Etiology, Diagnostic, and Rehabilitative Methods for Children with Central Auditory Processing Disorders-A Scoping Review.

APD (auditory processing disorders) is defined as difficulties in processing auditory stimuli within the central nervous system, with normative physical hearing and intellectual disabilities excluded. The scale of this phenomenon among children and adolescents and the need to raise awareness of its occurrence prompted the authors to review currently available diagnostic and therapeutic methods, as well as outline future directions for addressing children affected by APD.

Audiometric Outcomes of Ventilation Drainage Treatment for Otitis Media with Effusion in Children: Implications for Speech Development and Hearing Loss.

BACKGROUND Otitis media with effusion is the most commonly recognized condition in childhood. Chronic otitis media with accompanying hearing loss is particularly unfavorable in the first years of the child's life because it can not only permanently damage the structure of the middle ear, but also adversely affect speech development and intellectual abilities in the child. MATERIAL AND METHODS This study, from a single center in Poland, included 201 children (372 ears) requiring surgical treatment due to otitis media with effusion. The condition was diagnosed by an ear, nose, and throat specialist, and each patient had a hearing test performed. The control group consisted of 21 patients (42 ears) with negative outcomes following an audiological interview. RESULTS Among all of the patients enrolled in the study, a normal tympanometry result was found in 60.6% of ears, and otoemission occurred in 63.3% of ears. The average hearing threshold in the study group was 22.01 Hz in the 500 Hz frequency range, while they were 16.76 Hz, 12.72 kHz, and 14.78 kHz for the corresponding 1 kHz, 2 kHz, and 4 kHz ranges, respectively. CONCLUSIONS Ventilation drainage is an effective treatment for otitis media with effusion. The presence of genetic disease has the greatest impact on the course of otitis media. These patients most often require reinsertion of a ventilation tube.

Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance.

Adenoids (nasopharyngeal tonsils), being part of Waldeyer's ring, are masses of lymphoid tissues located at the junction of the roof and the posterior wall of the nasopharynx. Adenoids play an important role in the development of the immune system and serve as a defence against infections, being the first organs that come into contact with respiratory and digestive antigens. The causes of adenoid hypertrophy are not fully known. They are most likely associated with aberrant immune reactions, infections, environmental exposures and hormonal or genetic factors. The aim of this review is to summarise the current knowledge of adenoid hypertrophy in children and associated diseases. Adenoid hypertrophy has many clinical manifestations that are frequent in the paediatric population and is accompanied by various comorbidities.

An Evaluation of Health-Related Quality of Life in Children with Nasal Septum Deviation.

BACKGROUND: From the 1950s, the quality of life criterion came to be studied in earnest, originally forming a part of measurement of human development in Western Europe and the USA. The present study aims to compare the health-related quality of life (HRQL) between children with nasal septum deviation and healthy children controls. MATERIALS AND METHODS: Subjects were children suffering from nasal septum deviation, one of the commonest chronic diseases of the upper respiratory tract. Controls were randomly recruited from kindergarten, primary and secondary schools (junior high school & high school). All schools and subjects were randomly selected. The CHQ-PF50 questionnaire was used and outcome scores were calculated by an algorithm for the 13 tested HRQL variables. RESULTS: Means for all outcome scores in the test subjects (i.e., children with deviated nasal septums) varied between 3.65-89.27 with a standard deviation between 0.83-25.66 and a median between 3.4-100 (n = 101). Those for the controls (n = 102) were 3.78-97.11, 0.86-14.21 and 4.40-100, respectively. Test subjects showed significant scoring declines in Physical Fitness, Role/Social-Emotional/Behavioral, Role/Social-Physical, Mental Health, Self-esteem, General Health Perceptions, Parental Impact Emotional and Time and Family Limitations in Activities. CONCLUSIONS: 1. The well-being of children with nasal septum deviation was found to be chiefly limited by their physical fitness, effects of physical condition on social behavior/interaction and how health is perceived. 2. Parents considered their children's health to be paramount, as demonstrated by assessing the HRQL.

Physical and Psychosocial Concept Domains Related to Health-Related Quality of Life (HRQL) in 50 Girls and 52 Boys Between 5 and 18 Years Old in Poland Using the Parent-Reported 50-Item Child Health Questionnaire (CHQ-PF50).

BACKGROUND We used the parent-reported 50-item Child Health Questionnaire (CHQ-PF50) to evaluate parental by-proxy responses regarding 102 healthy Polish children and adolescents, aged 5 to 18 years, in 13 physical and psychosocial concept domains linked to health-related quality of life (HRQL) to determine which domains pose the greatest limitations to health. MATERIAL AND METHODS Participants were 50 healthy female and 52 healthy male school children (nursery, primary, junior-high, and high), selected randomly and found eligible from 585 participants originally recruited; participants with diseases/ailments and incomplete questionnaires were excluded. The CHQ-PF50 has 50 questions divided into 13 domains that represent physical and mental well-being; parents gave their retrospective responses from memory. Scores were expressed numerically using a standard algorithm and ranged from 0 to 100; higher scores represented more favorable HRQL outcomes. Summary statistics were performed, and age and sex effects were assessed. RESULTS Mean HRQL domain scores never attained 100 (maximum value). They were lowest (P<0.004) for domains of Family Cohesion (66.57), Parental Emotional (77.21), and General Health Perceptions (75.41), while highest (but still significantly <100, P<0.047) in Physical Functioning (97.11), Role/Social Emotional-Behavioral (96.51), and Role/Social-Physical (96.24). Neither age nor sex significantly affected domain scores. Outcomes were comparable to European and US studies but differed from a previous small-scale Polish study. CONCLUSIONS None of the CHQ-PF50 domain mean values reached the maximum in apparently healthy Polish children. HRQL was lowest in Family Cohesion, Parental Emotional, and General Health Perceptions. Outcomes are considered a useful control baseline in Polish studies on disease.

A review of health-related quality of life issues in children suffering from certain key otolaryngological illnesses.

Background: The health-related quality of life (HRQoL) concept is nowadays increasingly and more broadly used for helping evaluate the effectiveness of medical treatment, superseding the earlier "quality of life" approach. The HRQoL concept likewise applies to otolaryngology and this narrative review study is focused on HRQoL outcomes in four key childhood otolaryngological diseases as reported in the literature. Study aim: To retrospectively evaluate the literature on measuring HRQoL in children suffering from selected otolaryngological illnesses, during treatment. Materials and Methods: Published studies/case reports were searched for in Medline, PubMed, Web of Science, Scopus and ORCID on the quality of life based on paediatric patient questionnaires, whether completed by subjects themselves or by their parents (by proxy). The following key words were used: health quality of life, otolaryngology/ENT, pediatrics/paediatrics. Studies before 1999 were omitted because hitherto, the "quality of life" had been imprecisely defined thus rendering any subsequent comparisions problematic. Results: HRQoL scores and well-being were found to significantly deteriorate in child patients suffering from four important otolaryngological disorders: chronic sinusitis, nasal septum deviation, adenoid hypertrophy and hearing disease. The main problems found were infection, inflammation, disruption to family life and child-parental interaction, fitness-related issues, reduced ENT patencies and apnea. Conclusions: The HRQoL appears to significantly deteriorate in children suffering from otolaryngological diseases. Further such studies are needed for other ENT diseases.

Health-Related Quality of Life Assessed in Children with Chronic Rhinitis and Sinusitis.

INTRODUCTION: Quality of life (QoL) can be simply defined as an area of human life that directly affects people which they consider to be important. This can be defined in greater detail as 'an individual perception of an individual's life position within a cultural context, value system and in relation to their tasks, expectations and standards determined by environmental conditions'. The health-related quality of life (HRQoL) more specifically focuses on how the QoL affects health (including both medical and non-medical issues). Limitations in well-being will, by association, also occur in those children suffering with sinus diseases. STUDY AIM: To compare the quality of life in children-adolescents suffering from some of the most commonly occurring childhood diseases of chronic rhinitis and sinusitis on a group of healthy children-adolescents. Test materials and methods: Subjects were children-adolescents with at least one of the aforementioned conditions afflicting the upper respiratory tract. Admission criteria were: ages 5 to 18 years in the presence of a chronic disease such as chronic rhinitis and paranasal sinusitis. The Child Health Questionnaire-Parent Form 50 CHQ-PF-50 (CHQ-PF50) was used, which is a general-purpose research instrument based on psychometric testing designed for assessing physical and mental well-being in children-adolescents aged 5 to 18 years. RESULTS: Wellbeing significantly deteriorated in sick children within the following areas: current health status of the child (STAND), physical fitness (PF), social functioning resulting from behaviour or emotional state (REB), the impact of physical health on limitations in social functioning (RP), pain and discomfort (BP), behaviour (BE), mental health (MH), self-esteem (SE), general health perception (GH), influence of the child's health condition on parental emotions (PE), limitations on parental leisure time due to the child's health (PT) and restrictions on joint family activities (FA). CONCLUSIONS: The greatest impairment to well-being in children with chronic rhinitis and paranasal sinusitis was on the impact of the child's health status on parents' emotions, pain and discomfort and general perception of health. This study confirms that parents of healthy children attach great importance to their health and health-related quality of life.

Health-Related Quality of Life Assessed in Children with Adenoid Hypertrophy.

INTRODUCTION: The quality of life issue began to be earnestly studied in the second half of the 20th century. It had originally been used as a criterion for measuring levels of human development in the USA and Western Europe. At first, only objective parameters were assessed, such as material goods; however, later, subjective and non-material parameters were added, such as health, freedom, and happiness. Over time, more and more attention has been paid to the subjective parameters regarding any quality of life assessment. Adenoids are physiological clusters of lymphoid tissue included in Waldeyer's ring, which play an important role in shaping and directing the child's local and systemic lines of defence. Adenoid hypertrophy occurs due to a variety of factors, such as recurring or chronic infections of the upper respiratory tract. STUDY AIM: To assess health status in children with adenoid system hypertrophy compared with a group of healthy children. MATERIALS AND METHODS: The study group consisted of children suffering from adenoid hypertrophy, this being the most common chronic disease of the upper respiratory tract. The control group was composed of children attending nursery school (kindergarten), primary school, middle school, and high school. The study was performed by using the Child Health Questionnaire-Parent Form 50 CHQ-PF-50 (CHQ-PF50), which is a general purpose research tool based on psychometric testing when assessing physical and mental well-being in children aged 5 to 18 years. RESULTS: There were 101 filled out questionnaires for the test group (54 girls and 47 boys), mean age 8.62 years (ranging 5-17), whilst 102 questionnaires for the controls (50 girls and 52 boys), mean age 10.58 years (ranging 5-18). Insignificant differences were found between social functioning resulting from behaviour or emotional state (REB), pain and discomfort (BP), and family cohesion (FC). CONCLUSIONS: Children suffering from adenoid hypertrophy demonstrate the largest decreases in wellbeing in the following areas: behaviour, general perception of health, and mental health.

Comparison of tympanometry results for probe tones of 226 Hz and 1000 Hz in newborns.

INTRODUCTION: Impedance audiometry is a routine test for diagnosing hearing disorders in children. Typically, tympanometry uses a 220 or 226 Hz probe tone. However, using a 1000 Hz test tone is becoming increasingly popular, particularly in newborns, since it enables one to assess individual components of the ear's admittance. AIM: This study compares tympanograms for test frequencies of 226 Hz and 1000 Hz in newborns and evaluate the rate of occurrence of each type of tympanogram for both frequencies. MATERIAL AND METHOD: The study material was 53 newborns. All newborns underwent middle ear susceptibility testing at two measurement frequencies: 226 Hz and 1000 Hz. The parameters obtained with both frequencies were compared, and the utility of the 1000 Hz test frequency for middle ear diagnostics in newborns was evaluated. RESULTS: The results show that tympanograms obtained from the same ear using different test frequencies are significantly different. The 1000 Hz tone produced a higher rate of type B tympanograms (flat). CONCLUSIONS: Tympanometry curves for 226 Hz and 1000 Hz are different, and in newborns the 1000 Hz test tone revealed a higher rate of middle ear pathology. However, further studies are required to verify that 1000 Hz tympanometry is a high-sensitivity diagnostic method for middle ear problems in newborns.

The Formation of Biofilm and Bacteriology in Otitis Media with Effusion in Children: A Prospective Cross-Sectional Study.

BACKGROUND: Otitis media with effusion (OME) can cause serious complications such as hearing impairment or development delays. The aim of the study was to assess the microbiological profile of organisms responsible for OME and to determine if a biofilm formation can be observed. METHODS: Ninety-nine samples from 76 patients aged from 6 months to 12 years were collected for microbiological and molecular studies. RESULTS: In microbiological studies, pathogenic bacteria Haemophilus influenzae (38.89%), Streptococcus pneumoniae (33.33%), and Staphylococcus aureus MSSA (27.78%), as well as opportunistic bacteria Staphylococcus spp. (74.14%), Diphtheroids (20.69%), Streptococcus viridans (3.45%), and Neisseria spp. (1.72%) were found. The average degree of hearing loss in the group of children with positive bacterial culture was 35.9 dB, while in the group with negative bacterial culture it was 25.9 dB (p = 0.0008). The type of cultured bacteria had a significant impact on the degree of hearing impairment in children (p = 0.0192). In total, 37.5% of Staphylococcus spp. strains were able to form biofilm. CONCLUSIONS: Staphylococcus spp. in OME may form biofilms, which can explain the chronic character of the disease. Pathogenic and opportunistic bacteria may be involved in the etiopathogenesis of OME. The degree of hearing loss was significantly higher in patients from which the positive bacterial cultures were obtained.

Caustic Agents Ingestion in Children: A 51-Year Retrospective Cohort Study.

OBJECTIVES: Children experience serious gastrointestinal tract injuries due to consumption of caustic agents more often than adults. The aim of the study was to analyze diagnostic methods and treatment of children with esophageal burns according to the degree of the injury. METHODS: Our one-center population-based retrospective cohort study included 150 children admitted between 1967 and 2018 to Clinic of Pediatric Otolaryngology, Phoniatrics and Audiology of University Children's Hospital in Lublin, Poland, due to the chemical burn of the mouth, throat, larynx, and esophagus. Each patient underwent a thorough laryngological examination and endoscopy to assess the place and degree of injury. RESULTS: Of 150 patients, 65.3% were male and 34.7% female. The median age was 4 years and 3 months. Salivation, dysphagia, burning sensation, edema, and whitish coating on the oral mucosa, palate, and throat were the most common clinical symptoms. In addition, dyspnea and chest pain were observed in 30% of patients. Esophagus endoscopy results were: Zargar grade I burn (84.7%), grade IIA (8%), grade IIB (2.6%), grade III (0%), and grade 0 (4.7%). Treatment included antibiotics, proton pump inhibitors, analgesics, and intravenous fluid therapy. Late sequelae (scarred esophageal strictures) developed in 20 (13.3%) patients. CONCLUSIONS: Accidental intake of caustic agents is observed in young children, especially younger than the age of 5. Early esophagus endoscopy should be performed in all patients to assess the grade of injury, plan initial treatment, and predict the risk of developing complications. Early diagnosis and immediate pharmacological treatment reduce the number of late sequelae.

Virtual Reality Vestibular Rehabilitation in 20 Patients with Vertigo Due to Peripheral Vestibular Dysfunction.

BACKGROUND Vestibular compensation is disrupted in patients with chronic vestibular syndrome. Vestibular rehabilitation is an exercise therapy that optimizes the process of vestibular compensation. This study aimed to evaluate virtual reality (VR) vestibular rehabilitation in 20 patients with vertigo due to peripheral vestibular dysfunction at a single center.Our study aim was to initially assess the impact of using virtual reality technology in vestibular rehabilitation. MATERIAL AND METHODS The subjects were 20 patients with unilateral vestibular hypofunction (UVH), as confirmed by videonystagmography. These were divided into 2 groups: Group 1 underwent vestibular rehabilitation using virtual reality and Group 2 was treated by conventional therapy. A VSS-SF questionnaire and the VAS scale were used to assess the effects and levels of patient satisfaction with therapy. RESULTS Both groups demonstrated significantly (P.

[Maxillary sinus myxoma]. / Sluzak zatoki szczekowej.

Myxoma is a slow growing, benign neoplasm, which pathogenesis still remains disputed. The lesion has well-defined borders but a true capsule is absent. Because of that myxoma can be locally invasive causing bone destruction. A change is mainly observed among persons between 20-30 years of age and is very uncommon in the pediatric population. Most myxomas are observed in myocardium, but rarely may also manifest in the head and neck region. In the paper we describe an unusual case of myxoma of maxillary sinus in a female infant. Diagnostic challenges, treatment, outcome, post-operative follow-up are discussed as well as a review of the literature in order to present many features of this rare pathology.

Molecular Epidemiology of Streptococcus pneumoniae Isolates from Children with Recurrent Upper Respiratory Tract Infections.

A total of 125 isolates were recovered from adenoids and/or nasopharynx of 170 children aged 2 to 5 from south-east Poland; they had undergone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections. Pneumococcal isolates were analyzed by phenotyping (serotyping and antimicrobial resistance tests) and genotyping together with the clonality of the pneumococcal isolates based on resistance determinants, transposon distribution and multilocus sequence typing (MLST). Serotypes 19F, 6B and 23F constituted 44.8% of the isolates. Among all of the strains, 44.8% showed decreased susceptibility to penicillin and resistance to co-trimoxazole (52.8%), tetracycline (38.4%), erythromycin (53.6%), clindamycin (52.8%) and chloramphenicol (27.2%) was observed. Tn6002 was found in 34.8% of erythromycin-resistant isolates while composite Tn2010-in 16.7% of erm(B)-carrying isolates that harboured also mef(E) gene. Tn3872-related elements were detected in 27.3% of erythromycin-resistant strains. In the majority of chloramphenicol-resistant catpC194-carrying isolates (79.4%), ICESp23FST81-family elements were detected. The genotyping showed that pneumococcal population was very heterogeneous; 82 sequence types (STs) were identified, and the most frequent contributed to not more than 8% of the isolates. Nearly 44% STs were novel, each of them was recovered only from one child. Four STs belonged to one of the 43 worldwide spread resistant pneumococcal clones currently accepted by Pneumococcal Molecular Epidemiology Network (PMEN), i.e. Spain 9V-3, Spain 23F-1, Norway NT-42 and Poland 6B-20, accounting for 12 (16.7%) of the 75 nonususceptible isolates, and five STs were single-locus variants of PMEN resistant clones (England 14-9, Spain 9V-3, Spain 23F-1, Greece 21-30, Denmark 14-32), accounting 9 (12%) of nonsusceptible isolates. A few MDR clones belonging to 6B and 19F serotypes found among preschool children emphasizes rather the role of clonal dissemination of local strains in the community than international clones spreading in the increase of resistance among pneumococcal strains.

Accumulation of CD5+CD19+ B lymphocytes expressing PD-1 and PD-1L in hypertrophied pharyngeal tonsils.

Programmed death-1 (PD-1) is one of the most important inhibitory co-receptors expressed predominantly on activated T and B lymphocytes whose expression could be sustained by permanent antigenic stimulation accompanying chronic or recurrent tonsillitis. The expression of PD-1 and PD-1L was analyzed using flow cytometry on hypertrophied tonsils collected from 57 children. We observed high expression of PD-1 and PD-1L on certain lymphocytes subpopulations of hypertrophied tonsils; among T cells, the expression of PD-1 on protein level was higher on CD4+ cells (70.3 %) than on CD8+ cells (35 %). Interestingly, a limited expression of PD-1 was observed on CD19+ B lymphocytes (6.5 %), while CD5+CD19+ B cells overexpressed PD-1 (52.5 %). Moreover, the expression of PD-1L was also higher on CD5+CD19+ B cells (16.5 %) than on CD19+ B cells (3.5 %) and on CD4+ T cells (20 %) than on CD8+ T cells (10 %). PD-1 and PD-1L expressions correlated only on CD5+CD19+ cells. In conclusion, high expression of PD-1 and PD-1L on T and B cells could represent hallmark of immune system adaptation to chronic antigenic exposition in patients with tonsillitis.

Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production.

Haemophili are pathogenic or opportunistic bacteria often colonizing the upper respiratory tract mucosa. The prevalence of Haemophilus influenzae (with serotypes distribution), and H. parainfluenzae in the nasopharynx and/or the adenoid core in children with recurrent pharyngotonsillitis undergoing adenoidectomy was assessed. Haemophili isolates were investigated for their ability to biofilm production.Nasopharyngeal swabs and the adenoid core were collected from 164 children who underwent adenoidectomy (2-5 years old). Bacteria were identified by the standard methods. Serotyping of H. influenzae was performed using polyclonal and monoclonal antisera. Biofilm formation was detected spectrophotometrically using 96-well microplates and 0.1% crystal violet.Ninety seven percent (159/164) children who underwent adenoidectomy were colonized by Haemophilus spp. The adenoid core was colonized in 99.4% (158/159) children, whereas the nasopharynx in 47.2% (75/159) children (P < 0.0001). In 32% (51/159) children only encapsulated (typeable) isolates of H. influenzae were identified, in 22.6% (36/159) children only (nonencapsulated) H. influenzae NTHi (nonencapsulated) isolates were present, whereas 7.5% (12/159) children were colonized by both types. 14.5% (23/159) children were colonized by untypeable (rough) H. influenzae. In 22% (35/159) children H. influenzae serotype d was isolated. Totally, 192 isolates of H. influenzae, 96 isolates of H. parainfluenzae and 14 isolates of other Haemophilus spp. were selected. In 20.1% (32/159) children 2 or 3 phenotypically different isolates of the same species (H. influenzae or H. parainfluenzae) or serotypes (H. influenzae) were identified in 1 child. 67.2% (129/192) isolates of H. influenzae, 56.3% (54/96) isolates of H. parainfluenzae and 85.7% (12/14) isolates of other Haemophilus spp. were positive for biofilm production. Statistically significant differences (P = 0.0029) among H. parainfluenzae biofilm producers and nonproducers in the adenoid core and the nasopharynx were detected.H. influenzae and H. parainfluenzae carriage rate was comparatively higher in the adenoid core than that in the nasopharynx in children undergoing adenoidectomy, suggesting that their involvement in chronic adenoiditis. The growth in the biofilm seems to be an important feature of haemophili colonizing the upper respiratory tract responsible for their persistence.

Central auditory processing disorder (CAPD) tests in a school-age hearing screening programme - analysis of 76,429 children.

INTRODUCTION AND OBJECTIVE: Hearing disorders among school-age children are a current concern. Continuing studies have been performed in Poland since 2008, and on 2 December 2011 the EU Council adopted Conclusions on the Early Detection and Treatment of Communication Disorders in Children, Including the Use of e-Health Tools and innovative Solutions. The discussion now focuses not only on the efficacy of hearing screening programmes in schoolchildren, but what should be its general aim and what tests it should include? This paper makes the case that it is important to include central auditory processing disorder (CAPD) tests. One such test is the dichotic digits test (DDT). The aim of the presented study was to evaluate the usefulness of the DDT in detecting central hearing disorders in school-age children. MATERIALS AND METHODS: During hearing screening programmes conducted in Poland in 2008-2010, exactly 235,664 children (7-12-years-old) were screened in 9,325 schools. Of this number, 7,642 were examined using the DDT test for CAPD. Screening programmes were conducted using the Sense Examination Platform. RESULTS: With the cut-off criterion set at the 5th percentile, results for the DDT applied in a divided attention mode were 11.4% positive for 7-year-olds and 11.3% for 12-year-olds. In the focused attention mode, the comparable result for 12-year-olds was 9.7%. There was a clear right ear advantage. In children with positive DDT results, a higher incidence of other disorders, such as dyslexia, was observed. CONCLUSIONS: A test for CAPD should be included in the hearing screening of school-age children. The results of this study form the basis for developing Polish standards in this area.

High prevalence of Streptococcus pneumoniae in adenoids and nasopharynx in preschool children with recurrent upper respiratory tract infections in Poland--distribution of serotypes and drug resistance patterns.

BACKGROUND: Streptococcus pneumoniae is one of the major bacterial pathogens colonizing nasopharynx, and often causes upper respiratory tract infections in children. We investigated the prevalence of S. pneumoniae in nasopharynx and adenoid core in 57 children aged 2-5 years who underwent adenoidectomy for recurrent pharyngotonsillitis, and we determined serotypes and antibiotic resistance patterns of the isolated pneumococci. MATERIAL/METHODS: The nasopharyngeal specimens obtained before adenoidectomy and the adenoids after the surgery were cultured for pneumococci. All isolates were serotyped by means of Quellung reaction. Susceptibility to antibiotics was determined according to EUCAST recommendations. RESULTS: S. pneumoniae colonization was observed in 40 (70.2%) children. From 29 (50.9%) children S. pneumoniae was isolated both from nasopharynx and adenoid core; 2 or 3 different isolates were identified in 8 (14.0%) children. In 8 (14.0%) children pneumococci were obtained from adenoid core only and in 3 (5.3%) children from nasopharynx only. Among the isolates, 35.3% were susceptible to all tested antimicrobials and 45.1% had decreased susceptibility to penicillin. Multidrug resistance was present in 52.9% of the isolates. The most frequent was serotype 19F (25.5%). The prevalence of serotypes included in pneumococcal conjugate vaccines PCV10 and PCV13 was 51.0% and 62.7%, respectively. CONCLUSIONS: The adenoids, like the nasopharynx, can be regarded as a reservoir of pneumococci, including multidrug resistant strains, especially in children with indication for adenoidectomy due to recurrent respiratory tract infections refractory to antibiotic therapy. Good vaccine coverage among the isolated pneumococci confirmed the validity of the routine immunization by PCVs in young children.

Serotypes and antibiotic resistance of Streptococcus pneumoniae from adenoids in preschool children with recurrent upper respiratory tract infections.

We investigated children aged 2-5, who had gone adenoidectomy for recurrent and/or persistent symptoms of upper respiratory tract infections for prevalence of pneumococci in adenoid tissue. Serotypes and antibiotic resistance patterns of the isolated pneumococci were determined and also risk factors of pneumococcal colonization were defined. S. pneumoniae colonization in adenoids was found in 62 (60.2%) children. Serotypes belonged to 10-valent and 13-valent pneumococcal conjugated vaccines (PCVs) constituted 56.1% and 68.2% of the isolates, respectively. Decreased susceptibility to penicillin was found in 45.5% of isolates; pneumococci were resistant to cotrimoxazole (62.1%), tetracycline (43.9%), erythromycin (54.5%), clindamycin (54.5%) and chloramphenicol (31.8%). Multidrug resistant S. pneumoniae comprised 57.6% of the isolates. Antibiotic resistant pneumococci were mostly distributed among serotypes belonged to 10-valent and 13-valent PCVs. Good vaccine coverage among the isolated pneumococci confirmed that the introduction of PCVs in the national immunization programme may reduce the pool of resistant and multidrug resistant pneumococci in a community.

Distribution of vaccine serotypes among Streptococcus pneumoniae colonizing the upper respiratory tract in healthy pre-school children in south-east Poland.

AIM: Studies on the distribution of Streptococcus pneumoniae serotypes associated with colonization of the upper respiratory tract in young children are currently of general interest because of the impact of the new pneumococcal conjugate vaccines (PCV) on carriage of pneumococci and the incidence of pneumococcal disease. MATERIAL AND METHODS: Therefore, we evaluated the coverage of 10-valent PCV (PCV10) as well as 13-valent PCV(PCV13) of S. pneumoniae serotypes isolated from the upper respiratory tract in healthy pre-school children in south-east Poland. RESULTS: Among the 342 pneumococcal isolates, the serotype coverage by PCV-10 or PCV-13 was 73.7% or 80.1%, respectively. Moreover, 92.4% of the isolates belonged to serotypes included in the "old" 23-valent polysaccharide vaccine. A clear picture of the distribution of S. pneumoniae serotypes associated with colonization and/or infection in various geographical areas is needed in a light of recommended or routine vaccination.