Hemorrhagic tonsillitis in an infant: A case report.

This case report describes a case of severe hemorrhagic tonsillitis in a nine month-old child who suffered significant amount of blood loss and was emergently taken to operating room for control of hemorrhage. The child was brought to emergency room by mom after noticing blood around child's mouth and nose and a subsequent episode of hematemesis having awoken from sleep. Initial impression was bleeding secondary to epistaxis however a thorough bedside otolaryngology exam including flexible rhinolaryngoscopy ruled this out. Rapid pooling of blood in oropharynx, continued hemorrhage with significant blood loss and recent history of hematemesis prompted emergent intervention in operating room for endoscopy for control of hemorrhage including esophagogastroduodenoscopy (EGD). Bleeding was identified from a blood vessel at left lower tonsil pole. Although there is a description in literature of such cases, these are uncommon in the pediatric population and none has been described in a patient this young requiring emergent operative intervention. This case report discusses the diagnostic and decision making dilemma in an infant in setting of ongoing active hemorrhage and the role of multidisciplinary team management.

Pediatric button battery ingestion: Publication trends in the literature.

OBJECTIVE: Examine literature for evidence of changes in button battery (BB) research over time including: amount and rate of literature output, levels of evidence, and the location of the research. METHODS: Literature review of all peer-reviewed button battery literature available online through Pubmed and Embase was performed. Inclusion criteria were applied to ensure relevance. Publications were grouped into 4 time periods. Various study characteristics were compared between groups. RESULTS: A total of 255 original research studies were reviewed. A significant increase in study number was found with a 664% increase comparing 2009-2018 and 1977-1988 (p < 0.001) and a 187% increase comparing 2009-2018 and all previous years. Average author number significantly increased over the study period (range: 2.8 to 4.4; p < 0.001). Case report or case series were consistently the most common type of study design (range: 56.5% to 84.0%). Level of evidence has remained at 4-5 for the majority of studies (range: 87% to 92.1%). First author specialty remained stable over time, with non-otolaryngologist surgeons being the most common authors, followed by pediatricians and otolaryngologists (28.8%, 18.9%, 18.5%, respectively). Location of research has diversified, with US publications falling from 50% to 29.5% of all studies when comparing 1977-1988 to 2009-2018 time periods. CONCLUSIONS: Button battery ingestion in the pediatric population has been an important topic of discussion among various medical specialties due to a rise in morbidity and mortality surrounding these ingestions. Despite the increase in number of studies and authors, the strength of these studies has remained largely unchanged.

Hair cell and neural contributions to the cochlear summating potential.

The cochlear summating potential (SP) to a tone is a baseline shift that persists for the duration of the burst. It is often considered the most enigmatic of cochlear potentials because its magnitude and polarity vary across frequency and level and its origins are uncertain. In this study, we used pharmacology to isolate sources of the SP originating from the gerbil cochlea. Animals either had the full complement of outer and inner hair cells (OHCs and IHCs) and an intact auditory nerve or had systemic treatment with furosemide and kanamycin (FK) to remove the outer hair cells. Responses to tone bursts were recorded from the round window before and after the neurotoxin kainic acid (KA) was applied. IHC responses were then isolated from the post-KA responses in FK animals, neural responses were isolated from the subtraction of post-KA from pre-KA responses in NH animals, and OHC responses were isolated by subtraction of post-KA responses in FK animals from post-KA responses in normal hearing (NH) animals. All three sources contributed to the SP; OHCs with a negative polarity and IHCs and the auditory nerve with positive polarity. Thus the recorded SP in NH animals is a sum of contributions from different sources, contributing to the variety of magnitudes and polarities seen across frequency and intensity. When this information was applied to observations of the SP recorded from the round window in human cochlear implant subjects, a strong neural contribution to the SP was confirmed in humans as well as gerbils. NEW & NOTEWORTHY Of the various potentials produced by the cochlea, the summating potential (SP) is typically described as the most enigmatic. Using combinations of ototoxins and neurotoxins, we show contributions to the SP from the auditory nerve and from inner and outer hair cells, which differ in polarity and vary in size across frequency and level. This complexity of sources helps to explain the enigmatic nature of the SP.