Atopic children are more susceptible to viral respiratory infection at the age of 2-5 years old.

Background: The susceptibility of the atopic population to respiratory infections (RI) has not been fully elucidated. This susceptibility is attributed to the immune dysregulation that characterizes atopic diseases. Although, the exact mechanisms involved are not fully understood, there is evidence that shows that the maturation of innate immunity progresses differently in patients with atopy. Objective: The aim of the study was to evaluate the susceptibility to viral RIs (VRI) based on the number and duration of them in different age groups in subjects with atopy and subjects without atopy. Methods: Seventy-eight subjects (39 healthy and 39 with atopy) were included in the study. All the subjects were evaluated by a specialist and defined as being atopic if they had a clinical history and/or symptoms compatible with any allergic diseases and relevant sensitizations. Epidemiologic data were recorded based on a standardized questionnaire, which included recording habits, conditions, and living environment as well as the history of viral infections during the last year. Results: In our population, children with atopy were found to be more susceptible to viral RIs than children without atopy (p = 0.02), whereas there was no difference in susceptibility between healthy adults and adults with atopy (18-45 years old). More specifically, the atopic age group 2-5 years old showed the higher susceptibility to VRIs. Conclusion: This study provided evidence that children with atopy, especially at ages 2-5 years old, had more numerically and prolonged RIs than did the subjects without atopy. These clinical findings support the hypothesis of distracted maturation of innate immunity in subjects with atopy.

New concepts in pediatric rhinitis.

Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.

Features and Strategies in the Management of Choanal Atresia: A 6-Year Retrospective Analysis.

INTRODUCTION: Choanal atresia although rare, is the most common inborn nasal deformity and an important cause of newborn airway obstruction. This study aims to describe a single-center experience in the management of choanal atresia and emphasize the ambiguous issues regarding its surgical repair. PATIENTS AND METHODS: The authors retrospectively analyzed the treatment strategy of 18 patients with choanal atresia and their outcomes during the follow-up period. RESULTS: Bilateral choanal atresia was diagnosed in 9 patients, 6 of those had mixed bony-membranous type (67% versus 33% who had pure bony type). Almost half of the 18 patients had a mixed bony-membranous type of atresia (56%). Interestingly, 89% of patients with bilateral atresia underwent transnasal endoscopic repair with stenting, compared to 44% of those with unilateral atresia (P = 0.04). A trend to preference of stent procedure in patients with bony type was also observed, in comparison with mixed bony-membranous type (89% versus 50%, P = 0.09). No significant difference in the need for revision treatment was noticed among the two treatment groups. CONCLUSIONS: Both in our data and literature there is no clear supremacy of stenting. Considering the high incidence of re-stenosis, all patients should be under close follow up for a long-term period. Inevitably, further investigation is necessary to establish an ideal surgical procedure.

Rhinovirus Species-Specific Antibodies Differentially Reflect Clinical Outcomes in Health and Asthma.

Rationale: Rhinoviruses (RVs) are major triggers of common cold and acute asthma exacerbations. RV species A, B, and C may have distinct clinical impact; however, little is known regarding RV species-specific antibody responses in health and asthma.Objectives: To describe and compare total and RV species-specific antibody levels in healthy children and children with asthma, away from an acute event.Methods: Serum samples from 163 preschool children with mild to moderate asthma and 72 healthy control subjects from the multinational Predicta cohort were analyzed using the recently developed PreDicta RV antibody chip.Measurements and Main Results: RV antibody levels varied, with RV-C and RV-A being higher than RV-B in both groups. Compared with control subjects, asthma was characterized by significantly higher levels of antibodies to RV-A and RV-C, but not RV-B. RV antibody levels positively correlated with the number of common colds over the previous year in healthy children, and wheeze episodes in children with asthma. Antibody levels also positively correlated with asthma severity but not with current asthma control.Conclusions: The variable humoral response to RV species in both groups suggests a differential infectivity pattern between RV species. In healthy preschoolers, RV antibodies accumulate with colds. In asthma, RV-A and RV-C antibodies are much higher and further increase with disease severity and wheeze episodes. Higher antibody levels in asthma may be caused by a compromised innate immune response, leading to increased exposure of the adaptive immune response to the virus. Importantly, there is no apparent protection with increasing levels of antibodies.

A Case Report of Melanoma as Acute Mastoiditis in a 10-Month-Old Female Child.

We present a rare case of transplacental-transmitted maternal melanoma to the placenta and foetus during the pregnancy of a 34-year-old woman. She was diagnosed with a melanoma at the age of 25, for which she was treated with chemotherapy. During her pregnancy, she presented with a recurrence of the disease and died 3 months after delivery. The 10-month-old female child presented with a recurrent retroauricular oedema on the left side. A trephination of mastoid apophysis followed. Multiple fragments of dark-coloured tissue were sent for histological examination, and the immunophenotype showed a melanocytic tumour in the mastoid. A full radiological assessment showed no sign of metastasis. The child remained without treatment. Complete remission of bone metastatic lesion has been confirmed by follow-up; now, the child is 4 years old, alive, and without evidence of disease.

Histological features of osteofibrous hemangioma of the maxillofacial and skull base regions.

OBJECTIVES: The histological spectrum of hemangiomas of the skull base and maxillofacial skeleton was evaluated to help explain the variability of the clinical and radiological presentation of this tumor. DESIGN: Retrospective case series. PARTICIPANTS: Patients with surgically treated hemangiomas of the ear, sinuses, skull base, and maxillofacial bones. METHOD: Light microscopic appearance of surgical specimens. RESULTS: Review of specimens from 23 tumors revealed two distinct histological patterns: 1) typical histology consisting of vascular spaces lined by endothelium and a thin layer of smooth muscle, and 2) osteofibrous histology that consisted of prominent fibrous tissue between vascular spaces associated occasionally with neo-osseogenesis. The osteofibrous histology was more prevalent in the sinonasal and anterior skull base regions compared to the internal auditory canal. CONCLUSIONS: Connective tissue and bony proliferation within hemangiomas vary according to tumor location and may have implications for the radiological appearance, ease of surgical resection, and associated morbidity.

Surgical management of drooling: clinical and caregiver satisfaction outcomes.

INTRODUCTION: Various surgical techniques are used to manage problematic drooling. These include: (1) re-routing of the submandibular ducts/excision of the sublingual glands (group 1), (2) excision of the submandibular glands/parotid duct ligation (group 2), and (3) ligation of the parotid and submandibular ducts (group 3). PURPOSE: To compare the long-term effectiveness of three surgical techniques and to evaluate long-term caregiver satisfaction. SETTING: Tertiary care children's hospital. STUDY DESIGN: 10 year retrospective chart review and telephone follow-up questionnaire. METHODS: Demographic data, drooling severity, medical management and surgical outcomes using objective severity ratings were evaluated. Satisfaction scores were obtained by phone interview. RESULTS: 33 patients, 19 male and 14 female, age 1.1-27.6 years (mean 9.4+/-4.9) underwent surgery. Six patients were in group 1, 14 in group 2 and 13 patients in group 3. There was no difference in age, sex or severity of drooling among groups. Mean follow-up was 4.5 years (range 1.1-10 years). Post-operative anti-cholinergic use was most common in group 3 (53%) compared to 21% in group 2 and 33% in group 1. Overall caregiver satisfaction for each group was 83% for group 1, 79% for group 2, and 30% for group 3. Gradual return of drooling occurred in 8 of 13 (61%) patients in group 3 and resulted in dissatisfied caregivers. CONCLUSIONS: Although recent literature advocates four-duct ligation, our long-term results do not appear favorable. Reasons for this failure and strategies for avoidance are discussed.

Synaptic alterations at inner hair cells precede spiral ganglion cell loss in aging C57BL/6J mice.

Hearing deficits have often been associated with loss of or damage to receptor hair cells and/or degeneration of spiral ganglion cells. There are, however, some physiological abnormalities that are not reliably attributed to loss of these cells. The afferent synapse between radial fibers of spiral ganglion neurons and inner hair cells (IHCs) emerges as another site that could be involved in transmission abnormalities. We tested the hypothesis that the structure of these afferent terminals would differ between young animals and older animals with significant hearing loss. Afferent endings and their synapses were examined by transmission electron microscopy at approximately 45% distance from the basal end of the cochlea in 2-3 month-old and 8-12 month-old C57BL/6J mice. The number of terminals in older animals was reduced by half compared to younger animals. In contrast, there was no difference in the density of SGCs between the age groups. Older animals featured enlarged terminals and mitochondria and enlarged postsynaptic densities and presynaptic bodies. These morphological changes may be a combination of pathologic, adaptive and compensatory responses to sensory dysfunction. Improved knowledge of these processes is necessary to understand the role of afferent connectivity in dysfunction of the aging cochlea.

Juvenile recurrent respiratory papillomatosis: still a mystery disease with difficult management.

Juvenile recurrent respiratory papillomatosis (RRP) is the most common benign neoplastic disease of the larynx in children and adolescents and has a significant impact on patients and the health care system with a cost ranging from $60,000 to $470,000 per patient. The aim of this paper is to review the current literature on RRP and summarize the recent advances. RRP is caused by human papillomavirus (HPV; mainly by types 6 and 11). Patients suffer from wart-like growths in the aerodigestive tract. The course of the disease is unpredictable. Although spontaneous remission is possible, pulmonary spread and malignant transformation have been reported. Surgical excision, including new methods like the microdebrider, aims to secure an adequate airway and improve and maintain an acceptable voice. Repeated recurrences are common and thus overenthusiastic attempts to eradicate the disease may cause serious complications. When papillomas recur, old and new adjuvant methods may be tried. In addition, recent advances in immune system research may allow us to improve our treatment modalities and prevention strategies. A new vaccine is under trial to prevent HPV infection in women; the strongest risk factor for juvenile RRP is a maternal history of genital warts (transmitted from mother to child during delivery). Better understanding of the etiology of the disease and the knowledge of all available therapies is crucial for the best management of the affected patients.