with a cyst.The main lesions of NDSC included nasal root in 20 cases （33.9%）, nasal bridge in 34 cases （57.6%）, nasal tip in 4 cases （6.8%）, and nasal tip and nasal root in 1 case （1.7%）. The depth of lesions included 6 cases （10.2%） of superficial type of nasal frontal bone, 33 cases （55.9%） of nasal frontal bone, 19 cases （32.2%） of intracranial epidural type, and 1 case （1.7%） of intracranial epidural type. The main sites of infection included inner canthus in 15 cases （25.4%）, nasal dorsum in 22 cases （37.3%）, nasal root in 16 cases （27.1%）, and forehead in 6 cases （10.2%）. Among 59 cases, 7 cases （11.9%） were complicated with other diseases, and 4 cases（6.8%） had external nasal deformities. Surgical approaches included transverse incision in 12 cases（20.3%）, minimal midline vertical incision in 41 cases （69.5%）, external rhinoplasty in 4 cases （6.8%） and bicoronal incision with vertical incision in 2 cases （3.4%）. The range of lesions was completely consistent with MRI results.All cases were successfully operated without one-stage nasal dorsum reconstruction. All patients were followed up from 7 to 173 months（average 52.2 months）. There were 6 cases of recurrence, all of which were in situ recurrence. The operation was performed again, and no recurrence has occurred since the follow-up, No nasal deformity was noted, and cosmetic outcome were favorable for all patients. Conclusion:NDSC infection in children with midfacial infection as the first symptom is rare in clinical practice, and its manifestations are diverse. Early diagnosis and rational treatment are very important to improve the cure rate.Preoperative high resolution MRI combined with CT scanning is of great significance in judging the course of NDSC, especially the intracranial extension. The treatment goal is to achieve minimally invasive and individualized treatment under the premise of complete excision of the lesion, and take into account the cosmetic needs.

Predictive Significance of Enhanced Level of Angiogenesis and Tissue Neutrophils for Antrochoanal Polyps Recurrence in Children.

BACKGROUND: The pathologic features and potential predictive biomarkers for recurrence of antrochoanal polyps (ACPs) in children are not fully understood. OBJECTIVES: To identify the pathologic differences between recurrent and nonrecurrent group and to explore potential clinical markers which predict recurrence of ACPs in children. MATERIAL AND METHODS: A total of 11 recurrent and 21 nonrecurrent ACPs children were enrolled into this retrospect study. Clinical basic information was collected before the first surgery. The counts of vessels were evaluated by hematoxylin-eosin (HE) staining, and CD34 was detected by immunohistochemistry. Meanwhile, the percentage of each tissue inflammatory cells (eosinophils, neutrophils, lymphocytes, and plasma cells) was assessed by HE staining. RESULTS: No statistical significance was observed between the 2 groups in the basic clinical features. Moreover, both the counts of blood vessels and the tissue neutrophils percentage were enhanced significantly in group with ACPs recurrence (P < .05). According to the receiver operating characteristic curves, the area under the curve for the counts of blood vessels and tissue neutrophils percentage in the prediction of ACPs' recurrence was 0.779 (P = .0105) and 0.989 (P < .0001) respectively. CONCLUSIONS AND SIGNIFICANCE: It was concluded that the counts of blood vessels and the percentage of tissue neutrophils appeared to be potential excellent predictors of ACPs recurrence in children.

Intranasal glial heterotopia in an infant boy.

INTRODUCTION: Nasal glial heterotopia is a rare congenital developmental disorder characterized by meningeal epithelium and/or glial components. CASE PRESENTATION: A 2-month-old boy presented for treatment of a congenital mass in the right nasal cavity near the pharynx. The preoperative diagnosis was congenital intranasal neoplasm. Nasal endoscopic resection of the nasopharyngeal mass was performed under general anesthesia. Histological findings in the resected tissue supported a diagnosis of intranasal glial heterotopia. The surgical outcome was good and no surgical site infection occurred. During 1 year of follow-up, the patient did not exhibit recurrence of heterotopia or related symptoms. CONCLUSION: Transnasal endoscopic surgery is recommended for patients with intranasal glial heterotopia. Thorough preoperative imaging should be performed before glioma resection. The mass should be differentiated from encephalocele to prevent cerebrospinal fluid leakage and meningitis.

Combination of the endoscopic septonasal flap technique and bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants: a retrospective study.

BACKGROUND: Multiple surgical approaches have been proposed to repair the congenital choanal atresia. However, there remains no general consensus about the optimal surgical technique. This study aimed to describe and evaluate outcomes of the endoscopic septonasal flap technique combined with bioabsorbable steroid-eluting stents for repair of congenital choanal atresia in neonates and infants. METHODS: Clinical data of 37 neonates and infants with congenital choanal atresia who received nasal endoscopic surgery with the flap technique between January 2018 and July 2020 were analyzed retrospectively. All patients underwent the ultra­low­dose paranasal sinus computed tomography imaging preoperatively to confirm diagnosis and plan the surgery. In these patients, the mirrored L-shaped flap technique was performed for bilateral atresia and the cross-over L-shaped flap technique was performed for unilateral atresia. A total of 22 patients had silicone stents postoperatively and 15 patients had bioabsorbable steroid-eluting stents postoperatively. Silicone stents were removed at one month postoperatively under secondary general anesthesia, while no anesthesia was needed to remove the bioabsorbable steroid-eluting stents. Postoperative follow-up ranged from 10 months to 3 years. RESULTS: The septonasal flap technique was performed in all patients. Compared with the silicone stents group, the average operative duration and the hospital length of stay in the bioabsorbable steroid-eluting stents group were decreased [(97.46 ± 15.37) min vs (83.49 ± 19.16) min t = 13.733, P < 0.001] [(12.8 ± 3.22) d vs (7.67 ± 3.91) d t = 15.082, P < 0.001], the average number of procedures was reduced [(2.04 ± 0.64) vs (1.00 ± 0.001), t = 82.689, P < 0.001], the differences were statistically significant. There were no reports of postoperative restenosis and complications in the bioabsorbable steroid-eluting stents group, and follow-up endoscopic examinations showed patency and stable nasal passages in all cases. CONCLUSIONS: The endoscopic septonasal flap technique can effectively expose and expand the choanal bony structure for repair of congenital choanal atresia in neonates and infants. The combined use of this technique along with bioabsorbable steroid-eluting stents can help prevent the need for revision procedures and also against stent-related injuries.

Intranasal glial heterotopia in a male infant: A case report.

RATIONALE: Nasal glial heterotopia is a rare type of neoplasm consisting of meningothelial and/or neuroglial elements. PATIENT CONCERNS: A 2-month-old male was evaluated for treatment of a congenital mass in the right nasal cavity near the pharynx. DIAGNOSES: The patient was preoperatively diagnosed with a congenital intranasal neoplasm. INTERVENTIONS: Nasal endoscopic resection of the nasopharyngeal mass was performed under general anesthesia. Histological examination of the resected tissue provided a diagnosis of intranasal glial heterotopia. OUTCOMES: The surgical outcome was good, with no surgical site infection. After 1 year of follow-up, the boy was asymptomatic with no recurrence. LESSONS: Excision of a nasopharyngeal mass via nasal endoscopy resulted in no recurrence during 1 year of follow-up. Before any surgical treatment for suspected glial heterotopia, the mass should be differentiated clinically and radiologically from an encephalocele to prevent the risk of cerebrospinal fluid leakage and meningitis.

Detection of nasal microbiota in pediatric patients with antrochoanal polyps by TLDA.

OBJECTIVE: To evaluate and compare the microbiological features in ACPs groups and control subjects in pediatric group, further to explore the potential role of microbial in the etiology of ACPs. METHODS: A total of 32 patients with ACPs, and 10 control subjects were enrolled in this study. Demographic datas were collected. The TaqMan low-density array assays were used to detect the microbial of swab specimens and nasal tissue samples from ACPs patients. RESULTS: A total of 15 species were identified in all groups. Of all the species, Mycoplasma pneumoniae was the most common species in ACP patients, but was negative in control group. Of all the viruses detected, Adenovirus positivity was significantly higher in control group than that in ACPs middle meatus on unaffected side, ACPs middle meatus on affected side, and ACPs polypous surface group (P < 0.05). Cytomegalovirus positivity was significantly higher in control group than that in ACP polypous group (P < 0.05). Human herpesvirus 6 (HHV-6) was absent in control goup, and positive in ACP middle meatus on affected side was significantly higher than that in ACP polypous surface and ACP polyp group (P < 0.05). The expression of other microbial differed not significantly in unaffected side, affected side of ACPs, ACPs polypous surface, and ACPs polyp. CONCLUSIONS: Mycoplasma pneumoniae was the most common species in ACP patients. Streptococcus pneumonia and Moraxella catarrhalis were the only bacteria detected at certain frequency in nasal polyps and control subjects. Human herpesvirus 6 andMycoplasma pneumoniae may have potential role in the development of ACPs. The isolates rate of microbial differed in middle meatus on unaffected and affected side of ACPs, ACPs polypous surface, ACPs polyp, and their role in the etiology of ACPs need to be further studied.

Inflammatory patterns of antrochoanal polyps in the pediatric age group.

BACKGROUND: The pathogenesis and etiology of antrochoanal polyps (ACPs) remains obscure. This study aimed to characterize the inflammatory profiles and investigate the effect of atopy on the pathogenesis of pediatric ACPs. METHODS: Thirty-three ACP patients and ten control subjects were enrolled from January to December 2017. The severity of individual nasal symptoms was scored on a visual analogue scale (VAS). The serum total immunoglobulin E (IgE) and cytokines level was measured by multiplexed luminex assay. RESULTS: There was no significant difference in VAS scores and counts of inflammatory cells between atopic and nonatopic ACP. No difference in IFNγ, IL-4, IL-5, IL-13, IL-17A and IL-25 was found between control and whole ACP, nonatopic and atopic ACP. Significantly increased levels of IL-6 and IL-10 were found in ACP compared with control. For neutrophil chemotactic factor, significant increases of IL-8 and GRO were observed in ACP, but for eosinophil chemotactic factor, no difference was found in RANTES and GM-CSF. IL-6 level was positively correlated with IL-8, MCP1, and GRO level, and IL-10 level was positively correlated with IL-4 and IL-13 in ACP subjects. CONCLUSION: Nasal obstruction was the most common symptom in ACPs in children. Allergic condition may have a poor role in the pathogenesis of ACPs. IL-6 plays a crucial role in the pathogenesis of neutrophilic inflammation in patients with ACPs and may provide a new treatment strategy for ACPs in children. Treg cell associated cytokine IL-10 was involved in the inflammatory pathophysiological process of ACPs and played a certain regulatory role.

Endoscopic Treatment of Isolated Sphenoid Sinus Disease in Children.

In this article, we explore the disease spectrum and clinical characteristics of and the diagnosis and endoscopic approach to treating isolated sphenoid sinus disease (ISSD) in children. To these ends, we review a case series of 19 patients (mean age: 8.1 ± 4.9 years, range: 1.1-15 years, median age: 6.7 years, 13 males, 6 females) who underwent surgical treatment at our hospital for ISSD during the 4 years between 2012 and 2016. The symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific and include atypical headache, nasal congestion, epistaxis, postnasal drip, snoring, and impaired vision. Headache is the presenting symptom in 42% of patients, but headaches occurred in no specific or typical location. Ten patients underwent preoperative endoscopic examination, and abnormalities in the sphenoethmoidal recess were found in 6 (60%) of these 10 patients. All 19 patients underwent ultra-low-dose paranasal sinus computed tomography (CT) imaging, and 9 patients with suspected tumors or sphenoid mucoceles were further examined by magnetic resonance imaging (MRI). The endoscopic transostial approach was performed in all 19 patients: 16 patients received excision of inflammatory sphenoid sinus disorders and benign tumors, including sphenoid sinusitis, sphenoid sinus mucocele, sphenoid sinus polyp, and ossifying fibroma; 3 patients with suspected tumors received biopsies to detect rhabdomyosarcoma, Langerhans cell histiocytosis, and juvenile xanthogranuloma. No intraoperative or immediate postoperative complications were observed. Children with opacified sphenoid sinus identified by radiographic imaging presented a variety of pathologies. The most common lesions were associated with inflammatory disease. Because the symptoms of pediatric sphenoid sinus disease tend to be variable and nonspecific, CT remains the standard for evaluating sphenoid sinus disease, and ultra-low-dose paranasal sinus CT imaging is recommended and can provide images of equal or better quality compared with those obtained by standard dose CT. In addition, MRI is an essential adjunct in the diagnosis and selection of treatment for suspected tumors of the sphenoid sinus. The endoscopic transostial approach was especially suitable for the management of pediatric benign isolated sphenoid sinus lesions.

Nasal nitric oxide in allergic rhinitis in children and its relationship to severity and treatment.

BACKGROUND: Nasal nitrous oxide (nNO) is increased in allergic rhinitis (AR), but not in asthma, and is a non-invasive marker for inflammation in the nasal passages. METHODS: Levels of nNO were measured and compared in healthy children and children with mild and moderate-to-severe AR. Levels of nNO before and after treatment with steroids and/or antihistamine were then compared in the 2 AR groups. Their relationship to quality of life and nasal symptom and reactivity to outdoor and outdoor allergens were examined. RESULTS: nNO levels were higher in mild AR than in healthy children and higher in moderate-to-severe AR than in mild AR. One month steroid and/or antihistamine treatment lowered nNO levels to control levels in mild AR and approximately halfway to control levels in moderate-to-severe AR. nNO levels had a weak correlation to quality of life questions and a fair correlation to nasal symptom scores before treatment. This correlation was weakened or lost after treatment, and no correlation was seen between nNO levels and responses to indoor or outdoor allergens. CONCLUSION: nNO levels in children with AR may be useful for assessing the response to treatment. Their relationship to quality of life, nasal symptoms, and sensitivity to specific allergens needs further study.

HLA-DRB1 and HLA-DQB1 alleles in Chinese Han patients with Juvenile-Onset recurrent respiratory papillomatosis.

Juvenile-Onset recurrent respiratory papillomatosis (JORRP) is a rare benign neoplasm of the respiratory mucosa caused by human papilloma virus. Previous studies on the possible associations between HLA alleles and JORRP have shown various results in different ethnic groups. The present study aims to investigate the association between JORRP and HLA class II DRB1and DQB1 alleles in Chinese Han children. We found that the frequencies of HLA-DRB1*03:01 (pc = 0.0378, OR = 4.8) and HLA-DQB1*02:01 (pc = 0.021, OR = 4.8) alleles were significantly higher in patients with JORRP than in controls. In addition, HLA-DRB1*03:01 allele significantly correlated with aggressive JORRP (r = 0.467, p = 0.009). This was the first study on the HLA alleles in Chinese Han patients with JORRP. Future studies are required to further elucidate the correlation of HLA class II alleles and susceptibility to JORRP.

Pneumomediastinum Secondary to Foreign Body Aspiration: Clinical Features and Treatment Explorement in 39 Pediatric Patients.

BACKGROUND: Pneumomediastinum (PM) secondary to foreign body aspiration (FBA) is rare in children. Although it is mainly benign, some cases may be fatal. Due to the rare nature of this clinical entity, proper assessment and management have been poorly studied so far. Here, we characterized the presentation and management of this clinical entity and provided an evaluation system for the management. METHODS: We retrospectively reviewed children with PM secondary to FBA, who were treated in Beijing Children's Hospital from January 2010 to December 2015. All patients were stratified according to the degree of dyspnea on admission, and interventions were given accordingly. Bronchoscopic removals of airway foreign bodies (FBs) were performed on all patients. For patients in acute respiratory distress, emergent air evacuation and/or resuscitations were performed first. Admission data, interventions, and clinical outcomes were recorded. RESULTS: A total of 39 patients were included in this study. The clinical severity was divided into three grades (Grades I, II, and III) according to the degree of dyspnea. Thirty-one patients were in Grade I dyspnea, and they simply underwent bronchoscopic FBs removals. PM resolved spontaneously and all patients recovered uneventfully. Six patients were in Grade II dyspnea, and emergent drainage preceded rigid bronchoscopy. They all recovered uneventfully under close observation. Two exhausted patients were in Grade III dyspnea. They died from large PM and bilateral pneumothorax, respectively, despite of aggressive interventions in our hospital. CONCLUSIONS: PM secondary to FBA could be life-threatening in some patients. The degree of dyspnea should be evaluated immediately, and patients in different dyspnea should be treated accordingly. For patients in Grade I dyspnea, simple bronchoscopic FBs removals could promise a good outcome. For patients in Grade II dyspnea, emergent air evacuation and/or resuscitation should precede a bronchoscopy before the children become exhausted.

[To investigate the diagnosis and treatment of children with subglottic area tumor].

OBJECTIVE: To discuss the diagnosis and treatment method in children with mass in subglottic. METHOD: There were totally 35 patients with subglottic mass who complained with dyspnea in our department. All the patients got electronic laryngoscopy examination in order to get the preliminary judgment of the mass' property. Then they accepted ultrasound and CT scan to make the definite diagnosis. The patients with subglottic hemangioma accepted oral propranolol or intralesional Pingyangmycin injection. The other type of masses got the laryngoscope CO2 laser tumor resection. RESULT: There were 31 patients with subglottic hemangiomas, 2 patients with subglottic cysts, 1 patient with subglottic fibroma, 1 patient with subglottic granuloma. The substantial follow-up time was from 1 month to 3 years. 25 patients with subglottic hemangiomas were cured, 6 patients got improvement. The patients with non-hemangiomas were all cured. CONCLUSION: There was a high incidence of hemangioma in children with subglottic mass. We suggested making a diagnosis by doing electronic laryngoscopy, ultrasound and CT scan step by step. Oral propranolol was a safe and effective method in treating subglottic hemangioma. For the patients with non-hemangiomas, we considered the laryngoscope CO2 laser tumor resection as the first choice of treatment.