Síndrome de la apnea-hipoapnea obstructiva del sueño en el niño: más allá de la hipertrofia adenoamigdalar / Obstructive sleep apnea-hypopnea syndrome in children: Beyond adenotonsillar hypertrophy

La prevalencia del síndrome de la apnea-hipoapnea obstructiva del sueño en la población infantil general es del 1-2% y su causa más frecuente es la hipertrofia adenoamigdalar. Las prevalencias en las otras causas de este síndrome, más allá de la hipertrofia adenoamigdalar, son elevadas. En muchas de estas enfermedades los motivos por los que se genera el síndrome de la apnea-hipoapnea obstructiva del sueño son multifactoriales (hipotonía muscular, alteraciones dentofaciales, hipertrofia de tejidos blandos de la vía aérea, alteraciones neurológicas). Es fundamental la colaboración entre las diferentes especialidades implicadas, dada la gran variabilidad de enfermedades, la frecuente participación de diferentes factores en su génesis y los diferentes tratamientos que deben aplicarse. Se ha procedido a una amplia revisión bibliográfica de estas otras causas de síndrome de la apnea-hipoapnea obstructiva del sueño infantil, que van más allá de la hipertrofia adenoamigdalar. Se han intentado ordenar de una forma coherente, a criterio del autor, revisando los aspectos más destacados con relación a la prevalencia de síndrome de la apnea-hipoapnea obstructiva del sueño en cada una de ellas, los motivos por los que provocan este síndrome, sus interacciones y manejo (AU)

The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner (AU)

Clinical and pathologic characteristics of intranasal abuse of combined opioid-acetaminophen medications.

BACKGROUND: The nonmedical abuse of prescription opioids via intranasal administration is a growing problem. The objective of this study is to investigate of the typical presentation of intranasal opioid-acetaminophen abuse and outline optimal therapy. METHODS: This study was a retrospective chart review. Patients with intranasal pathology from inhalation of combined opioid-acetaminophen medications (COAMs) from 3 academic otolaryngology practices in western Pennsylvania from January 2012 to October 2012 were included in the review. RESULTS: Seven adults ranging in age from 23 to 46 years were identified with nasal complaints from the intranasal inhalation of COAMs. All patients presented with nasal pain and were found to have fibrinous necrotic nasal mucosa involving the posterior nasal cavity and nasopharynx. Of the 7 patients, 6 (85.7%) presented with a septal perforation. Pathology and culture revealed fungus in 85.7% of the patients; however, no invasive fungal disease was noted in any of the specimens. Patients did not improve with either systemic or topical antifungal therapy. Polarizable material characteristic of talc used as a tablet binder was present in the histopathology of 4 of 7 (57.1%) patients. Patients who abstained from intranasal drug use along with serial debridement demonstrated the greatest improvement. CONCLUSION: Intranasal COAM abuse causes nasal pain, tissue necrosis with potential septal and palatal perforation, and noninvasive fungal colonization. Antifungal therapy was of no benefit in the current series of patients. Current therapy should focus on recognition of the etiology of patients' pathology and encourage abstinence from intranasal use of these drugs along with serial debridements.

Paranasal sinus exostoses: an unusual complication of topical drug delivery using cold nasal irrigations.

OBJECTIVES/HYPOTHESIS: The use of topical drug delivery through nasal irrigations can minimize systemic side effects and deliver higher concentrations of drugs directly to diseased sinus mucosa. Complications related to this popular method of treatment are not well described. We present our experience with paranasal sinus exostosis (PSE), a new diagnostic entity that appears to be a complication of cold nasal irrigations. STUDY DESIGN: Retrospective chart review. METHODS: Retrospective chart reviews were performed on patients within the Cleveland Clinic Foundation from 2005 to 2011. Six patients were identified with sinus exostoses. A literature review for "sinonasal exostoses" and "paranasal sinus exostoses" was performed using PubMed. RESULTS: Six patients with PSE were identified at the Cleveland Clinic Foundation between 2005 and 2011. All patients had undergone sinus surgery, and none had documented evidence of PSE prior to surgery. There was no evidence of worsening PSE once the cold irrigations were stopped. No patients showed any resolution of PSE over time. None of our patients has progressed to have disease burden significant enough to require intervention. CONCLUSIONS: PSE is a rare condition that mirrors a well-described otologic process; exostoses of the external auditory canal. PSE appears to be a complication of cold nasal irrigations. It does not resolve with the halting of cold irrigations, but does not appear to progress further after intervention. PSE only affects postoperative patients. With the evolving trend to treat postoperative sinus disease topically, the clinician should be aware of the dangers of cold irrigations, and patients should be counseled accordingly.

A frontal mucocele caused by an immune reconstitution inflammatory syndrome in a patient with HIV infection.

We describe a 55-year-old bisexual Belgian man with a multi-drug resistant HIV infection who developed an Immune Reconstitution Inflammatory Syndrome (IRIS) presenting as a mucocele of the frontal sinus, one year after starting a new effective darunavir containing antiretroviral treatment regimen. His CD4+ lymphocyte count had increased from 3 cells/mm3 prior to the start of the latter treatment to 196 cells/mm3 just before he developed the IRIS phenomenon. IRIS is a paradoxical clinical deterioration during highly active antiretroviral treatment (HAART), due to an exaggerated immune-inflammatory reaction. With the increasing numbers of persons living with HIV infection and the increased use of HAART it is expected that in the future more otolaryngological manifestations of IRIS will be detected.

Bisphosphonate-induced osteonecrosis of the jaws: a case report and literature review.

Bisphosphonates are nonmetabolized analogues of pyrophosphate that are used for treating skeletal complications secondary to bone metastases. These drugs are capable of localizing to bone and inhibiting osteoclastic activity; however, their exact mechanisms of action remain unclear. Recently, it has been documented that administration of bisphosphonates has been associated with osteonecrosis of the jaws. This article details the case of a woman who received intravenous administration of bisphosphonate for metastatic breast cancer and subsequently developed osteonecrosis in both the maxillary and mandibular jaws.

Aspergillosis related to long-term nasal corticosteroid use.

Aspergillus is a ubiquitous mold that can cause several types of symptomatic infections: allergic aspergillosis, typically in young atopic patients; aspergillomas (often referred to as fungus balls); and invasive aspergillosis, typically seen in debilitated or immunocompromised patients. We describe an 85-year-old woman who was not immunocompromised but had invasive aspergillosis of the paranasal sinus that resulted in unilateral headache and retrobulbar optic neuropathy. After extensive differential diagnostic examination, we concluded that the condition was possibly related to the long-term use of nasal corticosteroids (fluticasone propionate aqueous nasal spray). Surgical removal of solid masses of Aspergillus organisms followed by extended treatment with antifungal agents resulted in a favorable outcome.

The correlation between blood and urine level of cadmium and nasal and paranasal sinuses disorders.

Over exposure to cadmium may produce numerous adverse health effects, including changes in the nasal mucosa. Cadmium levels were measured in blood and urine samples taken from 106 workers who were exposed to high levels of cadmium and nickel in a cadmium nickel battery plant. Pathological results were observed in 46% and 51% of the blood and urine samples respectively. A positive association was found between clinical nasal complaints and pathological levels of cadmium in blood (P = 0.006) and urine (P = 0.045) samples. All the workers underwent sinus X-rays and 63% of them were abnormal. No correlation was found between pathological sinus X-rays and pathological cadmium level in blood and urine samples. A positive correlation was found between clinical nasal complaints and abnormal sinus X-rays. The prevalence of sinus X-ray abnormalities in an asymptomatic general population is 33% as compared to 63% in our study. This difference is highly significant statistically (P < 0.0001). Our result shows a possible harmful effect of cadmium on the paranasal sinuses.

Nasal symptoms associated with cocaine abuse during adolescence.

A questionnaire on cocaine-use patterns and associated adverse effects on the nasal passages was completed by 464 adolescents. The respondents were abusers of various nonintravenous drugs enrolled in seven modified outpatient treatment facilities for alcohol and other drug abuse in five geographic regions of the country. Three hundred thirty-six respondents (72%) noted that they had used cocaine one or more times prior to their entry into the treatment program. The 336 recovering cocaine users were divided into three groups: those who had used cocaine fewer than 25 times (203 [60%]); those who had used cocaine between 25 and 99 times (107 [32%]); and those who had used the drug daily plus at least 100 times total use of the drug (26 [8%]). Statistically, we found a highly significant difference between the first group and the other two groups for cocaine-associated symptoms, such as frequent sniffing, "sinus" problems, and diminished olfaction. Approximately 30% of those who had "snorted" cocaine at least 25 times but less than daily, vs 47% of those who used the drug daily, recalled that they had nasal membrane irritation with nasal crusts or scabs, recurrent nosebleeds, or both. The astute otolaryngologist should consider cocaine abuse as a cause of puzzling or recalcitrant rhinitis, even during teenage years.

The nature of myospherulosis of the upper respiratory tract.

A case of myospherulosis of paranasal sinuses similar in appearance to those recently seen in St. Louis, Missouri, was examined to ascertain the nature of the sac-like structures seen in this disease. The morphologic features of these formations and their positivity with stains for hemoglobin, peroxidase, and lipofuscin strongly suggest that they represent collections of erythrocytes altered by a foreign substance. This interpretation was confirmed by experimental production of these structures by the action of tetracycline ointment on a pure preparation of human erythrocytes.