An approach to globus pharyngeus.

BACKGROUND: Globus pharyngeus, or globus, is characterised by the sensation of a lump or tightness in the throat. Symptoms can be persistent, difficult to treat and often reoccur. Globus is a common issue in the community, with lifetime prevalence occurring in up to 45% of the population. OBJECTIVE: This article aims to provide a narrative review of potential causes of globus, as well as a suggested guideline for work-up and management in the primary care setting. DISCUSSION: Causes for globus remain uncertain; however, current opinion focuses on a mixture of muscle tension and mucosal irritation. It is estimated that globus makes up 4% of all primary care referrals to otolaryngologists. There are a handful of proposed causes, with treatments often able to be initiated in the primary care setting. Although most causes are benign, it is important for clinicians to maintain suspicion for malignancy, because this is often the patient's main concern.

Acalasia cricofaríngea primaria / Primary cricopharyngeal acalasia

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Utilidad de los criterios clínicos para el adecuado diagnóstico de la faringoamigdalitis en la urgencia pediátrica / Utility of clinical criteria for the adequate diagnosis of the pharingoamigdalitis in the pediatric emergency service

OBJETIVO: Existen dos escalas (Centor y McIsaac) que describen los signos y síntomas frecuentes en la faringoamigdalitis y que determinan la actitud a seguir para su diagnóstico y tratamiento; entre ellas, los criterios de McIsaac son una de las escalas más empleadas. El objetivo del estudio fue determinar el valor predictivo de los criterios de McIsaac en el diagnóstico de la faringoamigdalitis por estreptococo beta hemolítico grupo A (EbhGA). El valor predictivo de estos criterios es determinante en la adecuada utilización de la prueba TDR y tratamiento antibiótico. MÉTODOS: Se realizó un estudio transversal cuya población objeto fueron pacientes entre 0 y 14 años atendidos en el Servicio de Urgencias Pediátricas del Hospital Casa de Salud de Valencia durante 2016, con diagnóstico de amigdalitis, faringoamigdalitis o faringitis y con las pruebas de detección rápida del antígeno estreptocócico (TDR) realizadas. Se estudió la presencia de los criterios de McIsaac en los grupos TDR positivo y negativo. Se midió la sensibilidad y especificidad, y se aplicaron los teoremas de Probabilidades Totales y de Bayes, así como medidas de razón de verosimilitud. RESULTADOS: Se obtuvo un resultado negativo del TDR en el 58,1% (n=330) y positivo en el 41,9% (n=238). Cumplieron al menos 3 criterios un 48,3% (n=115) de los que presentaban TDR+, de los cuales el más frecuente fue la edad mayor de 3 años (97,4%); y los cumplieron un 46,7% (n=154) de los que tenían TDR-, donde el más frecuente fue la ausencia de catarro (91,6%). El análisis predictivo de los criterios de McIsaac arrojó una sensibilidad de P(+/E)=48,3%, una especificidad de P(-/NE)=53,3%, un valor predictivo positivo de P(E/+)=42,7% y unas razones de verosimilitud de IEP+=1,04 y de IEP-=0,97. CONCLUSIONES: Los resultados indican un bajo valor predictivo de los criterios de McIsaac en la población de estudio. Debe implantarse de forma más asidua la prueba de TDR y reevaluar los criterios McIsaac para el correcto diagnóstico de la faringoamigdalitis por EbhGA y, con ello, facilitar un adecuado tratamiento para evitar la sobreprescripción de antibióticos

Objective: There are two scales (Centor and McIsaac) that describe the frequent signs and symptoms in pharyngotonsillitis and determine the attitude to be followed for diagnosis and treatment; among them, the McIsaac criteria are one of the most widely used scales. The goal of the study was to determine the predictive value of the McIsaac criteria in the diagnosis of pharyngotonsillitis due to EbhGA in a Pediatric Emergency Service. The predictive value of these criteria is decisive in the adequate use of TDR test and antibiotics as a treatment. Methods: Cross-sectional study. The target population were all patients between 0 and 14 years old treated in the Pediatric Emergency Service of the Casa de Salud Hospital of Valencia during 2016, with discharge diagnoses, tonsillitis, pharyngotonsillitis or pharyngitis and with the TDR performed. Two groups were set up according to whether TDR was positive or negative. The presence of the McIsaac criteria was studied in both groups. A sensitivity and specificity study was carried out and the Total and Bayes Probability theorems were applied as well as the likelihood ratio measures. Results: A negative result of TDR was obtained in 58.1% (n=330) and was obtained a positive result in 41.9% (n=238). At least three criteria met 48.3% (n=115) with TDR+ of which the most frequent was age >3 years (97.4%); and 46.7% (n=154) of children with TDR- where the most frequent was the absence of catarrh (91.6%). The output from the predictive analysis of meeting the McIsaac criteria was a sensitivity (P(+/E)=48.3%), a specificity (P(-/NE)=53.3%), a positive predictive value P(E/+)=42.7% and likelihood ratios LR+=1.04 and LR-=0.97. Conclusions: The results indicate a poor predictive value of the McIsaac criteria in the population being studied. The TDR test should be implanted more frequently and the McIsaac criteria should be re-evaluated for the correct diagnosis of pharyngotonsillitis due to EbhGA and with it an adequate treatment to avoid the overprescription of antibiotics

Fístulas del seno piriforme congénitas: reporte de 4 casos y revisión de la literatura / Congenital pyriform sinus fistula: report of 4 cases and review of the literature

Resumen Introducción: Las fístulas del seno piriforme, originadas desde el tercer o cuarto arco branquial, son entidades poco frecuentes. Se pueden presentar como aumento de volumen cervical, fístula cervical, absceso cervical, tiroiditis abscedada y/o disfonía. Objetivo: Reportar 4 casos tratados en nuestro hospital y revisión de la literatura. Discusión: Frente a un cuadro clínico compatible, se debe realizar estudio endos- cópico y de imágenes. El manejo quirúrgico sigue siendo el de mejores resultados, pero se han desarrollado terapias endoscópicas y combinaciones de estas con buenos resultados. Conclusión: El diagnóstico requiere un alto índice de sospecha clínica. La cirugía abierta se mantiene como el gold standard, sin embargo, en población pediátrica estaría indicada la resolución endoscópica debido a la alta morbilidad de la cirugía tradicional.

Introduction: Pyriform sinus fistula is a rare cervical branchial anomaly derived from the third and fourth branchial arch. Pyriform sinus fistula should be considered in children presenting enlarged neck mass, fistula, abscess, thyroid infection and/or dysphonia. Objective: We here report 4 cases treated in Hospital Clínico Universidad de Chile and review of the current literature on pyriform sinus fistula. Discussion: When clinical presentation is compatible with pyriform sinus fistula, endoscopic and imaging techniques are required. Surgical outcomes are better, although endoscopic therapies and combination of both surgery and endoscopy have also reported good outcomes. Conclusion: Diagnosis is made based on signs and symptoms and a high index of clinical suspicion. Open surgery is gold standard, however in pediatric population endoscopic resolution should be considered to reduce the high morbidity of traditional surgery.

Actinomicosis amigdalina imitando una recaída de un linfoma no Hodgkin / Tonsillar actinomycosis mimicking relapse of diffuse large B-cell non-Hodgkin lymphoma

La actinomicosis es una infección poco frecuente, lentamente progresiva y de difícil diagnóstico. Se presenta el caso clínico de una mujer de 63 años en remisión total de un linfoma no Hodgkin difuso de células B grandes de amígdala. Durante su seguimiento se observó un ligero aumento de la lactato deshidrogenasa (LDH). Por la posibilidad de una recaída de su linfoma se realizó una tomografía por emisión de positrones (TEP-TC) que detectó mayor densidad y actividad en la orofaringe izquierda. Se realizó la extirpación de la lesión, cuyo diagnóstico histopatológico fue de una actinomicosis amigdalina. El género Actinomyces es comensal de la orofaringe y de la vía respiratoria y digestiva. La forma cérvico-facial es la más frecuente. La extirpación quirúrgica es a menudo esencial para un diagnóstico definitivo. Es importante incluir esta enfermedad en el diagnóstico diferencial de las lesiones tumorales de la región cérvico-facial.

Tuberculosis faríngea: 5 casos clínicos / Pharyngeal tuberculosis: Report of 5 cases

La pandemia tuberculosa supone un problema de salud pública para muchos países, ya sean ricos o pobres. Su localización ORL extraganglionar es poco frecuente, y en la región faríngea predomina en el cavum. En un estudio retrospectivo sobre 3 años, se intentan poner de relieve, a través de 5 casos clínicos de tuberculosis faríngea, los aspectos epidemiológicos, clínicos, radiológicos, terapéuticos y pronósticos de esta enfermedad. Sus aspectos clínicos no son específicos, y suelen prestarse a confusión con afección tumoral. El diagnóstico positivo se orienta por los datos clínicos y radiológicos y se confirma por anatomopatología (AU)

Tuberculosis is a public health problem for many countries, whether rich or poor. Extranodal ENT locations are rare, and it prevails in the cavum in the pharyngeal region. Based on a 3-year retrospective study of 5 clinical cases, the authors aim to highlight the epidemiological, clinical, radiological, therapeutic and prognostic aspects of this disease. Clinical aspects are not specific and there is often confusion in the differential diagnosis with tumoral lesions. Positive diagnosis is guided by the clinical and the radiological findings, and confirmed by histology (AU)

Tuberculosis faríngea: Caso clínico / Pharyngeal tuberculosis: Case report

La tuberculosis faríngea es una manifestación extrapulmonar infrecuente. En Argentina, se notificaron 1752 pacientes enfermos de tuberculosis menores de 19 años en el año 2012. Solo 12,15% teman localización extrapulmonar. Se presenta el caso de una adolescente que consultó por odinofagia y fiebre intermitente de 6 meses de evolución, sin respuesta al tratamiento antibiótico convencional. La radiografía de tórax presentaba infiltrado micronodulillar bilateral, por lo que la paciente se internó para estudiar y tratar. El resultado del examen directo de esputo para bacilos ácido-alcohol resistentes fue positivo y se inició tratamiento con cuatro drogas antituberculosas, con buena evolución y desaparición de los síntomas. Se obtuvo confirmación diagnóstica con el aislamiento de la Mycobacterium tuberculosis del cultivo de esputo. La tuberculosis faríngea presenta como principal motivo de consulta odinofagia y dificultad en la deglución de larga evolución. Por ello, se resalta la importancia de descartar tuberculosis ante toda faringitis sin respuesta al tratamiento convencional.

Pharyngeal tuberculosis is a rare extrapulmonary manifestation. In Argentina, the number of cases of tuberculosis reported in children under 19 years in 2012 was 1752. Only 12.15% had extrapulmonary manifestation. A case of a 17 year old girl with pharyngeal tuberculosis is reported. The patient presented intermittent fever and swallowing pain for 6 months, without response to conventional antibiotic treatment. Chest X-ray showedbilateral micronodular infiltrate, so hospitalization was decided to study and treat. The sputum examination for acid-fast resistant bacilli was positive and treatment with four antituberculous drugs was started, with good evolution and disappearance of symptoms. Diagnostic confirmation with the isolation of Mycobacterium tuberculosis in sputum culture was obtained. The main symptoms of pharyngeal tuberculosis are sore throat and difficulty in swallowing of long evolution. It is important to consider tuberculosis as differential diagnosis in patients with chronic pharyngitis unresponsive to conventional treatment.

Enfisema retrofaríngeo espontáneo, una entidad rara a considerar / Spontaneous retropharyngeal emphysema: A rare clinical entity

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Variante faringo-cérvico-braquial del síndrome de Guillain-Barré

El síndrome de Guillain-Barré es una polineuropatía desmielinizante inflamatoria aguda, existiendo variantes locorregionales poco frecuentes como la faringo-cérvico-braquial. Presentamos el caso de un varón de 63 años de edad que acudió a urgencias por debilidad de extremidades superiores y a nivel cervical, con incapacidad para deglutir y masticar, y una insuficiencia respiratoria aguda rápidamente progresiva por debilidad de músculos respiratorios, todo ello secundario a la variante faringo-cérvico-braquial del síndrome de Guillain-Barré. Esta variante, aunque poco frecuente, presenta un patrón clínico y unos criterios diagnósticos bien definidos, importantes de reconocer para poder así iniciar de forma precoz el tratamiento y mejorar el pronóstico, no siempre favorable, de estos pacientes.

Guillain-Barré syndrome is an acute inflammatory demyelinating polyneuropathy. Infrequent loco-regional variants, like the pharyngeal-cervical-brachial, have been described. We report the case of a 63-year-old male admitted to the emergency department with cervical and upper limb weakness, inability to swallow and chew, he also presented a rapidly progressive acute respiratory failure due to weakness of the respiratory muscles secondary to the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. This variant, although unusual, presents a well-defined clinical pattern and diagnostic criteria, which is important in order to start an early treatment to improve the prognosis, not always favorable, to these patients.

Oropharyngeal histoplasmosis: report of eleven cases and review of the literature / Histoplasmose orofaríngea: relato de onze casos e revisão da literatura

INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.

INTRODUÇÃO: Histoplasmose é uma micose sistêmica, endêmica no Brasil, especialmente no Estado do Rio Grande do Sul, onde Histoplasma capsulatum foi isolado do solo. H. capsulatum pode acometer áreas não-usuais, como cavidade orofaríngea, particularmente em pacientes com histoplasmose disseminada, por sua vez, associada com estado de imunossupressão, como na AIDS. MÉTODOS: A partir de 265 casos de histoplasmose em um banco de dados de um laboratório de micologia, foram analisados retrospectivamente 11 prontuários de pacientes com diagnóstico histológico ou microbiológico de histoplasmose oral (HO) entre 1987 e 2008. RESULTADOS: Reportamos neste trabalho onze casos de HO, a grande maioria com evidências histopatológicas e microbiológicas de histoplasmose disseminada (HD). Nos pacientes com HD, HO foi a primeira manifestação de histoplasmose. Cinco dos onze casos relatados eram portadores do vírus do HIV, todos com diagnóstico clínico e laboratorial de AIDS. Quatro pacientes do total tinham concomitantemente tuberculose pulmonar e histoplasmose. Tratamento foi baseado no uso de itraconazol e anfotericina B principalmente. Oito pacientes tiveram sucesso terapêutico após um ano, dois não retornaram para reavaliação e um faleceu apesar da adequada terapia antifúngica. CONCLUSÕES: Histoplasmose oral está associada muitas vezes com estado de imunossupressão, especialmente em pacientes com AIDS. Em muitos casos pode representar o primeiro sinal indicativo de histoplasmose disseminada.

Pápula pediculada y fisura en línea cervical anterior de recién nacido / Pedunculated Papule and Fissure in the Anterior Midline of the Neck

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Extensive parapharyngeal and skull base neuroglial ectopia; a challenge for differential diagnosis and treatment: case report / Extenso tecido neuroglial ectópico em parafaringe e base de crânio; desafio no diagnóstico diferencial e tratamento: relato de caso

CONTEXT: Neuroglial ectopia has been defined as a mass composed of differentiated neuroectodermal tissue isolated from the spinal canal or cranial cavity and remains rare. This lesion has to be considered in the differential diagnosis among newborn infants with classical symptoms of respiratory distress, neck mass and feeding difficulties. We present a rare case of extensive parapharyngeal and skull base neuroglial ectopia in 6-month-old girl who presented respiratory and feeding obstruction at birth. CASE REPORT: A six-month-old girl who presented upper respiratory and feeding obstruction at birth and was using tracheostomy and gastrostomy tubes was referred to our institution. Complete surgical excision of the mass consisted of a transcervical-transparotid approach with extension to the infratemporal fossa by means of a lateral transzygomatic incision, allowing preservation of all vital neurovascular structures. The anatomopathological examination showed a solid mass with nests of neural tissue, with some neurons embedded in poorly encapsulated fibrovascular stroma, without mitotic areas, and with presence of functioning choroid plexus in the immunohistochemistry assay. Neurovascular function was preserved, thus allowing postoperative decannulation and oral feeding. Despite the large size of the mass, the child has completed one year and six months of follow-up without complications or recurrence. Neuroglial ectopia needs to be considered in diagnosing airway obstruction among newborns. Surgical treatment is the best choice and should be performed on clinically stable patients. An algorithm to guide the differential diagnosis and improve the treatment was proposed.

CONTEXTO: Tecido neuroglial ectópico é definido como uma massa composta de tecido neuroectodermal diferenciado, isolado do canal espinhal ou da cavidade craniana e permanece raro. Esta lesão tem de fazer parte do diagnóstico diferencial em neonatos com os clássicos sintomas de obstrução respiratória, massa cervical e dificuldade para alimentação. Descreve-se um raro caso de tecido neuroglial ectópico extensor em parafaringe e base de crânio em uma menina de seis meses de idade que apresentou os sintomas de obstrução respiratória e alimentar ao nascimento. RELATO DE CASO: Menina de seis meses de idade que apresentou obstrução respiratória alta e alimentar ao nascimento, usando traqueostomia e gastrostomia, foi encaminha à instituição. A ressecção cirúrgica completa da massa utilizou um acesso transcervical-transparotídeo com extensão para fossa infratemporal pela incisão lateral transzigomática, permitindo identificação e preservação das estruturas neurovasculares vitais. O exame anatomopatológico evidenciou uma massa sólida com ninhos de tecido neuronal com alguns neurônios imersos em estroma fibrovascular, de pouca cápsula, sem áreas de mitoses e presença de plexo coroide funcionante ao exame imunoistoquímico. As funções neurovasculares foram preservadas na cirurgia, permitindo a decanulação e alimentação via oral no pós-operatório. Apesar do grande tamanho da massa, a criança completou um ano e meio de acompanhamento sem quaisquer complicações ou recorrência. O tecido neuroglial ectópico deve ser considerado no diagnóstico de obstruções de vias aéreas no neonato. O tratamento cirúrgico é o melhor e deve ser feito no paciente clinicamente estável. Um algoritmo para orientar o diagnóstico diferencial e melhorar o tratamento foi proposto.

Laryngeal manifestations in atypical recurrent aphthous stomatitis / Manifestações laríngeas da Estomatite Aftoide Recorrente Atípica

Recurrent aphthoid stomatitis is characteristically observed in children and adolescents in the form of painful relapsing ulcers in the oral mucosa unaccompanied by evidences of systemic disease. The ulcers appear every one or two weeks for at least one entire year. Some patients suspected for recurrent aphthoid stomatitis develop lesions in atypical sites - mainly in the larynx - concurrently to the ones found in the oral mucosa. AIM: this study aims to describe a series of recurrent aphthoid stomatitis patients with atypical laryngeal injuries. Study design: this is a case series study. MATERIALS AND METHOD: patients diagnosed with recurrent aphthoid stomatitis with oral mucosa ulcers and laryngeal symptoms without altered lab test results and no evidence of systemic disease underwent fibroscopic examination, oral and laryngeal biopsies, followed by specimen evaluation by direct immunofluorescence. RESULTS: all six patients in this series had acute and chronic inflammatory processes according to pathology studies and negative direct immunofluorescence test results. CONCLUSION: laryngeal involvement in recurrent aphthoid stomatitis is rare. Therefore, during diagnostic examination thorough clinical history and meticulous physical examination accompanied by fibroscopic examination are necessary. When atypical lesions are found, biopsies for histological evaluation and direct immunofluorescence tests are required.

A Estomatite Aftoide Recorrente é definida como úlceras recorrentes e dolorosas na mucosa oral, de aparecimento na infância e adolescência, sem evidências de doenças sistêmicas, presentes quinzenal ou mensalmente por um período mínimo de um ano. No entanto existem quadros sugestivos de Estomatite Aftoide Recorrente que mostram lesões em localizações atípicas, principalmente em laringe, concomitantes àquelas localizadas na mucosa oral. OBJETIVO: Descrever uma série de portadores de Estomatite Aftoide Recorrente com apresentação atípica em laringe. Forma do Estudo: Estudo de uma série de casos. MÉTODO: Pacientes com diagnóstico clínico de Estomatite Aftoide Recorrente, com lesões em mucosa oral e sintomas laríngeos, sem alterações nos exames laboratoriais e sem evidências de doenças sistêmicas, foram submetidos a exame fibroscópico e a biópsia oral e laríngea, complementadas com Imunofluorescência Direta. RESULTADOS: Todos os seis pacientes desta série apresentaram como resultados histopatológicos processo inflamatório agudo e crônico e Imunofluorescência Direta negativas. CONCLUSÃO: O acometimento laríngeo na Estomatite Aftoide Recorrente é raro, por isso durante o diagnóstico faz-se necessária uma boa história clínica e um adequado exame físico, incluindo os exames fibroscópicos. Diante de lesões atípicas, faz-se necessário uso de biópsia para estudo histológico e de Imunofluorescência Direta.

Abcessos parafaríngeos na criança: estudo retrospectivo de 5 anos / Parapharyngeal abscess in children: five year retrospective study

Os abcessos laterofaríngeos e retrofaríngeos são infecções potencialmente fatais, designadamente na criança. Objetivo: Revisão de agentes etiológicos, achados clínicos e de exames de imagem de abcessos laterofaríngeos e retrofaríngeos em crianças, assim como de resultados e complicações do tratamento através de uma abordagem cirúrgica trans-oral. Material e método: Estudo retrospectivo abrangendo 11 crianças, internadas nos últimos 5 anos num hospital universitário terciário, com o diagnósticos de abcesso laterofaríngeo (n = 8) e retrofaríngeo (n = 3), com idades variando entre 0 e 12 anos. Os processos clínicos e exames de imagem foram revistos. Resultado: A idade média de apresentação foi de 3.3 anos de idade. Alterações da mobilidade cervical(64 por cento) e odinofagia(55 por cento) foram os sintomas mais frequentes. Febre(64 por cento), rigidez cervical(64 por cento), abaulamento da parede faríngea(55 por cento),massa cervical(55 por cento) e linfadenopatias(36 por cento) foram os achados clínicos mais frequentes. Todos os doentes foram submetidos a drenagem cirurgia por via trans-oral nas primeiras 48 horas após a admissão hospitalar. Cerca de 82 por cento dos doente apresentaram melhoria do quadro clinico após 48 horas e todos após 72 horas, sem quaisquer complicações. Conclusão: Considerando os bons resultados e a baixa taxa de complicações, o presente estudo sugere que uma antibioterapia sistémica associada a uma intervenção cirúrgica atempada parece ser uma opção válida no tratamento destes abcessos.

Lateropharyngeal and retropharyngeal abscesses are potentially life threatening infections in children AIM: To review the etiologic, clinical, and imaging signs of lateropharyngeal and retropharyngeal abscesses in children as well as treatment-outcomes and complications using a surgical trans-oral approach. Method: Retrospective analysis of 11 children, hospitalized in the last 5 years, with a diagnosis of lateropharyngeal (n = 8) and retropharyngeal (n = 3) abscesses, ages ranging from 0 to 12 years old. Charts and CT scans were reviewed. Result: The average age of presentation was 3.3 years. Neck stiffness (64 percent) and odynophagia (55 percent) were the most common symptoms. Fever (64 percent), stiff neck (64 percent), bulging of the oropharyngeal wall (55 percent), mass in the neck (55 percent) and lymphadenopathy (36 percent) were the most prevalent physical findings. All these patients were submitted to surgical drainage using a trans-oral approach in the first 48 hours after admission. About 82 percent of the patients showed improvement after 48 hours, and 100 percent after 72 hours, without any complications. Conclusion: Based on the good clinical outcomes and low incidence of complications, the present study suggests that antibiotic therapy complemented with a timely surgical treatment, is a valid treatment option in refractory parapharyngeal abscesses.

Colonización faríngea por bacterias potencialmente patógenas en niños sanos de una escuela primaria / Nasopharyngeal colonization by potentially pathogenic bacteria found in healthy children from an elementary school

INTRODUCCIÓN: la nasofaringe humana es un reservorio natural de bacterias potencialmente patógenas, agentes etiológicos importantes de infecciones comunes que afectan a todas las edades, en particular a la población infantil. OBJETIVO: conocer la prevalencia de estos patógenos potenciales en niños sanos. MÉTODOS: tomando en cuenta las exigencias bioéticas establecidas para este tipo de estudio, en el año 2002 se realizó un estudio transversal descriptivo de portadores en 318 estudiantes de una escuela primaria de La Habana. A los escolares se les tomó un exudado de la faringe y los padres respondieron un cuestionario donde se indagó sobre factores de riesgo que influyen en el estado del portador (edad, sexo, hacinamiento, condición de fumador pasivo, antecedente de enfermedad respiratoria infecciosa o alérgica). La muestra se tomó en la escuela, se sembró directo en los medios de cultivo y las bacterias aisladas se identificaron por métodos convencionales y el sistema API NH. RESULTADOS: el porcentaje de portadores de bacterias potencialmente patógenas fue elevado (55 por ciento), prevalecieron: Staphylococcus aureus (33,6 por ciento), estreptococos b-hemolíticos (17,3 por ciento) y Streptococcus pneumoniae (11,6 por ciento). Dentro de los estreptococos b-hemolíticos predominó el grupo G (49 por ciento), seguidos del A y C con 18,2 por ciento de portadores en cada grupo. La edad fue un factor de riesgo significativo (p< 0,05), con porcentajes de portadores mßs elevados en los ni±os de 10 (60 por ciento), 11 (75,5 por ciento) y 12 a±os (77,3 por ciento). Existió resultado estadísticamente significativo entre los portadores de meningococo y el hacinamiento (p= 0,043). Predominó la asociación de S. aureus mßs estreptococos b-hemolíticos (27,9 por ciento), sobre todo en los ni±os alérgicos (p< 0,05). Neisseria lactamica se aisló en 29,6 por ciento e impidió la colonización por N. meningitidis (p= 0,0004). CONCLUSIONES: esta investigación...

INTRODUCTION: human nasopharynx is a natural reservoir of potentially pathogenic bacteria which are important etiological agents of common infections that affect all age groups, particularly the child population. OBJECTIVE: finding out the prevelance of these potential pathogens in healthy children. METHODS: Taking into account the bioethical requirement set for these kind of study in 2002, a descriptive cross-sectional study of carriers was performed on 318 pupils from an elementary school in Havana. Samples from their pharynx were taken for testing and their parents answered a questionnaire on the risk factors affecting the condition of the carrier (age, sex, crowding, passive smoking, history of infectious or allergic respiratory disease). The sample was taken at the school, then the smear was directly placed in the culture media and the isolated bacteria were identified by conventional methods and by the API NH system. RESULTS: the percentage of potentially pathogenic bacteria carriers was high (55 percent) in which Staphylococcus aureus (33.6 percent), hemolytic streptococci b (17.3 percent) y Streptococcus pneumoniae (11.6 percent). Among the hemolytic streptococci b, the group G (49 percent) predominated, followed by A and C with 18.2 percent of carriers in each group. Age was a significant risk factor (p< 0.05), being the highest percentages of carriers in children aged 10 (60 percent), 11 (75.5 percent) and 12 (77.3 percent) years. There was statistically significant relation between meningococcal carriers and crowding (p= 0.043). The association of S. aureus plus hemolytic streptococci b (27.9 percent) predominated, mainly in allergic children (p< 0.05). Neisseria lactamica was isolated in 29.6 percent and prevented the colonization by N. meningitidis (p= 0.0004). CONCLUSIONS: this research study made it possible to identify the patterns of nasopharyngeal colonization by potentially pathogenic bacteria in healthy...

Faringocele / Pharyngocele

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Amiloidose com múltiplos focos em trato aéreo-digestivo superior: relato de caso e revisão de literatura / Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review

Há na literatura inúmeras descrições de amiloidose limitada à laringe, sendo que esta afecção corresponde a cerca de 1 por cento dos tumores benignos da laringe. Entretanto, há somente três relatos de amiloidose acometendo a região do anel de Waldeyer. Descreveremos um raro caso de amiloidose em que há acometimento de sítios distintos do trato aéreo-digestivo superior: pilar amigdaliano, rinofaringe, supraglote e glote, sem continuidade aparente do tecido amilóide. Abordaremos, também, o seguimento pós-operatório com uma disfagia grave.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Tumor miofibroblástico inflamatorio de amígdala: informe de un caso con revisión de la literatura / Inflammatory myofibroblastic tumour of the tonsil: case report and literature review

El tumor miofibroblástico inflamatorio (seudotumor inflamatorio) es una lesión idiopática, poco frecuente en cabeza y cuello, de etiología desconocida, que se presenta más comúnmente en tejidos blandos, pulmón y órbita. En la literatura mundial solo se tiene conocimiento previo de 2 casos con afección amigdalar. Informamos del caso de una niña de 10 años, que ingresó en nuestro hospital con cuadro clínico de dolor en la región cervical, tos con vómito, disnea y dislexia, la exploración física mostró halitosis y una neoformación dependiente de la amígdala izquierda, se le realizó amigdalectomía bilateral(AU)

Inflammatory myofibroblastic tumour (inflammatory pseudotumor) is an idiopathic lesion, rare in the head and neck, of unknown aetiology. It is primarily a soft tissue, lung and orbital condition. In the world literature, only two cases with tonsillar disease have been found. We report a case of a 10-year-old girl admitted to our hospital with clinical complaints of pain in the neck region, cough with vomiting, dyspnoea and dyslexia. Clinical examination revealed halitosis and a neoformation dependent on the left tonsil. Bilateral tonsillectomy was performed(AU)

Tuberculose faringolaríngea / Laryngo-pharyngeal Tuberculosis

A apresentação faringolaríngea da tuberculose como forma isolada da doença é rara, entretanto, nos últimos anos, com o aumento progressivo do número de casos de tuberculose em geral, a possibilidade dessas localizações aumentou. OBJETIVO: Descrever caso de tuberculose faringolaríngea primária em paciente grávida e imunocompetente. RELATORIO DE CASO: Paciente do sexo feminino, 30 anos, com história de odinofagia há 10 meses, sem qualquer sintoma sistêmico ou outras queixas referentes às vias aéreas superiores. Apresentava lesão granulomatosa em orofaringe e laringe, e o resultado da biópsia revelou bacilos álcool-ácido resistentes. Exames clínico e radiológico do aparelho respiratório sem alterações. Realizado tratamento anti-tuberculose por nove meses com resolução completa do quadro. CONCLUSÃO: Autores realçam a importância epidemiológica da tuberculose e a necessidade de um alto grau de suspeição de lesões das vias aéreas superiores para o diagnóstico precoce da doença.

Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM: To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT: A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS: The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.

La voz cantada / The singing voice

La voz cantada representa un subgrupo especial dentro del campo de la voz. Además de caracterizarse por aspectos diferenciales en cuanto a la fisiología, los pacientes-cantantes son con frecuencia un reto para los otorrinolaringólogos. Esto es debido probablemente a que la formación específica en nuestra especialidad en el campo de la voz no ha tenido el protagonismo que han tenido otras áreas. Pero además, en el caso de los cantantes, es imprescindible la existencia de una gran empatía en la relación médico-paciente que aquí, como en otras muchas ocasiones, forma parte del efecto terapéutico. Para lograrla, es imprescindible que el otorrinolaringólogo sepa qué es un cantante, cómo se forma, cómo se expresa, y qué patología le afecta. Esta revisión pretende dar una visión general de la fisiopatología de la voz cantada desde el doble aspecto científico y artístico, que, en el caso del canto, van indefectiblemente unidos (AU)

Singing voice is a special subgroup within the field of voice. In addition to the differences in physiology between singing and speaking voice, singer patients are often regarded as a challenge for the otolaryngologist. The reason for this is probably that the field of voice has not received as much attention as others in our speciality. Moreover, in the case of singers, empathy is vital in the doctor-patient relationship, and, as in many other cases, it forms part of the therapeutic effect. In order to achieve this, the physician has to know what singers are and which are the main pathologies they suffer, how they are formed and how they are expressed. This review offers an overlook of the pathological-physiology of singing voice from a double point of view, scientific and artistic, which in the case of singing are inevitably linked (AU)