An assessment of the efficacy and tolerability of nimesulide vs paracetamol in children after adenotonsillectomy.

The efficacy and tolerability of nimesulide were assessed and compared with those of paracetamol in the treatment of 35 children with pain and inflammation following adenotonsillectomy. The antipyretic and analgesic efficacy of the 2 drugs was similar, although more patients had complete remission of pain after 4 days of treatment with nimesulide. Both drugs were well tolerated, even though occasional elevation of transaminase enzymes and alkaline phosphatase was noted in the nimesulide-treated group. It is postulated that this effect may have been attributable to the volatile anaesthetics used during surgery.

Production rate and composition of cerumen: influence of sex and season.

The production rate and composition of cerumen have been studied in 11 participants (5 men and 6 women), 25 to 42 years old. The cerumen was obtained in January, May, July, and November to investigate the possible influence of the season. Only the triglyceride content decreased from November to July. Sex was not a factor, which supported the hypothesis that sex hormones play a minor role in the production rate of the lipid component of cerumen.

A technique for measuring the rate of cerumen production.

A technique is described for quantitatively measuring the rate of cerumen production. Two different washing solutions were tried. A mixture of alcohol/ether (3:1 v/v) appeared to be the best extracting solution yielding 2.05 +/- 0.22 versus 0.73 +/- 0.14 mg/week per ear obtained with Triton X-100 solution. In addition, reproducibility was definitely better. Triton X-100 may be useful whenever microbiologic evaluations are requested. Total lipids accounted for 73.3% of cerumen extracted with the former solution, triglycerides being 19.5%, and cholesterol 7.2%. Our extracting technique appears to be a good estimate of the cerumen global output and may supply important information about cerumen in several biologic conditions.

Plasma and tonsillar tissue pharmacokinetics of teicoplanin following intramuscular administration to children.

The population pharmacokinetics of teicoplanin in plasma and tonsillar tissue in children was determined following intramuscular administration. Thirty seven patients in all received either a single 5 mg/kg dose; 2 doses of 5 mg/kg, 12 h apart; 3 doses of 5 mg/kg, 12 h apart; or, a single 10 mg/kg dose. Limited data, comprising a maximum of 2 blood samples and 1 tonsillar sample were taken from each patient, with the maximum time being 48 h after the first dose of teicoplanin (in the 3 x 5 mg/kg dosing schedule). All plasma data were analyzed simultaneously by a maximum likelihood method employing a modified EM algorithm. A first-order absorption, one-compartment disposition model was fitted to the data. Mean parameter values (with lower and upper 95% confidence intervals) were: clearance/bioavailability, 0.024 L h(-1) kg(-1) (0.020-0.027); volume of distribution/bioavailability, 0.61 L kg(-1) (0.54-0.70); absorption rate constant, 0.43 h(-1) (0.31-0.61). A first-order transfer model for distribution of teicoplanin between plasma and tonsillar tissue was fitted to the tonsil data. The mean parameter values (95% confidence intervals) were: transfer rate constant between plasma and tonsils 0.49 h(-1) (0.35-0.67); transfer rate constant between tonsils and plasma 0.73 h(-1) (0.52-1.03). These rate constants correspond to a distribution half-life of 0.95 h and an equilibrium distribution concentration ratio between tonsillar tissue and plasma of 0.67. After normalising clearance and volume of distribution for body weight, there was no further influence of body weight on the pharmacokinetic parameters. Also, there was no effect of dose, and as two formulations were used, one for the 5 mg/kg dose and the other for the 10 mg/kg dose, no effect of formulation on the pharmacokinetics of teicoplanin after im (intramuscular) administration was found.

Otoneurologic evaluation of child vertigo.

In this study 282 children with vertigo are subdivided (according to previous experiences) into three large groups: (1) vertigo and cochlear diseases; (2) vertigo as an isolated symptom; and (3) vertigo and C.S.N. diseases. Due to the difficult etiopathogenetic investigation of the patients from the second group, the authors focused on that group as they are less studied, are without associated symptoms (deafness--first group; CNS diseases--second group) and where vertigo appears as an idiopathic and an isolated symptom. A careful anamnestic, clinical and instrumental analysis leads to the following observations: (1) in decreasing order of frequency we find the third group, followed by the first and finally by the second; (2) in spite of the overall lower incidence of the second group, this latter includes the paroxismal benign vertigo (PBV) which is overall the second most frequent vertiginous form (after vertigo due to cranial trauma). In this group the authors underline the reasonably high incidence of the iatrogenic syndromes, insisting on the need of their accurate prevention of these risks; (3) the authors confirm that, nowadays, a reliable etiopathogenetic cause of the apparently isolated vertigo (except for the ascertained iatrogenic forms) cannot be identified. Moreover, in spite of its frequency, PBV is the less known form of vertigo, of which we cannot give a certain diagnosis and which can be identified only the the exclusion of all the other known forms through instrumental and clinical observations.

The study of optokinetic 'look' nystagmus in children: our experience.

Seventy health children underwent an OKN trial. The authors have chosen to perform only four tests (slow and fast clockwise and counterclockwise OKN) taking into account (in agreement with several international studies) four parameters: sTAP, fTAP, sTSAP, fTSAP (where s and f indicate the velocity of the shifting target slow or fast, TAP is total asymmetry percentage of the SSC--speed of slow components--and TSAP is total asymmetry percentage of saccades). They carried out the statistical analysis of the results, which did not show peculiar difference between child and adult OKN. The result of the test was independent of the side first tested and of sex. The authors have tried to identify the normal range of values more suitable to the study of child OKN; on the basis of the calculation of the 95% percentile the normality range was wider than the range assumed for adults. The authors have also tried to subdivided the results for three different groups of age (I = 3-7 years; II = 8-11 years; III = 12-14 years) in order to observe the degree of OKN maturation with age. From the results obtained the maturation of OKN pathways seems to occur in the 7th year of age for the slow movements; the findings related to the fast movements are more doubtful and need further analysis. Finally, although the number of saccades interposed to the tracings depends on enormous variations unrelated to age, sex and first side tested, our data show their higher incidence during the slow test.

Electronystagmography findings in child unilateral sensorineural hearing loss of probable viral origin.

We studied the labyrinthine function in a group of 72 children aged between 4 and 14 years affected by unilateral sensorineural hearing loss of probable viral origin. From the analysis of the results obtained we confirm the concomitance of cochlear and vestibular damage. However, there were no statistically significant differences between type of audiogram at onset of hearing loss and type of electronystagmography (ENG), while we found a direct correlation between the presence of vertigo or dizziness and type of ENG. Finally hearing recovery was influenced by the presence of vertigo or labyrinthine function alterations. The results of statistical analysis confirmed a significant statistical difference between patients with vertigo or dizziness (V(+)) and those without vertigo (V(-)) and also between patients with ENG 3 (subjects with spontaneous nystagmus or positional nystagmus and canal paresis ipsilateral to the cochlear lesion) and those with ENG 1 (subjects without spontaneous nystagmus or positional nystagmus and with normal vestibular reflex). In fact, hearing recovery was worse in V(+) group and in ENG 3 group.

Study of labyrinthine function in children using the caloric test: our results.

We studied caloric responses in a group of 42 healthy children aged between 4 and 14 years and compared the results with those obtained with the same method and equipment in a control group of 57 healthy adults at the Methodist Hospital Electronystagmography Laboratory at Houston (Texas). The average response in children appeared to be rather low. The confidence regions for unilateral weakness (UW) and directional preponderance (DP) measures were much wider in children than in adults. The confidence limit for bilateral weakness (BW) was lower in the children. The confidence limit for the fixation index (FI) in the children, however, was close to that in adults.

Compared study of optokinetic and caloric nystagmus in children with unilateral hyporeflexia and other vestibular disorders.

The authors compare the nystagmus evoked by the caloric test and by two slow and fast optokinetic 'look' stimulations performed in 78 subjects subdivided into two groups and recorded by ENG: group 1 composed of 22 subjects with 'significative' unilateral hyporeflexia and group 2 composed of 56 subjects with important anomalies at the vestibular caloric test. The results can be summarized as follows: 1. the presence of unilateral vestibular hyporeflexia is not exceptional in the child: 22 over 140 cases (15.7%); 2. the comparison between the caloric test and the OKN test in the 22 subjects with significant unilateral hyporeflexia shows: slow and fast TAP homolateral to the side with labyrinthine deficit prevails in ten subjects (45.4%); TAP is inconsistency with respect to the hyporeflexic side (i.e. homolateral in one test and contralateral in the other) in seven cases (31.8%); TAP is contralateral in five cases (22.7%). Within the same group, STAP varies according to cases. 3. In group II, TAP values at the OKN test overlap considerably with respect to the caloric test (18 cases with a total TAP prevailing on the right side, 32.2%; 19 cases with divergent TAP, 33.9%; 19 cases with total TAP prevailing on the left side, 33.9%). 4. The data shown in group 1 with significant vestibular hyporeflexia can be correlated to the time elapsed between the last electronystagmography and that performed soon after disease onset. Since for ENG performed some days after vertigo onset (even though clinical examination is negative) shows a concordance of OKN TAP and the hyporeflexic side (as the mechanisms of central compensation are still being developed) and then when these mechanisms improve with time, an inconsistency of OKN TAP and hyporeflexic side and finally a contralaterality. We might rely on the comparison between OKN TAP and caloric test as a finding of the time distance from the vertigo onset (when unknown) and a rough prognostic sign. The only case of vestibular neuritis by us followed in time seems to confirm our assumption.

Comparison between air and water caloric tests in children.

The caloric test represents an essential part of each procedure evaluating vestibular function. The use of water has many contraindications: tympanic perforation, external otitis and mastoid diseases. Sometimes, nausea can make test execution very difficult. Several authors contributed to the study and diffusion of the caloric test for the evaluation of labyrinthine function using different types of otoalcorimeters. We compared two methods in the child--generally intolerant to the water test--and the results obtained were adapted to a mathematical model of air and water caloric nystagmus. Twenty-seven normal children, aged between 5 and 14 years, subdivided into three age groups (5-7, 8-10 and 11-14 years), underwent the water caloric test (250 cm3 at 31 and 43 degrees C for 40 s) and then the air test, together with another nine subjects undergoing only the air test (flow-rate 8 l/min at 25 and 49 degrees C) on different days. The comparison between the two stimulation methods showed a statistically significant difference (P < 0.002) between maximum slow speed component (max SSC) in degrees per second (degrees/s) of water (4.74 degrees/s) and air (2.98 degrees/s). The results of two caloric tests and the interindividual and intraindividual analysis of our electronystagmographic results are in agreement with the data obtained by other authors in studies on adults. Therefore, notwithstanding the differences between the two stimulation methods, the air caloric test can be applied in a larger number of cases, it is better tolerated and can thus be used even in children for the study of labyrinthine function.

Monothermal air caloric test in children.

We compared the efficacy of bithermal (BAT) and monothermal cold (MCAT) and warm (MWAT) air caloric tests in identifying labyrinthine function anomalies in the child. At first, we established confidence intervals of normality for both monothermal tests in 40 children (22 males, 18 females) aged 6-14 years, clinically healthy and normal as previously shown by BAT. Subsequently, we compared the results of BAT with those of MCAT and MWAT performed in 46 children (22 males, 24 females) aged 6-14 years, affected by multiple labyrinthine diseases. These results confirmed that, as in the adult, MCAT alone should not be used in the evaluation of labyrinthine function in vertiginous patients. As to MWAT, we obtained good sensitivity and specificity with respect to BAT (83% and 90% for 90% probability; 78% and 92.5% for 95% probability). Sensitivity values increased or decreased depending on the disease causing vertiginous symptoms, with decreased or increased number of false negatives. In our opinion, MWAT cannot replace BAT for the study of labyrinthine function in children. MWAT alone can be used when vertigo is ascribable to vestibular neuritis or to endogenous disease (dysmetabolic, dyscrasic, dysendocrine).

Acute mastoiditis: a 10 year retrospective study.

This retrospective study reviews our experience in the management of acute otomastoiditis over 10 years. During the study period we identified 40 cases in children aged 3 months-15 years with a peak incidence in the second year of life. Sixty per cent of them had a history of acute otitis media (AOM). All the children were already receiving oral antibiotic therapy. Otalgia, fever, poor feeding and vomiting were the most common symptoms, all the children had evidence of retroauricolar inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used to support the diagnosis and to evaluate possible complications. Streptococcus pneumoniae was the most common isolated bacterium. All the patients received intravenous antibiotics, 65% of children received only medical treatment, 35% also underwent surgical intervention. Mean length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child. We conclude from our study that acute otomastoiditis is a disease mainly affecting young children, that develops from AOM resistant to oral antibiotics. Adequate initial management always requires intravenous antibiotics, conservative surgical treatment with miryngotomy is appropriate in children not responding within 48 h from beginning of therapy. Mastoidectomy should be performed in all the patients with acute coalescent mastoiditis or in case of evidence of intracranial complications.

The air caloric test in children: subdivision and statistical analysis of the response.

Among a population of 200 children, suffering by dizziness that we examined in the ENT department of the G. Gaslini Institute of Genoa, we acquired and checked, through the statistical analysis, the data of an air caloric test (according to the standard stimulation method) performed in 20 children (resulted normal to neurological, ophtalmological and audiovestibuler examinations which included audiometry, tympanometry, spontaneous, positional and positioning nystagmus research, OKN and caloric tests) and subdivided into 10 s sequences. The statistical analysis of the results obtained showed the following: (1) in both cold and warm air caloric test, the response can be obtained already in the stimulation phase, requiring ENG recording to start at the beginning of stimulation; (2) even in children, response culmination occurs in a period ranging from 60 to 90 s from stimulation onset; therefore the Visual Suppression Test should be performed in this period to obtain more significant data; (3) in cold and warm test, considering SSCs, the response is constant and intense up to 130 and 110 s, respectively, from beginning of ENG recording. After these time ranges, the response is less intense and homogeneous, becoming poor and variable. In our opinion, this allows suspension of recording immediately after these periods without the risk of the excluding significant aspects of the response.