Prevention of recurrent respiratory infections : Inter-society Consensus.

Recurrent respiratory infections (RRIs) are a common clinical condition in children, in fact about 25% of children under 1 year and 6% of children during the first 6 years of life have RRIs. In most cases, infections occur with mild clinical manifestations and the frequency of episodes tends to decrease over time with a complete resolution by 12 years of age. However, RRIs significantly reduce child and family quality of life and lead to significant medical and social costs.Despite the importance of this condition, there is currently no agreed definition of the term RRIs in the literature, especially concerning the frequency and type of infectious episodes to be considered. The aim of this consensus document is to propose an updated definition and provide recommendations with the intent of guiding the physician in the complex process of diagnosis, management and prevention of RRIs.

Saline nasal irrigations for chronic rhinosinusitis: From everyday practice to evidence-based medicine. An update.

Saline nasal irrigations (SNIs) are often recommended as an additional non-pharmacological treatment for adults with chronic rhinosinusitis (CRS), for which it could even be considered a first-line treatment. However, there is a wide range of different SNI protocols. The aim of this article is to review the published literature regarding all of the potential therapeutic effects of SNIs in adult CRS patients who had not undergone sinus surgery and clarify the role of the various saline nasal solutions and protocols (particularly the volume, frequency and duration of treatment), and describe the nasal devices used. A search was made of the PubMed, Google Scholar and Ovid databases using the key words 'saline nasal irrigation' and 'chronic rhinosinusitis', or medical subject headings. The search identified 11 studies involving 663 patients. There was no consensus about but substantial agreement concerning the frequency and duration of treatment, the type of device, and the amount of solution to be used when managing CRS. A hypertonic solution with the addition of the natural minerals and oligo-elements found in seawater and some thermal waters may be associated with greater clinical benefit in terms of endoscopic scores and mucociliary clearance than isotonic solutions. Further studies are required to compare the different forms of SNI and define SNI protocols and nasal devices, while considering patient compliance.

Juvenile recurrent parotitis: A systematic review of treatment studies.

Juvenile recurrent parotitis is a rare recurrent inflammation of the parotid glands occurring in children. The etiology remains obscure and the treatment is still debated. In the present study, we perform a systematic review of the literature with the purpose of identifying and discussing the treatment options emerged over the last 28 years in order to prevent recurrent episodes of parotitis. We ultimately included 24 studies. The definitions used for juvenile recurrent parotitis varied widely and none of the selected studies referred exactly to the same definition. Only one was a randomized controlled trial and it showed marked benefits with the use of Bear Bile and Huangqi, two traditional Chinese medicines. Two additional study on sialendoscopy included a control group but was not randomized. All the remaining contributions were case series or case reports. The vast majority (n = 19) of the selected studies reported on sialendoscopy. They all documented improvement of the condition following this intervention. An analysis grouping all these studies (corresponding to 336 children) showed that only 25.8% (95% Confidence Interval: 21.5-30.8) of the treated children had further recurrences. However, the only two controlled study on sialendoscopy showed a similar improvement in controls. The remaining four studies were on sialography (n = 2), on oral appliance in the specific group of children with concomitant dental malocclusion (n = 1) on ductal hydrocortisone infusion through catheter inserted in the parotid duct (n = 1). Improvements were documented in all four contributions. This systematic review of the literature did not consent us to draw definite conclusions on the most suitable treatment for juvenile recurrent parotitis. The available evidence is indeed weak and difficult to interpret because of the scarcity of randomized controlled trials, the heterogeneity of the definitions used and the high rate of spontaneous resolution. Future large and well-designed randomized controlled trials that will include children fulfilling a shared definition of the condition are warranted.

Comparing postoperative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy.

OBJECTIVE: To evaluate postoperative quality of life in patients undergoing microdebrider intracapsular tonsillotomy and adenoidectomy (PITA) in comparison with traditional adenotonsillectomy (AT) and to assess PITA's efficacy in solving upper-airway obstructive symptoms. METHODS: 29 children with adenotonsillar hyperplasia referred for AT were included. Patients were divided into two groups: Group 1 (underwent PITA) included 14 children (age 5.1±1.8 years) affected by night-time airway obstruction without a relevant history of recurrent tonsillitis; Group 2 (underwent AT) included 15 children (age 5.2±1.7 years) with a history of upper-airway obstruction during sleep and recurrent acute tonsillitis. Outcomes measures included the number of administered pain medications, time before returning to a full diet, Obstructive Sleep Apnea survey (OSA-18), parent's postoperative pain measure questionnaire (PPPM) and Wong-Baker Faces Pain Rating Scale (WBFPRS). RESULTS: Postoperative pain was significantly lower in the PITA group, as demonstrated by PPPM and WBFPRS scores and by a lower number of pain medications used. PITA group also resumed a regular diet earlier (P<0.001). OSA-18 scores proved that both PITA and AT were equally effective in curing upper-airway obstructive symptoms. CONCLUSION: PITA reduces post-tonsil ablation morbidity and can be a valid alternative to AT for treating upper-airway obstruction due to adenotonsillar hyperplasia.

Antral retriever and displaced dental implants in the maxillary sinus.

PURPOSE: Removal of antral foreign bodies after implantation is mandatory to avoid infectious processes and may be a troublesome question. Different surgical approaches could be considered, with several limitations and morbidities. METHODS: We present a new tool (Antral Retriever) conceived to remove antral dental implants or any other migrated material through a minimally invasive canine fossa approach, under continuous endoscopic view and local anesthesia. RESULTS AND CONCLUSIONS: Antral Retriever enables the surgeon to successfully remove antral foreign bodies through a canine fossa approach under continuous endoscopic visualization and local anesthesia, with minimal discomfort for the patient

Carbon dioxide-enriched water inhalation in patients with allergic rhinitis and its relationship with nasal fluid cytokine/chemokine release.

BACKGROUND AND AIMS: Allergic rhinitis is characterized by eosinophil infiltration and accumulation in the nasal mucosa mainly due to IL-3, IL-5, and eotaxin activities. We undertook this study to investigate a possible in vivo effect of carbon dioxide-enriched water inhalation in patients with allergic rhinitis. METHODS: Twenty five consecutive patients inhaled carbon dioxide-enriched water at Fonti di Rabbi Spa Centre (Trento, Italy). Symptom scores for nasal obstruction, itching and sneezing were obtained before and after treatment. Nasal lavage was collected, and IL-3, IL-5, and eotaxin levels were assessed using the quantitative sandwich enzyme immunoassay technique. Cytometric analysis was performed on samples to measure total cell count, CD45+ cells, and percentages of polymorphonucleates and lymphocytes. RESULTS: There were statistically significant differences in chemokine levels and in cell populations between patients and healthy controls before treatment. After carbon dioxide-enriched water inhalation, we observed statistically significant improvements in symptom scores, chemokine levels, and percentages of cell populations. CONCLUSIONS: Our results seem to confirm the role of IL-3, IL-5, and eotaxin in the pathophysiology of allergy and the beneficial effect of carbon dioxide-enriched water inhalation in patients affected by allergic rhinitis.

Different therapeutic strategies for burning mouth syndrome: preliminary data.

BACKGROUND: To compare different therapeutic supportive approaches in patients with burning mouth syndrome. A prospective study was carried out for this purpose. MATERIALS AND METHODS: The study involved 56 patients with burning mouth syndrome. They were randomly assigned to treatment with capsaicin, alpha-lipoic acid or lysozyme-lactoperoxidase (test drugs) or boric acid (control group). Symptoms were scored after 60 days treatment and 60 days after drug discontinuation. RESULTS: At the end of the treatment period, there was a significant reduction in the symptom scores of all of the patients who received the test drugs (P<0.01), and at the end of the follow-up period in the test groups as a whole (P<0.01); the reduction was not significant when considering each test group separately after the treatment period. All of the treatments were more effective than boric acid and there was no significant difference in the symptom scores of the control group at either of the study time-points. CONCLUSIONS: Our results demonstrate the similar effectiveness of capsaicin and alpha-lipoic acid in controlling the symptoms of burning mouth syndrome. Lysozyme-lactoperoxidase may be effective in the supportive care of BMS patients with xerostomia. The transitory effect observed after discontinuing drug administration justifies the use of prolonged therapy in chronically affected patients.