Upper airway cough syndrome in 103 children / 中华医学杂志(英文版)

BACKGROUND@#In China, upper airway cough syndrome (UACS) is only less frequent than cough-variant asthma and accounts for 24.71% of chronic cough. This study aimed to determine the pathogenetic constituents and factors affecting UACS in children of different age groups, and to identify clinical clues for diagnosing UACS and a method for curative effect evaluation.@*METHODS@#A total of 103 children with UACS whose chief complaint was chronic cough were studied from January to November 2013 at Children's Hospital, Capital Institute of Pediatrics. According to their age, children with UACS were divided into 3 groups: nursing children, pre-school children, and school-age children. We analyzed the differences in pathogenetic constituents and factors affecting UACS in children. The effect of UACS treatment was evaluated by the visual analog scale (VAS) and an objective examination. Chi-squared test and analysis of variance were performed with the SPSS 19.0 statistical software.@*RESULTS@#There was a high incidence of UACS in school-age children. Rhinitis with adenoid hypertrophy was the main cause of 103 suspected UACS cases. Adenoidal hypertrophy was the major cause of UACS in the pre-school children group, while rhinitis was the major reason in the nursing children and school-age children groups. Among the 103 children, there were 45 allergen-positive children, with no significant difference among different age groups. VAS scores in the different disease groups after treatment were lower than those before treatment (all P < 0.01). VAS scores in different disease groups showed significant differences, except for 12 vs. 24 weeks after treatment (P = 0.023). Different age groups had different secondary complaints.@*CONCLUSIONS@#There are different pathogeneses in different UACS age groups. Clinical treatment efficacy of children with UACS can be evaluated by the VAS combined with an objective examination. We recommend that the course of treatment should be 12 weeks.

Clinical analysis of abnormal acoustic admittance in preschool children with nasal and nasopharyngeal disorders / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors of related disorders, which could lead to potential otitis media by observing the abnormal configuration of drum and abnormal acoustic immittance without symptoms in preschool children.</p><p><b>METHODS</b>Eighty-one cases (162 ears) received flexible pharyngorhinoscopy, skin prick test, CT examination of sinus, and were diagnosed as allergic rhinitis, chronic sinusitis, adenoid hypertrophy. They had no complaints of ear related symptoms, but were observed to have abnormality in ear drum by physical examined. Acoustic immittance measurement were performed, so as to estimate whether they were accompany with potential otitis media. The changes of examination and tests were analyzed before and after the treatment.</p><p><b>RESULTS</b>There were 15 cases (29 ears) with abnormal acoustic admittance among 81 cases (162 ears) who had no ear related symptoms but had different degree abnormality in ear drum. The morbidity rate of these 15 patients was 13.6% (6/44 ears) in allergic rhinitis patients, 18.2% (12/66 ears) in chronic sinusitis patients, and 21.2% (11/52 ears) in adenoid hypertrophy patients, respectively. The differences among the three diseases had statistical significance (χ² = 63.02,P < 0.05). Among 29 ears, 28 ears whose type of tympanic pressure curve were transferred from type C to type A two weeks after treatment. One ear whose type of tympanic pressure curve transferred from type B to type C four weeks after treatment. All cases had been followed up with no recurrent cases.</p><p><b>CONCLUSIONS</b>Some preschool children with nasal and nasopharyngeal disorders had abnormal configuration of drum and abnormal acoustic immittance, and had potential risk for otitis media. Among the disorders, adenoid hypertrophy impact more on middle ear function. The early intervention of related diseases could prevent the developing trend of otitis media.</p>

Preliminary study on normal aerification of paranasal sinuses in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the normal aerification of paranasal sinuses in Chinese children with magnetic resonance imaging.</p><p><b>METHODS</b>Two hundred and eighty Chinese children aged from 17 days to 14 years without any symptoms related to sinusitis were statistically analyzed in MRI features, including counting the number of paranasal sinus pneumatization and the maximum axial and sagittal area of the left maxillary.</p><p><b>RESULTS</b>The pneumatization rate of maxillary sinus was 85% in children aged from 0 to 1 years. Until 3 years the pneumatization rate of maxillary sinus was 95% and there was no significant difference in boys and girls (χ(2) = 0.741, P = 0.389). The pneumatization rate of maxillary sinus reached 100% after 4 years old. The pneumatization rate of ethmoid sinus was 100% in this study. The pneumatization rate of sphenoid sinus was 0 within 1 year old, 49% within 4 years old and 100% after 7 years old. There was no significant difference in boys and girls on the pneumatization rate of sphenoid sinus (χ(2) = 2.452, P = 0.117). The pneumatization rate of frontal sinus was 0 within 5 years old, 62% within 9 years old and 95% after 10 years old. There was no significant difference in boys and girls on the pneumatization rate of frontal sinus (χ(2) = 0.124, P = 0.724). The axial and sagittal maximum area of maxillary sinus was (689.28 ± 221.79) and (659.76 ± 263.31) mm(2) in girls and (668.13 ± 206.38) and (638.60 ± 207.67) mm(2) in boys. The differences were significant (t = -19.78, P < 0.001; t = -19.89, P < 0.001).</p><p><b>CONCLUSION</b>The study of the development and normal aerification of paranasal sinuses of children can help radiologist make correct diagnosis of paranasal sinuses in children.</p>

Analysis of intractable cough in 128 children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To disclose the etiological factors and to investigate the therapeutical effect on nasal disorders in 128 children with intractable cough.</p><p><b>METHODS</b>One hundred and twenty-eight children with intractable cough were consulted by ENT doctors using electronic nasopharyngoscope, for those children with nasal diseases, relevant treatment was given.</p><p><b>RESULTS</b>Among 128 children, one hundred and sixteen had nasal disorders. Upper airway cough syndrome (UACS) was diagnosed in 92 cases (71.9%), nasal disorders without UACS was diagnosed in 24 cases (18.7%), no nasal disorders were found in 12 cases (9.4%). Among children with UACS, allergic rhinitis was diagnosed in 76 cases, rhino-sinusitis in 39 cases, adenoid hypertrophy in 54 cases, and chronic rhinitis in 8 cases. However, for those children without UACS, 10 cases had chronic rhinitis and 14 cases had allergic rhinitis. Clinical symptoms, signs and the findings of electronic nasopharyngoscope were analyzed in 92 children with UACS. The results showed that regular cough occurred in 62 cases, nasal disease in 65 cases, subjective feeling of postnasal discharge in 18 cases, mouth breathing or snoring in 32 cases, purulent secretion in nasal meatus in 61 cases, retropharyngeal folliculosis in 58 cases, purulent secretion in pharynges detected from pharynx in 41 cases, and purulent or viscosity secretion were found in 91 cases by first electronic nasopharyngoscopy. After 14 days of treatment, the children with UACS (90/92) had significant higher remission rate (chi² = 32.21, P = 0.000) in cough than those who had nasal disorders but without UACS (13/24).</p><p><b>CONCLUSIONS</b>The nasal disorders, especially for UACS, were common in children with intractable cough. The therapy to nasal disorders could release the chronic cough symptoms in children with intractable cough.</p>

Analysis of the causes of pediatric rhino-source diseases / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze clinical features of pediatric rhino-source diseases for reducing missed diagnosis and misdiagnosis.</p><p><b>METHOD</b>Data of 3588 children with rhino-source diseases seen from April 2005 to May 2006 were retrospectively analyzed in this study in order to disclose the relationship of etiological factor, clinical features and diagnosis.</p><p><b>RESULT</b>Among all these cases, 2090 complained of nasal discomfort including nasal obstruction, discharge, rhinalgia and epistaxis. However 1498 cases (41.76%) did not, of whom 470 cases had snoring and apnea, 332 cases of otalgia and otorrhea, 145 cases had chronic cough, 138 had headache and 92 had lower respiratory infection.</p><p><b>CONCLUSION</b>A high percentage of children who suffered from pediatric rhino-source disease did not develop nasal symptoms. Pediatric rhino-source disease should be considered for patients in whom the therapeutic effect is unexpectedly poor.</p>

Effect of snoring on facial growth in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of snoring on facial growth in children and the changes after surgery.</p><p><b>METHODS</b>Observations on facial growth were taken by X-ray 1.5 - 2 years before and after surgery on 40 children snorers aged between 2 - 5 years old, whose tonsils and (or) adenoids were completely removed. The data collected before surgery in the 2 - 3 years old snorers and in the 4 - 5 years old ones were compared with the data from healthy children at the same age respectively.</p><p><b>RESULTS</b>The comparison of data between 21 children snorers aged from 2 - 3 and 17 healthy children of the same ages showed that there was no significant difference in the diameter of pharyngeal cavity at tongue base (PAS), the diameter of nasopharyngeal cavity (UPW-PNS) and the angle between mandibular plane and frankfort horizontal plane (FH-MP) within 2 - 3 years group by statistically (P > 0.05). There is no significance in UPW-PNS and FH-MP angle within 4 - 5 years group by statistics (P > 0.05). Others results is significance in all groups (P < 0.05 or P < 0.01). There was no significant difference in all groups expect Y-axis Angle 1.5 - 2 years after surgery (P > 0.05).</p><p><b>CONCLUSIONS</b>Abnormal facial growth was caused by the consistent force from the changed way of breathing due to the increasing narrowness of upper airway obstruction and the long-existing obstructive sleep. Surgery done as soon as possible is helpful to reduce the force caused by the obstruction and helpful to the normal facial growth.</p>