A laryngeal presentation of Churg-Strauss syndrome in childhood.

A 10- year-old female, known to have bronchial asthma, presented with an unusual laryngeal lesion, eventually diagnosed as Churg-Strauss syndrome (CSS). She was referred to our hospital with history of recurrent stridor. On endoscopyhe, the larynx showed signs similar to recurrent respiratory papillomatosis (RRP). CSS is a systemic disorder and is now defined as one of the ANCA ( antineutrophil cytoplasmic antibodies)-associated vasculitides. CSS is a systemic disease that may involve unusual sites like the larynx. Such an unusual presentation of CSS should be kept in mind, especially in patients with history of asthma.

Hemoptysis. A rare presentation of a vallecular cyst.

Hemoptysis is a frightening experience for both patient and clinician and warrants prompt evaluation and diagnosis. We report a case of a vallecular cyst (VC) in a 30-year-old gentleman presenting with hemoptysis. Carbon dioxide laser dissection of the VC after needle decompression was carried out with no complications or recurrence in a 2 months follow-up. In such rare lesions, the authors tend to have conflicting opinions in their classification, evaluation, and management. In this report, these opinions are reviewed and discussed.

The use of nasal stent for choanal atresia.

OBJECTIVE: To assess the role of the use of nasal stent (NS) on the outcome of choanal atresia (CA) surgeries, as well as the effect on the age at the time of surgery. METHODS: The study involved a retrospective review of the files of the case with the diagnosis of congenital CA that were surgically managed at King Abdul-Aziz University Hospital between January 1999 and June 2005. The review included: the age, gender, associated congenital anomalies, surgical intervention, and use of nasal stent (NS). A comparative study was carried out between the outcome of the cases who received NS, and those who did not. RESULTS: A total of 31 cases with the diagnosis of CA comprised our study group. Thirteen of the cases received NS and 18 did not. Generally, the use of NS for CA surgery resulted in poor outcome. Seventy-five percent of the unilateral cases with no-NS had successful outcome compared to 13% of those who received NS (p=0.00988). On the other hand, only 33% of the bilateral cases with no-NS had a successful outcome compared to 60% of those who received NS (p=0.3917). CONCLUSION: NS mandates an increased medical care. Its use in unilateral CA was associated with poor outcome. Based on our findings, it is recommended not to use NS in unilateral CA, as well as to postpone the surgical intervention, if possible, until the child is one year old or more.

Monopolar electrodissection versus cold dissection tonsillectomy among children.

OBJECTIVE: To compare cold dissection to monopolar tonsillectomy in terms of operative time, intraoperative bleeding, post operative bleeding, and pain. METHODS: The study included 100 children who underwent tonsillectomy between January 2002 and January 2004. This study was carried out at King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia. Patients were randomly selected to have either the right or left tonsils removed by either technique (cold dissection or monopolar dissection technique). We compared both techniques in each side on the same patient. RESULTS: There was no significant difference in operative time between both sides by either technique, however, when the patients were grouped into < or =3 minutes and >3 minute groups, the result showed that a greater number of patients were operated up on < or =3 minutes by diathermy procedure compared to dissection method (44 versus 67) (p=0.0011). Blood loss was minimal with the diathermy technique; averaging 25.37 ml compared to 88.5 ml for cold dissection tonsillectomy. There was a significant increase in postoperative pain on the first postoperative day in the diathermy group compared to the cold dissection group (27% versus 12%) (p=0.0151). However, there was no significant difference in pain between both sides in the first 24 hours and from the 2nd to 10th postoperative days. CONCLUSION: Monopolar dissection tonsillectomy is a safe technique. It significantly reduces the operative time and intraoperative blood loss. However, it causes more pain on the 1st post operative day, while on the rest of the days until the 10th post operative day, there was no significant difference in pain between two sides.

Effect of use of mitomycin C on the outcome of Choanal atresia repair.

OBJECTIVE: To investigate the effectiveness of topical mitomycin C (MMC) on outcome of endoscopic repair of choanal atresia (CA) in cases that had never had this operation and when nasal stent was not used. METHODS: Endoscopic repair of CA was performed in 20 children at King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia between January 1999 and October 2005. Intra-operative application of topical MMC (0.4 mg/mL for 4 minutes) was carried out in 13 children, and 7 children did not receive MMC. The follow-up period ranged between 9 months and 6 years. The association between the 2 categorical variables was investigated using Fisher's exact test. RESULTS: Sixty-nine percent of the cases receiving MMC had a successful outcome compared with 57% of non-MMC cases, however, the difference was not statistically significant (p=0.230). In unilateral CA, 70% of those who received MMC had a successful outcome compared with 60% of those who did not; again the difference was not statistically significant (p=0.566). Successful outcome was considered when the posterior choana was patent during the successive follow up, without the need for revision surgeries. CONCLUSION: We did not demonstrate a statistically significant difference between the percentages of children treated with MMC versus no-MMC who remained patent after surgery.

Presentation of choanal atresia in Saudi children.

OBJECTIVE: To present data of cases with choanal atresia (CA) from Saudi patients, and to compare them to the data from the international literature. METHODS: A retrospective analysis of the data available from the files of 37 consecutive patients with the diagnosis of CA at King Abdul-Aziz University Hospital, Riyadh, Kingdom of Saudi Arabia between January 1999 and December 2005. This involved reviewing the age, gender, presenting symptoms, associated anomalies, surgical intervention, and outcomes. RESULTS: Twenty-three of our cases had unilateral and 14 had bilateral CA. Strikingly, 83% of unilateral CA involved the right side. In our study, we found the female to male ratio to be 2:1. Approximately, 95% of the cases had mixed bony and membranous CA. Thirty-two percent of the cases had other associated congenital anomalies. Most of our cases had their surgical intervention by endoscopic technique. CONCLUSION: Choanal atresia is a rare anomaly. In Saudi children, female is more commonly affected than male. There is a striking rate of involvement of the right side in the cases of unilateral CA.

Otolaryngologic manifestation of gastroesophageal reflux in children.

OBJECTIVE: This study was performed to assess the role of gastroesophageal reflux (GER) in varieties of otolaryngologic dysfunction. METHODS: This study was carried out over a one year period, between January 1995 and January 1996, at Sainte-Justine Hospital, Montreal, Canada. Thirty-seven charts were examined for different variables including, symptoms, signs, dysfunction, investigations, treatment and outcome. RESULTS: In children with otolaryngologic manifestation of GER, apnea and regurgitation were common presenting symptoms. Gastroesophageal reflux was also found to be more commonly associated with ear infection, adenoid hypertrophy, bronchial asthma and recurrent pneumonia. CONCLUSION: Gastroesophageal reflux has complicated manifestations in otolaryngology that are difficult to prove. High index of suspicion is recommended in order to diagnose GER as a cause of some otolaryngologic dysfunction.