Acute subglottic laryngitis. Etiology, epidemiology, pathogenesis and clinical picture.

In about 3% of children, viral infections of the airways that develop in early childhood lead to narrowing of the laryngeal lumen in the subglottic region resulting in symptoms such as hoarseness, abarking cough, stridor, and dyspnea. These infections may eventually cause respiratory failure. The disease is often called acute subglottic laryngitis (ASL). Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this disease. Although the differential diagnosis should include other rare diseases such as epiglottitis, diphtheria, fibrinous laryngitis and bacterial tracheobronchitis, the diagnosis of ASL should always be made on the basis of clinical criteria.

Impact of adenoid hypertrophy on the open bite in children.

Nasal obstruction caused by adenoid hypertrophy can lead to malocclusion. The research material consisted of children aged 7-12 years with adenoid hypertrophy qualified for adenoidectomy. On the basis of the conducted tests (laryngological, orthodontic, pediatric), the occurrence of open frontal bite in children with pharyngeal tonsil hypertrophy, in particular in boys, was confirmed in comparison to children without hypertrophy correctly breathing through the nose.

Bacterial lysates in the prevention of respiratory tract infections.

Bacterial lysates stimulate the general immunity of the body in a non-specific way. They act on non-specific defense mechanisms, leading to an increase in type A antibody in mucous membranes, phagocytic activity and INF-Æ´ production. They can also stimulate the production of specific antibodies against the bacterial antigens that make up the preparation. The oral immunomodulatory preparations with the best documented clinical efficacy available on the Polish market are Ismigen, Broncho-Vaxom, Ribomunyl and Luivac. They are all lysates of bacterial strains that most often cause respiratory tract infections. In many clinical trials, oral bacterial lysates have been shown to minimize the risk of recurrent respiratory infections in children and adults and reduce the need for antibiotics.

Treatment strategy of allergic rhinitis in the face of modern world threats.

Allergic rhinitis (AR) is the most common form of allergy, which - as epidemiological research has shown - applies to nearly 25% of the population. AR significantly affects the quality of life of the patient, and the more severe the disease, the greater the risk of developing bronchial asthma. One of the factors affecting the severity of symptoms and the degree of their control is air pollution. In some patients, despite proper treatment, persistence or only partial remission of symptoms (uncontrolled allergic rhinitis) is observed. This can lead to an increase in comorbidities - inflammation of the paranasal sinuses, otitis media and asthma - both in children and in adults. The treatment of allergic rhinitis, in accordance with the standards, consists in: education of the patient, elimination of the allergen from the environment and factors intensifying the course of the disease, selection of proper pharmacotherapy and specific allergen immunotherapy. Many factors influence the selection of the antihistamine used, e.g., the opportunity of safe increase of the dosage.

Role of Chlamydia pneumoniae in the pathogenesis of hypertrophy and adenoid tissue inflammation in children.

OBJECTIVE: A tropism to epithelial cells and lymphocytes, an inhibition of apoptosis in host cells, an ability to occurrence in persistent form resistant to antibiotic treatment are the features of Chlamydia pneumoniae, which can have connection with chronic inflammation of an adenoid tissue and adenoid hypertrophy. This study aimed to (1) detect the C. pneumoniae in an adenoid in children undergoing adenoidectomy, (2) estimate a connection between C. pneumoniae occurrence and the size of adenoid, (3) demonstration in which of adenoid cells C. pneumoniae occurs most often. MATERIAL AND METHODS: The examined group consisted of 200 children aged from 2 to 16 years (mean age 6,4) undergoing adenoidectomy. In all children during qualification for adenoidectomy a fiberoscopic examination of the nasopharynx was performed. A part of removed adenoid tissue was analysed by real-time PCR for C. pneumoniae. Adenoids from children with positive PCR examination and from 10 children with negative PCR examination were examined using immunohistochemistry (IHC). RESULTS: C. pneumoniae in the adenoid was present in 5,5% children. Positive results were obtained most frequently (24,14%, 7/29) in the eldest group (10-16 years). A statistical analysis demonstrated the correlation between C. pneumoniae occurrence in an adenoid tissue and the size of adenoid. In immunohistochemistry C. pneumoniae was found the most frequently in lymphocytes and in epithelial cells. CONCLUSIONS: A presence of C. pneumoniae in lymphocytes and epithelial cells of the adenoid first of all in older children with adenoid hypertrophy confirms the participation of this bacteria in adenoid pathology.

Evaluation of the Interleukin-1 Receptor Antagonist and Immunoregulatory Interleukin-10 in the Middle Ear in Chronic Otitis Media With Effusion in Children With and Without Atopy.

OBJECTIVES: The role of pro-inflammatory cytokines in the course of chronic otitis media with effusion (COME) has been documented. However, there are fewer studies on the action of anti-inflammatory cytokines in the middle ear. We sought determine whether there is an association between COME and anti-inflammatory cytokines and whether there are any differences in the cytokine profile in COME children with and without atopy. METHODS: Eighty-four children were divided into 3 groups: 32 nonatopic children with COME (group NA), 31 atopic children with COME (group A), and 21 children without COME and without atopy (control group C). Specimens from the middle ear were collected and evaluated by enzyme-linked immunosorbent assay for the cytokines interleukin-1 receptor antagonist (IL-1Ra) and immunoregulatory IL-10. RESULTS: Significantly higher IL-10 concentrations were found in both nonatopic and atopic children with COME compared to controls. No significant differences in IL-1Ra levels were found between atopic and nonatopic children with COME and the control group. CONCLUSION: We found no differences in the levels of IL-1Ra in atopic and nonatopic children with COME compared to controls. However, we found elevated IL-10 levels in the middle ear effusions from children with COME, with or without atopy. These elevated immunoregulatory cytokine levels suggest a role for new immunomodulatory treatments to prevent disease progression in COME, regardless of atopy.

Pro-inflammatory interleukins in middle ear effusions from atopic and non-atopic children with chronic otitis media with effusion.

Chronic otitis media with effusion (OME) is associated with irreversible changes in the middle ear, sometimes leading to hearing loss and abnormal language development in children. While the pathogenesis of OME is not fully understood, inflammatory and allergic factors are thought to be involved. The study aimed to investigate the role of cytokines in the local development of chronic OME, and assess differences in the cytokine profiles between atopic and non-atopic children. 84 atopic and non-atopic children with chronic OME (mean age of 6 years 7 months) were studied. Age-matched children with hypertrophy of the adenoids and Eustachian tube dysfunction served as the control group. The number of past acute otitis media (AOM) episodes, their age, and the type of effusion were recorded for all children. Pro-inflammatory cytokine concentrations (TNF-α, IL-1ß, IL-6 and IL-8) were determined and the presence of pathogenic bacteria in the patients' effusions was examined. High concentrations of TNF-α, IL-1ß, IL-6 and IL-8 were found in the effusions in all children with chronic OME, with the highest levels observed in the non-atopic group. The atopic group showed persistently high IL-1ß levels, while in the non-atopic children, IL-1ß and TNF-α levels positively correlated with the patient's age and the number of past AOM episodes. Pathogenic bacteria were more frequently isolated from effusions in non-atopic children. In both atopic and non-atopic children, pro-inflammatory cytokines are found at high concentrations. This argues in favor of instituting anti-inflammatory management for treating OME, regardless of atopy.

Antibiotic resistance of Streptococcus pneumoniae in children with acute otitis media treatment failure.

OBJECTIVES: The emergence of antibiotic-resistant bacteria is a major cause of treatment failure in children with acute otitis media (AOM). This study aimed to analyze the types of bacterial strains in fluid isolated from the middle ear of children with AOM who did not respond to oral antibiotic treatment. We also determined the antibiotic resistance of the most frequently isolated bacterial strain (Streptococcus pneumoniae) found in these children. METHODS: This was a prospective study of 157 children with AOM aged from 6 months to 7 years admitted due to unsuccessful oral antibiotic treatment. All children underwent a myringotomy, and samples of the middle ear fluid were collected for bacteriological examination. RESULTS: Positive bacterial cultures were obtained in 104 patients (66.2%), with Streptococcus pneumoniae (39.69%), Haemophilus influenzae (16.03%) Staphylococcus aureus (16.03%), Staphylococcus haemolyticus (6.9%) and Streptococcus pyogenes (5.34%) found most frequently. The majority (65.4%) of S. pneumoniae strains were penicillin-intermediate-resistant or penicillin-resistant, and 67.2% strains of S. pneumoniae were multidrug-resistant. CONCLUSIONS: We identified S. pneumoniae as the most frequently isolated pathogen from the middle ear in children with AOM treatment failure and determined that the majority of strains were antibiotic-resistant. We propose that the microbiological identification of bacterial strains and their degree of antibiotic resistance should be performed prior to therapy in order to choose the most appropriate antibiotic therapy for children with AOM treatment failure.

Utility of antimicrobial susceptibility testing of multiple Haemophilus influenzae isolates from throat swabs of children with adenoid hypertrophy.

Eleven out of 40 children with adenoiditis were colonized with multiple genotypes of Haemophilus influenzae. Heterogeneous antibiotic susceptibility to ampicillin and cotrimoxazole was observed in 6 children. A multiple-colony methodology may potentially help to find the resistant strains of H. influenzae in patients who do not respond to the antibiotic treatment.

Carriage of antibiotic-resistant Haemophilus influenzae strains in children undergoing adenotonsillectomy.

Haemophilus influenzae is one of the major pathogenic bacteria in upper respiratory tract of children. In this study, the presence of various H. influenzae genotypes were followed-up for at least 13 weeks, starting from one week before surgery. Forty-one children with chronic adenoid hypertrophy were prospectively enrolled to the study. The consecutive swabs of adenoid and tonsils, two before adenotonsillectomy and two after the surgery together with homogenates of adenotonsillar tissues and lysates of the CD14(+) cells fraction were acquired from 34 children undergoing adenotonsillectomy. Up to ten isolates from each patient at each collection period were genotyped using a PFGE method and their capsular type and antibiotic susceptibility was determined. Of the 1001 isolates examined, we identified 325 isolates grouped into 16 persistent genotypes, which colonized throats for more than seven weeks and were not eliminated by the surgery. The other 506 isolates grouped into 48 transient genotypes that had been eliminated by the surgery. The resistance to ampicillin were found in 23.8% of the transient strains, and 4.7% of the newly acquired strains following the surgical intervention. In contrast, none of the persistent strains were resistant to ampicillin; however, these strains showed apparently higher level of resistance to co-trimoxazole when compared to transient strains. The transient and persistent strains did not significantly differ in bacterial viability in the biofilms formed in vitro. Some of the strains were identified in two or three different patients and were considered as the strains circulating in the region between 2010 and 2012.

Chlamydia pneumoniae and typical bacteria occurrence in adenoid in children qualified for adenoidectomy.

OBJECTIVE: The ability to occur in a persistent form and to inhibit apoptosis in host cells are the features of Chlamydia pneumoniae which may be associated with adenoid hypertrophy. This study aimed to (1) demonstrate the presence of C. pneumoniae DNA in the adenoid in children qualified for adenoidectomy, (2) evaluate the correlation between the presence of C. pneumoniae in the adenoid and the child's age, the size of adenoid, the incidence of recurrent respiratory tract infections, (3) demonstrate the co-occurrence of C. pneumoniae and typical bacteria in the adenoid tissue. METHODS: A group of 200 children aged from 2 to 16 years (mean age 6.4) undergoing adenoidectomy from February 2010 to May 2011 were enrolled to the study. Adenoid tissue removed during planned adenoidectomy was analyzed for the presence of C. pneumoniae by real-time PCR and for the presence of typical bacteria by bacteriological culture. Statistical analysis was conducted using SPSS PASW Statistics 18 software. RESULTS: C. pneumoniae was detected in the adenoid in 5.5% of the 200 children. Positive results were obtained most frequently (24.1%, 7/29) in the eldest group (10-16 years). In PCR positive children the degree of choanal narrowing by an adenoid tended to be larger than in PCR negative children. The occurrence of C. pneumoniae in the adenoid was not associated with a presence of a specific typical bacterium. CONCLUSIONS: The presence of C. pneumoniae in an adenoid was most frequently detected in the children of 10-16 years qualified for adenoidectomy.

Test for screening olfactory function in children.

OBJECTIVE: The research determining odors recognizable by children from Poland and Eastern Europe has not been widely described in the literature. The aim of the study was to determine the odors recognizable by Polish children which could be used in a screening olfactory test. METHODS: The study was performed in Children's Hospital in Warsaw. Ninety-one children aged from 2.9 years to 10 years (SD=5.6 years) were examined, 85 (93.4%) of which completed a full olfactory test. Children were separated into three age groups. The olfactory test consisted of 21 odors. RESULTS: The analysis of the results of all children's examinations showed statistically significant influence of age on the number of odors identified (p=0.0001; r=0.676). The olfactory test score enabled identification of 6 odors to be included in the screening test: bubble gum, lemon, cola, mint, toffee, fish. Correct identification of at least 4 out of them was accepted as a norm and was achieved by 96.5% of children. CONCLUSIONS: Olfactory evaluation is possible for children as young as 3 years old. Child's age influences the number of odors recognized and the specific odors recognition depends also on the home place geographic location and eating habits. Eastern European children most often recognized the following odors: bubble gum, lemon, cola, mint, toffee and fish, as so these odors were considered for olfactory screening test. The 6 odors test has good ability to generalize performance to olfactory status, has normative data and good validity and reliability, is fast, easy and inexpensive to administer.

[Emergence pathogens infections in ENT Department of Children's hospital in 2005-2008]. / Zakazenia patogenami alarmowymi na Oddziale Otolaryngologicznym Szpitala Dzieciecego im. prof. dr. med. Jana Bogdanowicza w latach 2005-2008.

INTRODUCTION: The development of medicine, in this the new techniques and antibiotic therapy enlarged the survivability of patients in hospital. Applying antibiotics caused breakthrough in treatment stepping out in ill's group infections treated in hospital, however enlarging resistance is natural this effect, resulting from: the selection of resistant strains, the formation of new mechanisms of resistance, and/or the spreading of gene of resistance. Multidrug-resistant strains were included to emergence-pathogens group: MRSA, penicillin-resistant Streptococcus pneumoniae, VRE, Gram-negative producing beta-lactamase of type the ESBL and/or resistant to carbapenems. Emergence-pathogens occurrence leads to: therapeutic failures, the use extorts in therapy of dear medicines or with possibility of workings undesirable. The multidrug-resistant strains spread in hospital environment easily, especially on departments about high waste of medicines with the patients' simultaneously large susceptibility on infection, resulting mainly with state of reduced resistance of organism. The control of hospital infections recognize by present hospitality for the most important criterion of quality of work. AIM: Analysis of the emergence-pathogens isolated during treatment in hospital in 2005-2008, from special regard the ENT Department. MATERIAL AND METHODS: 50586 children treated in this period in hospital in which was executed 39386 bacteriological investigations, in this 6528 (12.9%) children in ENT Department in which was executed 1566 bacteriological investigations (3.98%). The diagnostics were executed according to routine microbiological procedures with qualification of resistance to antibiotics. RESULTS: Emergence-pathogens infection was confirmed at 2369 children's (4.68%) treated in Hospital, in this in ENT Department at 84 children (1.29%). The most frequent emergence-pathogens in ENT Department were Streptococcus pyogenes, Streptococcus pneumoniae penicillin-resistant and average sensitive on penicillin, Staphylococcus aureus methicillin-resistant and Rotavirus. CONCLUSIONS: Streptococcus pneumoniae penicillin-resistant and average sensitive to penicillin and Rotavirus infections are the most frequent hospital infections. The systematic microbiological supervision is indispensable in prevention the spreading of infections of the emergence-pathogens in hospital.

[Treatment of the nasal septal hematoma and abscess in children]. / Leczenie pourazowych krwiaków i ropni przegrody nosa u dzieci.

OBJECTIVES: Estimation of the treatment of the nasal septal hematoma and abscess after injury was performed. MATERIAL AND METHODS: In 1998-2005 in Department of Otolaryngology Children's Hospital in Warsaw 2500 children after nasal injury were examined. Nasal septal hematoma and abscess were diagnosed in 22 (0,9%). They were reviewed retrospectively and some of them were examined 1-8 years after. RESULTS: In 22 children with nasal septal hematoma and abscess no complication were observed during treatment. In 12 children examined 1-8 year after treatment 1 child developed saddle nose deformity (qualified to observation) and 1 child developed nasal septum deformities with nasal obstruction (qualified to septoplasty). CONCLUSIONS: Complex treatment of nasal septal hematoma, drainage of the hematoma with septoplasty and reduction of fracture of the nose, makes good functional and cosmetic effect. Drainage of the nasal septal abscess with antibiotic prevent the early complications but it isn't enough functional and cosmetic effect in the future.

[Atypical bacteria in respiratory tract infections --pathogenesis and diagnosis]. / Bakterie atypowe w zakazeniach dróg oddechowych--patogeneza i diagnostyka.

Atypical bacteria, including Mycoplasma pneumoniae, Chlamydophila pneumonia and Legionella pneumophila play significant role in respiratory tract infections and account for 40% of all cases of community acquired pneumonia (CAP). These organisms also commonly occur as co-pathogens in mixed infections with mortality rates as high as 25%. The biological mechanisms and diagnosis of atypical infections is presented in this study.

[Upper respiratory tract infections in children caused by atypical bacteria]. / Zakazenia górnych dróg oddechowych u dzieci wywolane przez bakterie atypowe.

UNLABELLED: It encounters despite solid progress in development of diagnostic methods diagnostics the diseases of upper respiratory tract and ears in children called out by atypical bacteria's on the ground clinical symptoms and their treatment is difficulty still. AIM: The performance of accessible review of current literature was on the aim of work opinion of the atypical bacteria's part in evocation the infections the upper respiratory tract and ears in children, and performance of characteristic symptoms of clinical diseases these organs the bacteria's also. CONCLUSIONS: The quoted in work results of investigations do not it let on the unambiguous opinion the atypical bacteria part in contagions of infections the upper respiratory tract and ears in children. It seems however, that Mycoplasma pneumoniae answers first of all for evocation the acute infections of upper respiratory tract; however Chlamydophila pneumoniae plays the larger part in illnesses chronic as well as co-existent pathogen in illnesses sharp. Atypical bacteria can cause upper respiratory tract infections significantly more often than previously thought. These infections often occur in patients with history of respiratory recurrences.

[The existence vomeronasal organ in adult humans]. / Wystepowanie narzadu lemieszowo-nosowego u ludzi doroslych.

The influence of chemical substances (feromones) on human emotional and physical condition has fascinated psychologists, sexuologists and laryngologists since centurie. Literature conveys inconsistent information on vomeronasal organ (VNO) occurrence in humans. This organ is often called Jacobson's, and 2 symmetrical openings leading into it, located on both sides of septum, are called Ruyasch's ducts. The aim of the study was to analyze vomeronasal organ occurrence in humans in relation to age and sex. The study was conducted in a group of 634 patients, aged 18-80 years. All patients underwent routine ENT examination including rhinoscopy, nasal cavity examination with usage of 2.5x magnification lens (surgical glasses) and surgical microscope with 10x magnification. All persons had nasal cavities examined endoscopically. Every time presence of vomeronasal organ openings, along with localization, size and symmetry of these was noted. Subjects, who presented Jacobson's organ, were asked to fill a questionnaire concerning influence of smells on erotic sensations. Vomeronasal organ was fund in 312 persons, that is 49.21%. In 83.65% of cases vomeronasal organ opening size was smaller than 0.2 mm, what restricted its visibility to usage of magnifying lens, microscope, or endoscope. In 16.34% of cases only vomeronasal organ ducts openings were well visible in routine rhinoscopy without magnification. Vomeronasal organ was found more often in men than women. VNO was significantly more rare in patients with nasal septal deviation. In these cases, vomeronasal organ was usually found unilaterally, in all the cases on the concave side of deviated nasal septum.

[Complications of acute sinusitis in children treated in own material]. / Powiklania ostrego zapalenia zatok przynosowych u dzieci w materiale wlasnym.

We describe children with orbital complications of acute sinusitis and analyse symptoms, diagnostic procedure and treatment options. We used X-ray and/or CT of paranasal sinuses to make diagnosis. The most frequent presenting orbital and occular symptoms are preseptal cellulitis and orbital cellulitis. Management of these children included intravenous antibiotic and we made maxillary sinus puncture with drainage. Proper recognition and treatment lead to total recovery.