Earlier recovery of lingual dysfunction after middle ear surgery in pediatric versus adult patients.

OBJECTIVES: It is generally thought that the recovery of damaged chorda tympani nerve (CTN) function after middle ear surgery is different in pediatric patients from that in adult patients. The purpose of this study was to investigate the changes and the progress of taste and somatosensory functions of the tongue after middle ear surgery in pediatric patients compared with those of adult patients. STUDY DESIGN: Prospective study. METHODS: Fifty-nine pediatric patients and 106 adult patients underwent middle ear surgery. Taste and somatosensory functions of the anterior tongue, the so-called CTN functions, were assessed using electrogustometry (EGM), a 2-point discriminator, an electrostimulator, and a questionnaire before and 2 weeks and 6 months after surgery. RESULTS: Two weeks after surgery, there was no significant difference in the incidence of dysgeusia and abnormal EGM thresholds between the patient groups. The incidence of tongue numbness was significantly lower in pediatric patients than in adult patients regardless of CTN manipulation. Although the lingual somatosensory thresholds of adult patients were significantly increased, those of pediatric patients were not increased. Six months after surgery, the incidences of dysgeusia and an abnormal EGM threshold were lower in pediatric patients than in adult patients. Tongue numbness disappeared, and the thresholds of lingual somatosensory tests returned to normal in most pediatric patients. CONCLUSION: Not only taste function but also lingual somatosensory function was damaged after middle ear surgery even in pediatric patients. Pediatric patients complained of tongue numbness less frequently and showed earlier recovery than adult patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1016-1022, 2020.

Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery.

OBJECTIVES: Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery. STUDY DESIGN: Prospective study. METHODS: Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM). RESULTS: The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms. CONCLUSION: These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:701-706, 2018.

[A case of the complications following glycerin enema which suggested malignant hyperthermia].

We experienced a case of the complications following glycerin enema which suggested malignant hyperthermia. A 73-year-old man with knee osteoarthritis was scheduled for total knee arthroplasty under general and epidural anesthesia. The patient received glycerin enema before surgery. After epidural catheterization, anesthesia was induced with thiopental, fentanyl, vecuronium and sevoflurane. The trachea was intubated and the patient was ventilated with sevoflurane-air-oxygen. Then, cola-like urine was drained and he became febrile up to 37.9 degrees C. Although there were no other symptoms suggesting malignant hyperthermia, the surgery was cancelled. We suspected not only hemolysis by the color of the serum and the blood chemistry, but also rhabdomyolysis by increased levels of serum creatine phosphokinase and myoglobin as well as urine myoglobin. He recovered uneventfully. On the third day, perirectal abscess and anal fissure were diagnosed, which were considered to be the cause of the fever. It is well-known that glycerin enema could cause hemolysis, but rabdomyolysis as a complication of glycerin enema has rarely been reported. We speculate that injection of hypertonic glycerin into the perirectal tissue could have caused rhabdomyolysis as well as hemolysis, which led to cola-like urine. The complications following glycerin enema can be incorporated to a differential diagnosis of malignant hyperthermia.

Detection of drug-resistant Escherichia coli in patients with complicated cystitis: analysis of risk factors.

OBJECTIVES: To determine the prevalence and risk factors for isolation of drug-resistant Escherichia coli (E. coli) in patients with complicated cystitis. METHODS: We analyzed 170 patients with complicated cystitis and urine culture was positive for E. coli in all of them. Detailed clinical features were identified and risk factors for isolation of drug-resistant E. coli were determined. RESULTS: The drug susceptibilities of 170 isolates to levofloxacin and cefotaxime or cefpirome were 77% and 96%, respectively. Fluoroquinolone-resistant E. coli (FQREc) was detected at least once in 39 patients. Prior use of fluoroquinolones within 1 month, between 1 and 3 months, and hospitalization were risk factors for FQREc infection (P < 0.05), with odds ratios of 24 (95% confidence interval [CI] 6.4-89), 4.7 (95% CI 1.8-12), and 3.1 (95% CI 1.4-6.8), respectively. All six organisms resistant to cephems were extended-spectrum beta-lactamase (ESBL)-producing E. coli. The isolation of ESBL-producing E. coli tended to be more frequent in patients who were hospitalized (P < 0.05), with an odds ratio of 7.9 (95% CI 1.4-45). There was no significant correlation between growth rate of ESBL-producing E. coli and prior use of antibiotics. CONCLUSIONS: The frequencies of FQREc and ESBL-producing E. coli were 23% and 4%, respectively. Prior use of fluoroquinolones within 3 months and hospitalization were risk factors for FQREc. Hospitalization was a risk factor for ESBL-producing E. coli infection.