[Efficacy of bioregulative drugs in the treatment of otitis media with effusion associated with rhinosinusitis and adenoiditis]. / Effektivnost' preparatov bioregulyatsionnoi meditsiny pri lechenii ekssudativnogo srednego otita, sopryazhennogo s rinosinusitom i adenoiditom.

PURPOSE: Improving of otitis media with effusion (OME) with rhinosinusitis (RS) and adenoiditis treatment effectiveness. MATERIALS AND METHODS: The study included 112 patients 12-18 y.o. with otitis media with effusion, who were divided into 2 groups depending on the treatment scheme. The Group I (the main group) patients treatment included Traumeel S and Euphorbium compositum Nasentropfen S in addition to the standard treatment, and the Group II (comparison), children were prescribed standard therapy. Patients of both groups were divided into 3 subgroups depending on the upper respiratory tract inflammation symptoms: A - patients with adenoiditis; B - with rhinosinusitis and C - combination of adenoiditis and rhinosinusitis. The comparison group (groups IIB and IIC) treatment scheme (children with rhinosinusitis) included topical corticosteroids and the main group patients didn't receive corticosteroids. All patients went through complaints and anamnesis collection, routine otorhinolaryngological and instrumental examination before and after treatment. RESULTS: Analysis of treatment results demonstrated high efficacy of multicomponent drugs with low doses of active ingredients in the therapy of patients with OME, regardless of comorbid pathology. Significantly better results were obtained in the patients treated with bioregulatory drugs when comparing the outcomes of OME therapy in combination with adenoiditis (groups IA and IIA). Comparable efficacy results were obtained in the treatment group of patients with OME associated with RS (in groups IB and IIB as well as in groups IC and IIC), where GCS was received in the comparison group. The high efficacy and safety of bioregulatory drugs makes the use of these agents a promising treatment for patients with OME, RS and adenoiditis.

Association of Preinjury Medical Diagnoses With Pediatric Persistent Postconcussion Symptoms in Electronic Health Records.

OBJECTIVE: To identify risk factors and generate hypotheses for pediatric persistent postconcussion symptoms (PPCS). SETTING: A regional healthcare system in the Southeastern United States. PARTICIPANTS: An electronic health record-based algorithm was developed and validated to identify PPCS cases and controls from an institutional database of more than 2.8 million patients. PPCS cases (n = 274) were patients aged 5 to 18 years with PPCS-related diagnostic codes or with PPCS key words identified by natural language processing of clinical notes. Age, sex, and year of index event-matched controls (n = 1096) were patients with mild traumatic brain injury codes only. Patients with moderate or severe traumatic brain injury were excluded. All patients used our healthcare system at least 3 times 180 days before their injury. DESIGN: Case-control study. MAIN MEASURES: The outcome was algorithmic classification of PPCS. Exposures were all preinjury medical diagnoses assigned at least 180 days before the injury. RESULTS: Cases and controls both had a mean of more than 9 years of healthcare system use preinjury. Of 221 preinjury medical diagnoses, headache disorder was associated with PPCS after accounting for multiple testing (odds ratio [OR] = 2.9; 95% confidence interval [CI]: 1.6-5.0; P = 2.1e-4). Six diagnoses were associated with PPCS at a suggestive threshold for statistical significance (false discovery rate P < .10): gastritis/duodenitis (OR = 2.8; 95% CI: 1.6-5.1; P = 5.0e-4), sleep disorders (OR = 2.3; 95% CI: 1.4-3.7; P = 7.4e-4), abdominal pain (OR = 1.6; 95% CI: 1.2-2.2; P = 9.2e-4), chronic sinusitis (OR = 2.8; 95% CI: 1.5-5.2; P = 1.3e-3), congenital anomalies of the skin (OR = 2.9; 95% CI: 1.5-5.5; P = 1.9e-3), and chronic pharyngitis/nasopharyngitis (OR = 2.4; 95% CI: 1.4-4.3; P = 2.5e-3). CONCLUSIONS: These results support the strong association of preinjury headache disorders with PPCS. An association of PPCS with prior gastritis/duodenitis, sinusitis, and pharyngitis/nasopharyngitis suggests a role for chronic inflammation in PPCS pathophysiology and risk, although results could equally be attributable to a higher likelihood of somatization among PPCS cases. Identified risk factors should be investigated further and potentially considered during the management of pediatric mild traumatic brain injury cases.

Grisel's Syndrome: Non-traumatic Atlantoaxial Rotatory Subluxation-Report of Five Cases and Review of the Literature.

BACKGROUND: In children, when unresponsive neck rigidity and distress are observed after ear, nose and throat (ENT) surgical treatment or nasopharyngeal inflammation, Grisel's syndrome should be suspected. This is a rare syndrome involving non-traumatic rotatory subluxation of the atlantoaxial joint. Conservative management with external cervical orthoses and empirical antibiotic, muscle relaxant and analgesic therapy should be the first choice of treatment. Surgical stabilization is indicated when high-grade instability or failure of stable reduction are observed. The instability is graded according to the classification system devised by Fielding and Hawkins. Several recommendations for treatment are available in the literature, but there are no common guidelines. In this paper, the authors discuss the need for prompt diagnosis and treatment considerations. CASE DESCRIPTION: Five children with Fielding type I-III rotatory subluxation are reported. Three patients were treated with a cervical collar, and one patient was treated with skull traction and sternal-occipital-mandibular immobilizer (SOMI) brace application. Surgical treatment was necessary for one patient after failure of initial conservative management. The intervals between the onset of torticollis and radiological diagnosis ranged from 12 to 90 days. A relationship between an increased grade of instability and delayed diagnosis was observed. CONCLUSION: In children with painful torticollis following ENT procedures or nasopharyngeal inflammation, Grisel's syndrome should always be suspected. Cervical magnetic resonance imaging (MRI) allows prompt and safe diagnosis, and a three-dimensional computed tomography (CT) scan provides better classification of the instability. Surgery, which is indicated in cases of high-grade instability or failure of conservative treatment, may be avoided with prompt diagnosis.

Sinus and Upper Airway Surgery in Children.

PURPOSE OF REVIEW: Chronic sinus and upper airway disease in children is a common health problem encountered every day. Its pathophysiology is complicated which leads to different treatment options and approaches. We seek to review the current literature and evidence to surgical treatments. RECENT FINDINGS: Medical treatment with antibiotics and topical nasal sprays continues to be the first-line treatment. Surgical interventions include adenoidectomy, balloon catheter sinuplasty (BCS), and endoscopic sinus surgery (ESS). Each modality has proven to be safe; however, its effectiveness is widely variable. More research with higher level of evidence is needed to help in choosing the right surgical treatment with optimal benefit.

Paediatric nasopharyngeal cytology: a new diagnostic opportunity?

The purpose of this investigation was to describe the first application of nasopharyngeal cytology (NPC), a new cytological technique to collect cellular material from the nasopharyngeal surface non-invasively in children with chronic adenoiditis associated with recurrent acute otitis media and/or otitis media with effusion. Cellular material was collected transorally using an extra-thin flexible wire nasopharyngeal swab and then examined under a light microscope. The diagnostic accuracy of NPC in detecting the presence of allergy and pathogens (compared to microbiological evaluation of nasopharyngeal aspirates, NPAs) was assessed. NPC was performed on 121 children (mean age 69.4 ± 15.5 months). Inflammatory cells and pathogens were detected in 61.1 % and 44.2 % of patients, respectively. The specificity of nasopharyngeal eosinophils in detecting allergy was good (91.9 %), as was the specificity of mast cells, but the sensitivities were less. The NPAs revealed bacterial colonisation in 84.7 % of the patients, and Streptococcus pneumoniae was the most frequently isolated (60.0 %). NPC revealed the presence of bacteria in 94.9 % of patients, including bacillary species in 33.9 %. NPC was highly sensitive in detecting pathogens (96.0 %). Its specificity in detecting bacillary species was fairly good (75.0 %), but the corresponding values of the specificity of NPC in detecting pathogens and its sensitivity in detecting bacillary species were poor. Our findings suggest the need for more structured studies that can test the real effectiveness and usefulness of NPC in defining nasopharyngeal cytological patterns in children with chronic nasopharyngeal diseases by comparing it with established diagnostic techniques.

Adenoids in children: Advances in immunology, diagnosis, and surgery.

Adenoids are strategically located for mediating local and regional immune functions as they are exposed to antigens from both the outside air and the alimentary tract. Recurrent or chronic respiratory infections can induce histomorphological and functional changes in the adenoidal immunological barrier, sometimes making surgical treatment necessary. Our aim in this review is to summarize the crucial points about not only the immunological histopathology of adenoidal tissue, especially in patients with adenoid hypertrophy, but also the most common and useful diagnostic techniques and surgical options.

[The experience with the application of selective polarized chromotherapy in the clinical practice].

A series of investigations have demonstrated the anti-inflammatory, bactericidal, analgesic, and vegetocorrective effects of extraocular selective polarized chromotherapy using blue and red light and the possibility to optimize autonomous regulation with the help of this technique. The results of the study confirmed the high clinical effectiveness and safety of the method being considered for the treatment of acute respiratory diseases, chronic tonsillitis, cervical dorsopathies, and vegetative dysfunction.

Acute Herpetic Nasopharyngitis in an Adult Patient: A Case Report and Literature Review.

OBJECTIVE: To report a case of herpes virus-associated nasopharyngitis in an adult patient. METHODS: The patient's medical record was reviewed for demographic and clinical data. For literature review, all case reports or other publications published in English literature were identified using Pubmed with the MeSH terms "herpes," "nasopharyngitis," and "upper respiratory infection." RESULTS: A 40-year-old male presented for nasal congestion and a suspected nasal mass. Computed tomography of the sinuses revealed edematous changes in the nasopharynx which exerted a downward mass effect at the right aspect of the soft palate. Flexible fiberoptic laryngoscopy (FFL) revealed a lesion arising from the posterior aspect of the soft palate with extension into the posterior nasal cavity as well as copious mucopurulent secretions consistent with a superimposed acute sinusitis. Rigid nasal endoscopy demonstrated a friable and ulcerated lesion arising from the aforementioned anatomical location. Biopsy of this lesion and subsequent immunohistochemical analysis revealed a diagnosis of herpetic nasopharyngitis. CONCLUSIONS: Herpetic infection should be in the differential diagnosis of patients presenting with atypical symptoms of nasopharyngitis. Early accurate diagnosis and appropriate specific management can limit the duration of disease course and prevent further complications.

Role of ectodysplasin signalling in middle ear and nasal pathology in rat and mouse models of hypohidrotic ectodermal dysplasia.

Patients with mutations in the ectodysplasin receptor signalling pathway genes - the X-linked ligand ectodysplasin-A (EDA), the receptor EDAR or the receptor adapter EDARADD - have hypohidrotic ectodermal dysplasia (HED). In addition to having impaired development of teeth, hair, eccrine sweat glands, and salivary and mammary glands, HED patients have ear, nose and throat disease. The mouse strains Tabby (EdaTa ) and downless (Edardl-J/dl-J ) have rhinitis and otitis media due to loss of submucosal glands in the upper airway. We report that prenatal correction of EDAR signalling in EdaTa mice with the agonist anti-EDAR antibody rescues the auditory-tube submucosal glands and prevents otitis media, rhinitis and nasopharyngitis. The sparse- and wavy-haired (swh) rat strain carries a mutation in the Edaradd gene and has similar cutaneous HED phenotypes to mouse models. We report that auditory-tube submucosal glands are smaller in the homozygous mutant Edaraddswh/swh than those in unaffected heterozygous Edaraddswh/+ rats, and that this predisposes them to otitis media. Furthermore, the pathogenesis of otitis media in the rat HED model differs from that in mice, as otitis media is the primary pathology, and rhinitis is a later-onset phenotype. These findings in rodent HED models imply that hypomorphic as well as null mutations in EDAR signalling pathway genes may predispose to otitis media in humans. In addition, this work suggests that the recent successful prenatal treatment of X-linked HED (XLHED) in humans may also prevent ear, nose and throat disease, and provides diagnostic criteria that distinguish HED-associated otitis media from chronic otitis media with effusion, which is common in children.

Association of laryngeal and nasopharyngeal tuberculosis: a case report.

INTRODUCTION: To the best of our knowledge, the association of nasopharyngeal and laryngeal tuberculosis has never been described before in the literature. We report here a first observation. CASE PRESENTATION: We report the case of a 38-year-old Arab man who presented with an isolated hoarseness. Radiological and endoscopic examinations showed a thickening of the left lateral wall of his nasopharynx and the left vocal cord. Pathology revealed the diagnosis of tuberculosis of both localizations. He received a 6-month antituberculous chemotherapy with a satisfying uneventful evolution. CONCLUSIONS: Tuberculosis should be considered in the differential diagnosis of soft tissue masses of the head and neck, particularly when the imaging findings and clinical presentation are atypical. The diagnosis of tuberculosis is mainly based on histopathological and/or bacteriological examination.

Nasopharyngitis and the sudden infant death syndrome.

Infants who died of SIDS in Onondaga County (New York) were classified into a Nasopharyngitis Group (N = 59) or a No Nasopharyngitis Group (N = 57) on the basis of symptoms, within one week prior to death, referable to the upper respiratory tract. Examination of the postnatal age of death revealed that infants in the Nasopharyngitis Group tended to be older than those in the No Nasopharyngitis Group. These results are consistent with a prediction derived from the hypothesis that prolonged sleep apnea is part of a pathophysiologic process resulting in SIDS.

Phenothiazines and sudden infant death syndrome.

A relationship between sudden infant death syndrome (SIDS), sleep apnea, and upper airway infections has been reported. The present observation stresses the possible influence of phenothiazine-containing medications and the occurrence of SIDS. The drug is commonly used for the treatment of infants with nasopharyngitis in Belgium and in some other European countries. In a prospective study, 52 SIDS victims, 36 near miss infants, and 175 control infants were compared for the coexistence of nasopharyngitis and phenothiazine treatment in the days preceding death or hospitalization. The incidence of nasopharyngitis was comparable in the three groups (approximately 31%), but phenothiazines were used significantly more frequently in SIDS victims (23%) and near miss infants (22%) than in control subjects (2%). It is postulated that phenothiazines, as CNS depressors, may contribute to the occurrence of SIDS.

Nasopharyngitis and prolonged sleep Apnea.

The effect of nasopharyngitis on the simultaneous occurrence of prolonged sleep apnea (greater than or equal to 20 seconds in duration) was studied in 26 infants managed at home on an apnea monitor. During the observation period, these infants had a total of 69 illnesses which appeared to represent an upper respiratory tract inflammatory process. In general, the daily frequency of prolonged apneic episodes was significantly greater during nasopharyngitis when compared to comparable time intervals immediately prior to and following the illness. In addition, there was a decrease in the frequency of apneic episodes with increasing postnatal age until the episodes finally ceased to occur during the illness-related intervals. Apneic episodes ceased to occur at an earlier age for the before- and after-illness intervals than for the time interval during which there were clinical symptoms. Thus, it would appear that infants go through an age-related phase wherein prolonged apnea occurs during nasopharyngitis but not when free of illness. The implications of these results for the management of infants having prolonged sleep apnea are discussed. In view of the hypothesis that prolonged sleep apnea is part of the physiological process resulting in the sudden infant death syndrome, these results also provide for the prediction that infants who suddenly die in association with nasopharyngitis would do so, in general, at a later age than those who succumb when free of an upper respiratory tract inflammatory process.

Chromobacterium violaceum infection in children: a case of fatal septicemia with nasopharyngeal abscess and literature review.

This previously healthy 5-year-old boy initially presented with fever and purulent conjunctivitis. The course evolved rapidly into preseptal and facial cellulitis, nasopharyngeal abscess and sepsis. Chromobacterium violaceum was isolated from conjunctival exudate and blood cultures. He received intravenous cefazolin therapy for 2 days, followed by penicillin, oxacillin and netilmicin. However, no improvement was noted, and he died on the fifth days of illness.

A common pathophysiology for sudden cot death and sleep apnoea. "The vacuum-glossoptosis syndrome".

Several congenital and acquired conditions, characterized by upper airway narrowing, may result in respiratory, cardiac, and sleep disturbances. In all these conditions the leading clinical feature is the occurrence of cyclic obstructive apnoea, mainly during sleep. The common pathogenic mechanism for the airway occlusion seems to be a backward displacement of the tongue and mandible, favoured by the muscle relaxation which occurs during sleep and by gravity in the supine position. A constant factor determining the glossoptosis is the pharyngeal vacuum occurring in these conditions as a result of inspiratory efforts in face of a narrowed upper airway. The response to this type of obstruction is age-dependent, since only in early infancy may these apnoeic spells be life-threatening. A similar pathophysiology is suggested for sudden cot death, which could be considered as a peculiar presentation of this "vacuum-glossoptosis syndrome". This hypothesis could explain why sudden cot death is often associated with nasopharyngitis and occurs always in infancy, almost invariably during sleep.

Mucosa-associated lymphoid tissue in middle ear and Eustachian tube in children.

The presence of mucosal lymphoid follicles with germinal centers, so called mucosa-associated lymphoid tissue (MALT), in the Eustachian tube (ET) and middle ear (ME) was investigated in 23 human temporal bones containing the entire ET obtained from 23 children, 3 months to 10 years old at death. Greater numbers of MALTs were found in specimens from children with otitis media (OM) than from those without OM. MALT showed a wedge-shaped distribution through the ME and ET: in all 3 specimens that had MALTs in the ME, these tissues were seen throughout the ET; in all 4 specimens with MALTs in the bony portion of the ET, these tissues were present both in the tympanic and pharyngeal portions of the cartilagines ET; all 7 specimens that had MALTs in the tympanic half of the cartilagines ET had MALTs in the pharyngeal portion of the cartilagines ET as well. Furthermore, MALTs were noted in the pharyngeal portion of the ET in more than half of the specimens without OM but in none of the MEs of specimens without OM. These results support the hypothesis that persistent and recurrent inflammation in the nasopharynx spreads through the ET to play a role in the pathogenesis of chronic OM in children.

Normal and abnormal middle ear ventilation.

Studies in infants and children have suggested a functional rather than mechanical obstruction of the Eustachian tube as a predisposing factor in middle ear effusions (MEE). To simulate this condition in the laboratory, an animal model was prepared using juvenile Rhesus monkeys. The tensor veli palatini muscle was transected or expunged posterior to the hamulus of the medial pterygoid lamina. Transection of the muscle resulted in negative middle ear pressure without effusion, whereas when the muscle was expunged, the animals developed a brief episode of negative middle ear pressure followed by a persistent MEE that was sterile for bacteria. An acute bacterial MEE developed following instillation of Streptococcus pneumoniae into the nasopharynx of animals that had had a previous unilateral transection of the muscle. The condition of the middle ear was documented by impedance measurements and presence of the effusion was verified by myringotomy. Animals were periodically examined and tested for Eustachian tube ventilatory function over a period of one year. Before surgical alteration of the tensor muscle. Eustachian tube function tests demonstrated normal ventilatory function, whereas, functional Eustachian tube obstruction patterns similar to studies in children who had MEE were found during the postoperative period. Only after the development of a reliable animal model can current and future methods of management of MEE be tested under controlled laboratory conditions. These data suggest that the Rhesus monkey appears to be an excellent model for the study of normal as well as abnormal tubal function.