[Analysis of the factors associated with non-adherence to therapy with home-based remote monitoring noninvasive positive pressure ventilation in children with obstructive sleep apnea-hypopnea syndrome and risk factors].

OBJECTIVE: To discuss the factors associated with non-adherence to therapy with home-based remote monitoring noninvasive positive pressure ventilation (NIPPV) in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and risk factors. METHODS: Twenty-one children with OSAHS and risk factors from March 2001 to December 2012 were enrolled in this study. They all received home-based remote monitoring NIPPV therapy. After admission, all children underwent NIPPV titration, then the parents were trained to operate the ventilator, after that, the children were discharged. Remote monitoring started to monitor NIPPV parameters and the adherence to NIPPV. RESULTS: Under remote monitoring, ten children (50.0%) were adherence to NIPPV therapy. Seven children (31.8%) gave up NIPPV therapy within one week and four children (19.0%) gave up one month after NIPPV therapy started. The reason for non-adherence was as follows: 3 cases (27.3%) had some economic problems, 3 cases (27.3%) considered NIPPV therapy as a inconvenient therapy and lost patience; 2 cases(18.2%) resisted the therapy and 3 cases (27.3%) could not tolerate the therapy. CONCLUSIONS: Under remote monitoring, non-adherence to home-based remote monitoring NIPPV therapy is still high in children during the early treatment, mainly due to economic problems, intolerance to the therapy and lack of the recognition of the importance of the therapy.

[Application of minimally invasive technique of coblation in 30 infants with epiglottic cyst].

OBJECTIVE: To present the efficacy of minimally invasive technology of coblation in the treatment of infant epiglottic cyst. METHODS: The clinical data of 30 infants with epiglottic cyst treated between January 2008 and January 2011 were reviewed retrospectively. All infants with epiglottic cyst were treated with the ArthroCare ENT Coblator II Surgery System after being checked completely. RESULTS: All 30 patients were successfully operated. The blood loss was less than 2 ml during the surgery. The infants recovered without any complications and were discharged from hospital in 10 days after surgery. The clinical symptoms improved significantly or disappeared. No patients showed recurrence during followed-up over 6 months. CONCLUSION: The advantage of the minimally invasive technology of coblation in infant epiglottic cyst was less bleeding, little injury and postoperative organization reaction.

[Study of arousal index in children with sleep-disordered breathing].

OBJECTIVE: To explore which index is more suitable to show the degree of sleep fragment in children with sleep-disordered breathing (SDB). METHODS: Between October 2009 and August 2011, Forty-five children (4 - 8 years) who were diagnosed as obstructive sleep apnea hypopnea syndrome (OSAHS) were enrolled in OSAHS group[obstructive apnea index (OAI) > 1 times/h or apnea hypopnea index (AHI) > 5 times/h, lowest oxygen saturation (LSaO2) < 0.92] and 54 children were enrolled in SDB group (1 ≤ AHI ≤ 5 times/h and OAI ≤ 1 times/h), 18 children with chorditis nodules made up control group (AHI < 1 times/h and LSaO2 ≥ 0.92, without SDB-related history). The difference of respiratory arousal index (RAI), spontaneous arousal index (SAI), total arousal index (ARtotI) and sleep pressure score (SPS) were compared among three groups. The correlation between RAI, SAI, ARtotI, SPS and AHI were also analyzed. Furthermore, RAI, SAI, ARtotI and SPS were compared before and after operation in 14 OSAHS children with detailed pre- and after polysomnography data. RESULTS: The difference of SAI and ARtotI between SDB group and OSAHS group and ARtotI between OSAHS group and control group were not significant (P > 0.017), except this, the difference of other index between any two groups or SAI and ARtotI between otherwise two groups were significant (P < 0.017). RAI and SPS was correlated with AHI (coefficient correlation: 0.751, 0.829, P was 0.000). RAI and SPS decreased after operation and the difference was significant (Z were -3.045 and -2.982, P were 0.002 and 0.003). The difference of sleep structure was not significant. CONCLUSIONS: RAI and SPS were more suitable to show the degree of sleep fragment than other arousal index.

[Reasons of multiple operations in children with airway foreign body].

OBJECTIVE: To explore the reasons of multiple operations in children with airway foreign body through analyzing the clinical data of children who received two or more operations. METHODS: From 2003 to 2009, all children with airway foreign body who received two or more operations in hospital were enrolled. The clinical manifestations, image before and after operation and intraoperative conditions were retrospectively analyzed, in order to find the reasons of multiple operations. RESULTS: All children fully recovered, no serious complications or death. The reasons of two or more operations were multiple: 21 cases (42.8%) were related to the factor of apparatus, 20 (40.8%) cases were related to the quality, surrounding conditions and location of the foreign body and experience and surgical skills of operator, 4 (8.2%) cases were due to incarceration of foreign body, another 4 (8.2%) cases were due to unstable intraoperative oxygen saturation. CONCLUSIONS: Both subjective and objective factors (quality, surrounding conditions or location of foreign body, et al) were related to multiple operations. To reduce the chance of multiple operations, careful preoperative assessment and preparation are necessary.

[Diagnostic role of pulse transit time in children with sleep disordered breathing].

OBJECTIVE: To explore the diagnostic value of pulse transit time (PTT) in children with sleep disordered breathing(SDB). METHODS: Forty eight randomly selected snorers (2 - 13 years) with SDB were examined by PSG and PTT in the same time. Data obtained were analyzed by different technicians respectively. Statistics and analysis of the data were performed. RESULTS: Apnea hypopnea index (AHI), obstructive apnea index (OAI), the lowest oxygen and micro-arousal index were obtained by PSG and PTT. The results was described as M [25 percentile; 75 percentile]: 4.9[1.3;10.1], 4.6[1.5;11.8]; 1.2[0.7;4.9], 1.3[0.6;5.0]; 0.93[0.85;0.95], 0.93[0.84;0.95]; 14.5[12.6;16.4], 26.0[17.4;30.6]. The difference of AHI, OAI, and the lowest oxygen were not significant (P > 0.05), while the PTT arousal index detection rate was higher than PSG (Z = -5.19, P < 0.01). There was no significant difference in the diagnosis of obstructive sleep apnea-hypopnea syndrome (OSAHS) and determination of degree of patient's condition (P > 0.05). PTT could identify upper airway resistance syndrome in children without OASHS. CONCLUSIONS: Both methods can be used to diagnose SDB. However, PTT is easy to use and suitable for the diagnosis of SDB in children, especially for UARS.

[Study on periodic limb movement during sleep in children with sleep-disordered breathing].

OBJECTIVE: To explore the correlation between periodic limb movement index (PLMI) and the apnea-hypopnea index (AHI), apnea index (AI), hypopnea index (HI) and lowest oxygen saturation (LSaO2) in sixty-four children with sleep-disordered breathing (SDB). METHODS: Between March 2008 and May 2009, sixty-four children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion. Sixty-four children were divided into two groups. Thirty children were diagnosed as OSAHS and 34 children were diagnosed as primary snoring (PS, 32 children) or upper airway resistance syndrome (UARS, 2 children). The difference of PLMI and periodic limb movement index during sleep associated with arousals (PLMI-arousal) were compared between the two groups. Besides this, the correlation between PLMI, periodic limb movement index during sleep associated with arousals and AHI, AI, HI and LSaO2 were also analyzed in all SDB children. Furthermore, all SDB children were divided into two groups according to PLMI (< 5 events/h vs ≥ 5 events/h). AHI, AI, HI, LSaO2 and sleep structure were compared between the two groups. RESULTS: (1) The difference of PLMI and PLMI-arousal between the children with OSAHS and children with other SDB types (PS and UARS) were not significant (z value, -1.279, -1.490; P value, 0.201, 0.136, respectively). (2) The increased sleep stage I was significant as being compared between the two groups (< 5 events/h vs ≥ 5 events/h, t = -2.16, P < 0.05). However, other sleep stages and sleep efficiency were not significantly different (P value, all > 0.05). (3) The difference of HI, AI, AHI, arousals index (ArI) and LSaO2 were not significant between the two groups (< 5 events/h vs ≥ 5 events/h, P value, all > 0.05). (4) PLMI and PLMI-arousal were not correlated with AHI, HI, AI, AHI and LSaO2 (Spearman rank correlation analysis). CONCLUSIONS: PLMS may be independent of SDB and PLMS had a little influence on sleep structure.

[Clinical analysis of upper airway resistance syndrome and obstructive sleep apnea-hypopnea syndrome in children].

OBJECTIVE: To analyze the similarities and differences of the clinical manifestations between the children with upper airway resistance syndrome (UARS) and obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the clinical features and characteristics of sleep respiratory parameters. METHODS: Using the double-blind method, all children were diagnosed as UARS or OSAHS through the polysomnography test and the results of all children were analyzed by a sleep technician and an otolaryngologist. Another ENT doctor recorded their clinical and physical examination in detail. RESULTS: Polysomnography showed that the apnea-hypopnea index (AHI) and the lowest oxygen in 253 children with OSAHS were 3.60[2.00;7.55] times/h and 0.90[0.85;0.91], and were 0.90[0.50;1.10] times/h and 0.95[0.92;0.96] in 102 children with UARS, the difference of the two groups by rank test was statistically significant. The proportion of UARS and OSAHS was more common during preschool period than during school-age period. The chief complaint in two groups was sleep snoring, and the main symptoms were sleep restless, attention deficit/hyperactivity and breath with mouth open. The incidence rate of above symptoms were as follows, 94.1%, 72.5%, 62.7% and 37.3% in children with UARS, 92.9%, 78.7%, 57.7% and 45.5% in children with OSAHS. The difference was not significant by chi-square test (P>0.05). Tonsil and adenoid hypertrophy were also observed in the two groups, the difference was not significant (chi2 = 0.27, P= 0.87). However, the children with OSAHS were more apt to have the sleep apnea than with UARS, the difference was statistically significant (chi2 = 34.07, P<0.001). CONCLUSIONS: The clinical manifestations of two groups are similar, the difference between UARS and OSAHS can not be determined by the patient's clinical performance. Sleep apnea can be more easily observed in children with OSAHS than that in UARS, the final diagnosis is based on polysomnography.

[Evaluation and analysis of auditory function and its clinical characteristics in low birth weight premature infants.].

OBJECTIVE: To investigate and analyze dynamic changes of auditory function in premature babies with fetal age of less than 37 weeks who were categorized into different birth weight groups and to detect abnormalities of auditory function in these babies and to describe the early development patterns of auditory function in infancy. METHODS: Total of 252 subjects (504 ears) from neonatal ward, neonatal intensive care unit and auditory clinic in Guangzhou Children Hospital, whose fetal age were less than 37 weeks, were included in our study and received auditory function evaluation from January 2004 to February 2008. To investigate the correlation between birth weight and development and abnormality of auditory function in premature babies, all subjects were divided into four groups according to birth weight: 2.5 kg. Each group was further categorized by subject's age on first auditory function evaluation in 0 - 3 months (include 3 months), 3 - 6 months (include 6 months) and above 6 months, respectively. Subjects who were evaluated more than once in different age frame would be grouped into multiple evaluation subgroups. All subjects underwent one or more objective auditory examinations including auditory brainstem response (ABR), distortion product otoacoustic emission (DPOAE), tympanometry and acoustic stapedius reflex. RESULTS: A tendency of decreased wave V threshold of ABR was seen as birth weight increased, while the percentage of subjects with ABR wave V threshold

[Audiological characteristics and localization of lesions in children with retrocochlear auditory nerve impairment].

OBJECTIVE: To explore the clinic characteristics, audiological characteristics and location of lesions in children with retrocochlear auditory nerve impairment which, including auditory neuropathy characterized by severely abnormal results of ABR and normal results of DPOAE. METHODS: Between 2002 and 2006, eighty-six cases (165 ears) with severely abnormal ABR but normal results of DPOAE were enrolled in the study group. The mean patient age was one year and one-month-old, with a range of 8 days to 7 years. The cases with abnormal conductive function were excluded. The cases with severely abnormal ABR and normal cochlear functions as measured by DPOAE and without abnormal conductive function were selected as the cochlear lesion group. Some same age healthy children without hearing loss were subjected as normal control group. The latency and amplitude of waves I, III and V, the inter peak latency I-III was compared among the three group. RESULTS: (1) Fifty-one cases (59.3%) had a history of hypercholesterolemia during neonatal period, but 40 cases (46.51%) had a severe hypercholesterolemia and 11 cases (12.79%) had mild or moderate hypercholesterolemia. Clinical features common among the population included a history of dyskinesia [n = 40 (46.51%)], hearing and language disorder [n = 10 (11. 63%)]. Thirty-two cases (37.2%) were accompanied by cerebral palsy . (2) Among the 165 ears, absent ABRs to click stimuli presented at 103 dB was in 103 ears, only wave I was developed in 27 ears and only wave V was developed in 19 ears,wave I and III in 13 ears and differentiated wave I and V in 3 ears. (3) When compared to control group, the latency of wave I was prolonged and amplitude of wave I was lower in cases with only wave I developed (t = -6.75 and 2.58, P < 0.05). For for cases with only wave I and III differentiated, the latency and amplitude of wave I was the same but the latency of wave III was prolonged and amplitude of wave III was lower while interpeak latency I-III was prolonged. CONCLUSIONS: Auditory neuropathy which was characterized by severely abnormal ABR was the most common type of retrocochlear auditory nerve impairment. It was mainly due to a disorder of VIII nerve. The pathologies that affect higher levels of the auditory pathway, from the brainstem to the auditory cortex, might be the main sites of lesion in cases with only wave I developed. Superior olivary nucleus where wave III was generated and higher levels of the auditory pathway might be the main sites of lesion in cases with wave I and III differentiated. The low-amplitude wave V was not characteristics of auditory neuropathy. Cerebral cortex, brain stem auditory nucleus and VIII nerve might be damaged successively in cases with retrocochlear auditory nerve impairment induced by hypercholesterolemia.

[Comparison of the sleep architecture and symptom of inattention-hyperactivity in children with obstructive sleep apnea hypopnea syndrome before and after surgery].

OBJECTIVE: To observe the symptoms of inattention, hyperactivity among obstructive sleep apnea hypopnea syndrome (OSAHS) children, also to investigate the effects of surgery (tonsillectomy and adenoidectomy or adenoidectomy alone) on the changes of sleep architecture and inattention-hyperactivity score (IHS). METHODS: Between June 2004 and may 2007, eighty children diagnosed as OSAHS with overnight polysomnography (PSG) were included in this study, only sixteen children had complete pre-op and post-op PSG data. Thirty children with vocal cord nodules were selected as control group. DSM-IV-derived IHS was evaluated by neurologist. All OSAHS children accepted surgery (tonsillectomy and adenoidectomy or adenoidectomy alone) and IHS evaluation. The pre-op and post-op sleep architecture and IHS were compared with that of control group. RESULTS: (1) The median IHS 80 OSAHS children was higher than that it in control group (0.89 vs 0.17) and the difference was significant (Z = -4. 276, P < 0.05). After surgery, it showed a significant reduction in IHS (0.44 vs 0.89, t = 6.219, P < 0.05). (2) Twenty-five OSAHS children had pre-op IHS greater than 1.25 and nine had post-op IHS greater than 1.25, while only three children in control group had IHS greater than 1.25. The difference was statistically significant (chi2 = 5.192, 9.56 respectively, P < 0.05). (3) For sixteen OSAHS children who had both pre-op and post-op PSG data, a decrease in the percentage of phase 1 sleep and an increase in the percentage of phase 2 sleep, slow wave sleep (SWS) and rapid eye movement (REM) sleep were observed in six months after surgery and the difference was significant (t = 12.2, -5.4, -6.3, - 8.1 respectively, P < 0.001). After surgery, apnea-hypopnea index (AHI) decreased from 13.9 times/h to 1.5 times/h while lowest saturation of blood oxygen (LSaO2) increased from 0.855 to 0.940 (t = 5.3, - 3.7 respectively, P < 0.01). REM sleep percentage and LSaO2 was still lower than that of control group six months after surgery. CONCLUSIONS: Children with OSAHS showed significantly impaired attention and hyperactivity as compared with control group. Improvement of behavior and sleep architecture were observed after adenoidectomy and tonsillectomy.

[Diagnosis and treatment of obstructive sleep apnea hypopnea syndrome in children with risk factors].

OBJECTIVE: To analyse the clinical features of children with obstructive sleep apnea-hypopnea syndrome (OSAHS), accompanying with risk factors. METHODS: The clinic data of 19 patients treated in the Department of Otorhinolaryngology of Guangzhou Children's Hospital between January 2005 to January 2008 were investigated retrospectively. Among them, 5 were < 2 years old, 6 with craniofacial deformity: small mandible and (or) mandibular retrusion (5 cases), transverse facial cleft (1 case), Down's syndrome (2 cases), cerebral palsy (2 cases), chronic bronchitis (3 cases) and mucopolysaccharidoses (1 case). Nineteen patients with symptoms of snoring, mouth breathing, were diagnosed as OSAHS by polysomnography (PSG) and treated by tonsillectomy and (or) adenoidectomy in hospital. All patients were closely followed-up. RESULTS: Fourteen patients underwent PSG 6 months to 1 year after operation, 11 patients recovered, the median [percentiles 25; percentiles 75] apnea-hypopnea index (AHI) decreased from the pre-operative 22.5 [16.5; 24.3] times/h to 2.0 [1.5; 4.3] times/h, and the lowest oxygen saturation (LSaO(2)) before operation was 0.63, and was higher than 0.92 after operation, 1 case accompanying with chronic bronchitis, the pulmonary hypertension was improved after operation. One case with Down's syndrome was not significantly improved, preoperative AHI and LSaO(2) was 22.4 times/h and 0.67, and after operation was 14.2 and 0.84; 2 cases accepted adenoidectomy only, snoring, mouth breathing reappeared 3 months after operation, pre-operative PSG results showed AHI 24.6 times/h and 26.6 times/h, LSaO(2) was 0.69 and 0.73, after operation the AHI was 10.6 times/h and 8.5 times/h, LSaO(2) was 0.90 and 0.88, the symptoms disappeared after adenotonsillectomy. Five cases did not have PSG because they lived far away in the other cities, their pre-operative PSG showed AHI 16.4 to 26.2 times/h, LSaO(2) was 0.65 to 0.76. One year after operation, these patients were followed-up by telephone, 4 children were significantly improved, 1 case with mandibular symptoms showed no improvement. CONCLUSIONS: For OSAHS children accompanying with risk factors, if they have adenoid and tonsil hypertrophy, adenotonsillectomy is the major treatment. Because of the existence of risk factors, perioperative risk increased, even the failure of operation. so these patients must be comprehensively assessed before operation. Satisfied results can be achieved by close observation after operation and management of complications as soon as possible.

[Arousals in children with obstructive sleep apnea-hypopnea syndrome].

OBJECTIVE: To explore the difference of arousal index between the children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and children with primary snoring. Furthermore, to explore the correlation between the above mentioned arousals and the apnea-hypopnea index (AHI) and lowest oxygen saturation (LSaO(2)). METHODS: Between March 2007 and February 2008, 102 children suspected of OSAHS underwent overnight polysomnogram monitoring in our medicine sleep center. OSAHS was diagnosed according to the general criterion [Draft of guidelines for the diagnosis and treatment of pediatric sleep apnea hypopnea syndrome (Urumqi) which was published in Chin J Otorhinolaryngol Head Neck Surg in February, 2007]. One-hundred and two children were divided into two groups according to the guidelines. Sixty six children [56 boys, 10 girls; aged 4 - 17 years, (7.01 +/- 2.24) years (x(-) +/- s)] who were diagnosed as OSAHS were enrolled in study group and 36 children [29 boys, 7 girls; aged 4 - 13 years, (7.44 +/- 2.68) years] who were diagnosed as primary snoring made up control group. The difference of spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared between the two groups. Besides this, the correlation between spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement and AHI and LSaO(2) were also analyzed. Furthermore, the study group were divided into three subgroups according to AHI (< or = 10 times/h, 10 times/h < AHI < or = 20 times/h, > 20 times/h). Spontaneous arousal index, total arousal index and arousal index related to respiratory stimuli and limb movement were compared among the three groups. RESULTS: The increased total arousal index and arousal index related to respiratory stimuli and the decreased spontaneous arousal index of study group were significant as compared to those of control group (Mann-Whitney U, z value, -3.148, -3.866, -2.791; P value, 0.002, 0.000, 0.005, respectively). The increased arousal index related to respiratory stimuli were significant as being compared among the three groups. Arousal index related to respiratory stimuli was correlated with AHI (coefficient correlation: 0.734, P = 0.000). Other kinds of arousals and arousal index related to respiratory stimuli were not correlated with LSaO(2) (Spearman rank correlation analysis). When compared to control group, stage I increased and stage REM decreased and the difference was significant (z were -2.423, -3.519; P were 0.015, 0.000). CONCLUSIONS: The arousal index related to respiratory stimuli were increased and spontaneous arousal index were decreased in children with OSAHS. Arousal index related to respiratory stimuli is more suitable to show the degree of sleep fragment than other arousal index.

[Analyses of polysomnogram in children suspected of obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To analyze polysomnogram characteristics of children with suspected obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the role of obstructive apnea index (OAI), apnea hypopnea index (AHI) and arousal index for pediatric OSAHS diagnosis. METHODS: Sixty one suspected pediatric OSAHS cases had overnight polysomnography for at least 8 h in a quiet, dark room. Sleep studies were interpreted according to diagnostic criteria of Guangzhou Children's Hospital (Obstructive apnea was defined as cessation of nose and mouth airflow, while the respiratory effort continues for any duration. Hypopnea was defined as reduction of oronasal flow > 50% accompanied by a desaturation of 0. 04 or greater) and Urumqi diagnostic criteria (Obstructive apnea was defined as cessation of airflow at the nose and the mouth, while the respiratory effort continues for at least two breaths. Hypopnea was defined as reduction of oronasal flow > 50% accompanied by a desaturation of more than 0.03, or/and by an arousal) respectively. The OAI, AHI and arousal index were recorded and analyzed according to the two different diagnostic criteria respectively. RESULTS: (1) Forty - one children (67.2%) had 206 obstructive apneas. Fifty - four children (88.5%) had 2249 obstructive hypopneas. Apnea - hypopnea events mainly occurred during rapid eye movement sleep. (2) OAI and AHI were analyzed by diagnostic criteria of Guangzhou Children's Hospital and Urumqi diagnostic criteria respectively. OAI < 1 was observed in 68. 9% and 75.4% children respectively and AHI < 5 occurred in 34.4% and 24.6% children respectively. (3) Statistically significant difference found between spontaneous arousal index and respiratory - related arousal index (z = -5.787, P = 0.000). CONCLUSIONS: As the criteria of pediatric OSAHS, arbitrary OAI number should be determined on the basis of large sample investigation, the significance of spontaneous arousal index still needs further investigation.

[Hearing evaluation of infants failed in hearing screening].

OBJECTIVE: To analyze the confusing factors and clinical and audiological characteristics in infants failed in hearing screening. METHODS: Between August 2004 and January 2006, 166 infants (315 ears) with detailed birth record and hearing screening record were reviewed in the study. The age of this series ranged from 2 to 6 months. They were born in maternal and child health hospitals (MCH) in Guangzhou city and surrounding areas, and had hearing screened by otoacoustic emissions (OAE). However, they failed in the first and second hearing screening. The birth history, high-risk factors of hearing-impaired during newborn period and pregnancy history of subjects were fully detailed. Subjects were classified according to the age: 2 to 3 months old infants were considered as group 1, while 4 to 6 months old infants were considered as group 2. Auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE) and acoustic immittance measurement were examined. Subjects with abnormal hearing-evaluation were retested during the following one to three months (before 6-month-old). The ABR results, DPOAE results and tympanic cavity pressure and static compliance value were compared between the two tests and then diagnosis was made. RESULTS: (1) Among the 166 cases, 34 (20.5%) cases were once suffered from hypercholesterolemia of newborn, and 10 cases (6.0%) had asphyxia and hypoxia history. (2) The proportion of presenting type B tympanogram in group 2 was higher than that of group 1 (chi2 = 26.22, P < 0.01). (3) The proportion of normal ABR in group 2 (37.2%) was significantly higher than that of in group 1 (23.4%, chi2 = 0.527, P < 0.05). Fifty-six percent of infants accepted twice ABR test had improving ABR results during the second test. (4) The proportion of normal DOPAE in group 2 (39.7%) was slightly lower than that of in group 1 (42.2%, chi2 = 0.14, P > 0.05). Among the infants who accepted twice DPOAE test, 32.0% had improving results in the second test. (5) Four cases (4 ears ) were diagnosed as auditory neuropathy. CONCLUSIONS: Middle ear function and development of auditory system in infants may be confusing factors in hearing screening. The results of hearing screening should be interpreted appropriately.

[Clinical features and surgery in children with plastic bronchitis].

OBJECTIVE: To review the clinical features and therapeutic experience in children with plastic bronchitis. METHODS: Fourteen children with plastic bronchitis were reviewed retrospectively, 12 of which were under two years old. The clinical features are characterized by sudden onset, episodes of profound hypoxia and respiratory tract obstruction. SaO2 was between 0.70 and 0.80 even with mask oxygen inhalation. Eight cases were pyretic, 4 cases expectorated jel-like bronchial casts. The chest X-ray picture showed patchy consolidation or atelectasis unilaterally (10 cases) or bilaterally (2 cases). Pulmonary marking thickening and patchy shadow were observed in 2 cases. Twelve cases underwent rigid bronchoscopy and the bronchial casts were removed. Two cases underwent endotracheal intubation. RESULTS: Eight cases of 12 children received therapeutic bronchoscopy were cured. Other 4 cases had second therapeutic bronchoscopy and bronchial casts were removed again in 3 cases, one died from pulmonary hemorrhage. Two cases who underwent endotracheal intubation died from the multiple organ failure (MOF). Pathologic results showed:the bronchial casts were composed mainly of mucus and fibrin, inflammatory cell infiltrate were observed in 6 cases (Type 1, inflammatory), no cellular infiltrate occurred in 8 cases (Type 2, acellular). CONCLUSIONS: Plastic bronchitis is a severe and dangerous disease. The branching plastic casts may obstruct part or the entire tracheobronchial, causing respiratory failure. Bronchoscopy and pathologic examination are essential for it's diagnosis and treatment.