Acute Suppurative Thyroiditis in Children: Clinical Decision-Making.

Acute suppurative thyroiditis are infrequent infections, although their early and proper management are needed to reduce complications and recurrences. We review the clinical presentation, etiology, clinical outcome and management of 9 cases of thyroid infections diagnosed in children, and analyze the existence of predisposing factors for these infections.

Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors.

INTRODUCTION: Intratemporal or intracranial complications of acute mastoiditis are often of significant severity, can be life-threatening, and require prompt and usually aggressive treatment. This study focused on analyzing the outcomes and complications of different surgical techniques used in intracranial and intratemporal complications of acute mastoiditis, the most common complication of acute otitis media. METHODS: A retrospective study of pediatric patients with mastoiditis with intratemporal and intracranial complications was designed at the Niño Jesús University Children's Hospital in Madrid, Spain, from 2005 to 2021. RESULTS: Of 417 patients with mastoiditis, 112 patients developed intratemporal and intracranial complications, with subperiosteal abscess being the most frequent complication. The most frequently isolated pathogens were Streptococcus pneumoniae, Streptococcus pyogenes, and Fusobacterium necrophorum. The most used surgical technique was myringotomy with placement of transtympanic drainage, in 86.6% of all cases. In patients with intracranial complications, neurosurgical procedures were necessary for 19.2%, with craniotomy with mastoidectomy being the most frequent. Most of the cases evolved favorably, and only 5.4% of the patients required surgical reintervention, being more frequent in intratemporal complications. In terms of complications, we found cases of neutropenia in 3.6%, neurological sequelae in 5.4%, and permanent hearing loss in 2.7%. CONCLUSIONS: There was a favorable evolution with a low incidence of reoperation and sequelae within our series. The surgical technique of choice correlated with the severity of the complication. If the mean size of the abscess exceeds 20 mm, incision and drainage, along with myringotomy and tube placement, should be considered as the initial treatment. Closed mastoidectomy should be reserved for deteriorating of clinical evolution or acute mastoiditis with intracranial complications. Intracranial and multiple concomitant complications were associated with a more extended hospital stay, ICU occupancy, neurosurgical intervention, and risk of neurological sequelae and neutropenia. Conversely, intratemporal complications may result in permanent hearing loss.

Risk of contagion of SARS-CoV-2 among otorhinolaryngologists in Spain during the "Two waves".

INTRODUCTION: The aim of our study was to obtain data about the contagion rate among Otolaryngologists in Spanish ENT Departments and about the clinical outcomes in positive otolaryngologists. As a secondary objective, we aim to assess the rate of contagion in the first and the second Covid-19 wave in Spain among Otorhinolaryngologists and the regional distribution by ENT-Departments. METHODS: Study design and population: This is a prospective observational study in a cohort of 975 Otolaryngologists from 87 ENT Departments conducted from March 25 to November 17 in our collaborative group, COVID ORL ESP. COVID-19 polymerase chain reaction (PCR) was the diagnostic standard. Hospitalization and/or intensive care admission and mortality was recorded as non-identified data. RESULTS: Data collected from 975 otolaryngologist from 87 Departments resulted in 157 (16.5%) otolaryngologists testing positive for SARS-CoV-19 by RT-PCR. Important geographic differences in contagion are reported. A total of 136 (86.6%) otolaryngologists were tested positive during the first wave and 21 (13.3%) during the second wave. At the last cut-off point of the study only 30/87 ENT Departments (34.5%) remained COVID19-free and 5 Departments reported more than 50% staff members testing positive. The majority of positive tested otolaryngologists (126/157; 80.2%) had only mild or no symptoms, 17 developed moderate symptoms (10.8%) and 3 had pneumonia not requiring hospitalization (2%). Five colleagues were admitted at hospital, 4 required ICU (2.5%) and 2 colleges died from COVID-19. CONCLUSIONS: During the first wave of the SARS-CoV-19 pandemic otolaryngologists in Spain have been overall the group suffering the highest rate of contagion, particularly during the first month. Subsequently, the Spanish Ministry of Health should include otorhinolaryngologists as a high-risk group in airborne pandemics.

Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain.

BACKGROUND: The question of an optimal strategy and outcomes in COVID-19 tracheostomy has not been answered yet. The critical focus in our case study is to evaluate the outcomes of tracheostomy on intubated COVID-19 patients. METHODS: A multicentric prospective observational study of 1890 COVID-19 patients undergoing tracheostomy across 120 hospitals was conducted over 7 weeks in Spain (March 28 to May 15, 2020). Data were collected with an innovative approach: instant messaging via WhatsApp. OUTCOME MEASUREMENTS: complications, achieved weaning and decannulation and survival. RESULTS: We performed 1,461 surgical (81.3%) and 429 percutaneous tracheostomies. Median timing of tracheostomy was 12 days (4-42 days) since orotracheal intubation. A close follow-up of 1616/1890 (85.5%) patients at the cut-off time of 1-month follow-up showed that in 842 (52.1%) patients, weaning was achieved, while 391 (24.2%) were still under mechanical ventilation and 383 (23.7%) patients had died from COVID-19. Decannulation among those in whom weaning was successful (n = 842) was achieved in 683 (81%) patients. CONCLUSION: To the best of our knowledge, this is the largest cohort of COVID-19 patients undergoing tracheostomy. The critical focus is the unprecedented amount of tracheostomies: 1890 in 7 weeks. Weaning could be achieved in over half of the patients with follow-up. Almost one out of four tracheotomized patients died from COVID-19.

Hemangioma de la fosa nasal en la infancia / Hemangioma of the nasal fossa in infants

Los hemangiomas en la infancia son los tumores benignos más frecuentes de cabeza y cuello en los niños. La localización intranasal es muy rara. Al obstruir toda la fosa nasal, produce un cuadro de dificultad respiratoria en el período neonatal que obliga a tomar medidas terapéuticas en los primeros meses de vida. Se presenta un paciente que nació con un hemangioma intranasal, se analizan las diferentes opciones terapéuticas y se expone la resolución final del caso, mediante vaporización con láser CO2 (AU)

Hemangiomas in infancy are the most frequent benign tumors of the head and neck in children. However, intranasal location is very rare. By obstructing the entire nasal fossa, it produces a problem of breathing difficulty in the neonatal period, which leads to therapeutic measures being taken in the first months of life. We present a patient who was born with intranasal hemangioma, we study the various therapeutic options and we expose the final resolution of the case, which was vaporization using CO2 laser (AU)

[Hemangioma of the nasal fossa in infants]. / Hemangioma de la fosa nasal en la infancia.

Hemangiomas in infancy are the most frequent benign tumors of the head and neck in children. However, intranasal location is very rare. By obstructing the entire nasal fossa, it produces a problem of breathing difficulty in the neonatal period, which leads to therapeutic measures being taken in the first months of life. We present a patient who was born with intranasal hemangioma, we study the various therapeutic options and we expose the final resolution of the case, which was vaporization using CO(2) laser.

[Post-traumatic haematoma and abscess in the nasal septa of children]. / Hematoma y absceso de tabique nasal postraumático en niño.

Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows.

Hematoma y absceso de tabique nasal postraumático en niño / Post-traumatic haematoma and abscess in the nasal septa of children

El hematoma septal tras traumatismo nasal es una complicación que de no ser diagnosticada y tratada precozmente puede evolucionar a un absceso septal. Presentamos el caso de un varón de 10 años que sufrió traumatismo nasal con fractura de huesos propios y un hematoma septal que no fue diagnosticado, y cuya evolución fue un absceso septal. Durante el drenaje de este absceso se evidenció una necrosis del cartílago cuadrangular. Posteriormente el paciente presentó un hundimiento del dorso nasal y una desviación del tabique nasal. Esta secuela se corrigió mediante la utilización de un injerto osteocondral costal. Ante cualquier traumatismo nasal es importante explorar correctamente el tabique nasal para descartar un hematoma, que si no se drena de forma precoz, puede evolucionar a un absceso por compresión del cartílago cuadrangular, cuyas consecuencias son su necrosis en pocos días y posterior hundimiento del dorso nasal en el curso del desarrollo del niño

Septal haematoma following nasal trauma is a complication that, if not diagnosed and treated early, may evolve into a nasal septal abscess. We present the case of a 10-year-old male who suffered nasal trauma with fracture and an undiagnosed septal haematoma that evolved into a septal abscess. During drainage of the abscess, necrosis of the quadrangular cartilage was noted. The patient later presented collapse of the nasal dorsum and deviation of the nasal septum. This sequela was corrected by means of an osteochondral costal graft. In the presence of any nasal trauma, it is important to explore the nasal septum correctly to discard the presence of a haematoma which, if not drained early, may evolve into an abscess due to compression of the quadrangular cartilage, leading to its necrosis in a few days and later collapse of the nasal dorsum as the child grows