Adenoidectomy can improve obstructive sleep apnoea in young children: systematic review and meta-analysis.

OBJECTIVE: To systematically search for studies reporting outcomes for adenoidectomy alone as a treatment for paediatric obstructive sleep apnoea and use the data to perform a meta-analysis. METHODS: Nine databases, including PubMed and Medline, were systematically searched through to 1 April 2016. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. RESULTS: A total of 1032 articles were screened and 126 full texts were reviewed. Three paediatric studies (47 patients) reported outcomes. Overall, apnoea-hypopnoea index values decreased from 18.1 ± 16.8 to 3.1 ± 5.5 events per hour (28 patients). Random-effects modelling demonstrated a mean difference of -14.43 events per hour (I2 = 23 per cent (low inconsistency)). The apnoea-hypopnoea index standardised mean difference was -1.14 (large magnitude of effect). The largest reduction in apnoea-hypopnoea index was observed in children aged less than 12 months (reduction of 56.6-94.9 per cent). Lowest oxygen saturation values improved from 80.0 ± 9.5 to 85.5 ± 6.0 per cent (13 children). CONCLUSION: Adenoidectomy alone has improved obstructive sleep apnoea in children, especially in those aged less than 12 months; however, given the low number of studies, isolated adenoidectomy remains an area for additional research.

Image-guided transphenoidal drainage of a cholesterol granuloma of the petrous apex in a child.

Cholesterol granulomas of the petrous apex are well-described lesions that originate from chronic obstruction of the air cells in the petrous pyramid. Intracranial surgery, associated with multiple potential complications, has been the salutary action to treat this entity with only two reports of endoscopic drainage of a cholesterol granuloma of the paranasal sinuses. We present the first pediatric patient to be treated by not only endoscopic drainage, but also by the incorporation of computer-assisted image-guided surgery to minimize risk of injury to structures adjacent to the posterior wall of the sphenoid sinus.

The effect of corticosteroids in the treatment of experimental sinusitis.

Emerging evidence indicates that medically recalcitrant sinusitis may be associated with a prolonged and excessive state of inflammation rather than a simple bacterial infection. Corticosteroids have been anecdotally reported to be helpful in treating patients with sinusitis; however, there are no scientific studies documenting the safety and efficacy of corticosteroid therapy in sinusitis. To resolve the controversy over whether corticosteroids promote or inhibit the resolution of sinusitis, we present a prospective study of 80 rabbits with surgically introduced pseudomonal sinusitis that were then treated in one of four arms: control, ceftazidime, methylprednisolone, and ceftazidime with methylprednisolone. Sinus cavities were then evaluated after 5, 14, 21, and 28 days of treatment both by histologic inflammation grading and bacterial quantification. Results showed a significant decrease in bacterial loads in both the antibiotic and antibiotic with steroid arms over control animals, although no difference was seen between the two. Histologic grading showed a similar trend, although statistical significance was not obtained. Overall, this study demonstrated no clear advantage of steroids in the treatment of sinus infections using this model. At the same point, no significant reduction in the effectiveness of antibiotic therapy was seen with concurrent steroid use. A number of limitations of the animal model are noted and the need for human studies in this area is discussed.