Ambulatory adenotonsillectomy in children less than 5 years of age.

OBJECTIVE: Post-tonsillectomy monitoring has received a significant amount of attention in recent years. Although the literature questions the safety of ambulatory adenotonsillectomy in children less than 5 years of age, age alone did not exclude eligibility for day surgery at our institution. METHOD: A retrospective chart review was performed between 1995 and 1998 for all children who had undergone adenoidectomy or adenotonsillectomy at the London Health Sciences Centre in London, ON. RESULTS: There were 119 adenoidectomies and 278 adenotonsillectomies performed. The average age was 3 years at the time of surgery. One hundred and ninety-six cases were performed for obstruction, and 201 were done for infection. Average time spent in the postanaesthesia care unit was 6 hours for adenotonsillectomy and 4.5 hours for adenoidectomy. There were 26 planned and 60 unplanned admissions. One (4/397) percent of the unplanned admissions were for postoperative hemorrhage; 14% (56/397) were for vomiting and dehydration. No cases were admitted for postoperative desaturations or hypotensive episodes. The readmission rate was 0%. CONCLUSIONS: Ambulatory adenotonsillectomy is a safe procedure in children less than 5 years old. However, a well-informed, reliable caretaker and support from the day surgery staff is essential in early discharge of young patients after adenotonsillectomy.

The association of human papillomavirus with Schneiderian papillomas: a DNA in situ hybridization study.

Human papillomavirus has been identified with DNA hybridization techniques in Schneiderian papillomas, though results reported in the literature have been conflicting. This study investigated 33 cases of Schneiderian papilloma (26 inverted papillomas, seven fungiform papillomas). In situ hybridization using a cocktail of human papillomavirus (HPV) probes 6/11, 16/18, 31/33/35 failed to identify HPV genome in any of the inverted papillomas. This is contrasted by the detection of HPV 6/11 in six of seven fungiform papillomas. Of the 26 cases of inverted papilloma, 10 had recurrences, five were associated with dysplasia, and two were associated with squamous cell carcinoma. Of the seven cases of fungiform papillomas, two had recurrences, and two were associated with dysplasia, but not malignancy was found. This study supports the concept that fungiform papilloma and inverted papilloma are two distinct lesions: the former is associated with HPV 6/11.

Aerodynamic, acoustic, and perceptual changes following adenoidectomy.

Fourteen children were seen prior to adenoidectomy and at 1 month, 3 months, and 6 months following surgery. On each visit, nasal airway resistance values, nasal cross-sectional area estimates, nasalance scores, and perceptual ratings of nasality were collected. These data were analyzed to identify changes that were related to the time of the test, and to the primary indication for surgery (nasal airway obstruction or recurrent infection). Results revealed significant reduction in nasal airway resistance and significant changes in nasalance following surgery. Perceptual changes were not significant. Clinical implications of these findings are discussed.

Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence.

This investigation was designed to evaluate the relationship between aerodynamic measures of velopharyngeal competence and laryngeal function in individuals with repaired cleft palate. Twenty-seven cleft lip and palate or cleft palate individuals, between the ages of 4 and 16 years, were evaluated in an ENT clinic for assessment of vocal function. A commercially available aerodynamic (pressure/flow) system for evaluating velopharyngeal function was used to classify estimated opening of the velopharyngeal port during speech production. Aerodynamic measures of laryngeal function (transglottal pressure and airflow, and laryngeal airway resistance) were also collected. A computerized system for acoustic analyses of voice production was employed to determine vocal characteristics of pitch perturbation (jitter), amplitude perturbation (shimmer) and signal-to-noise ratio (SNR). The results suggested that the cleft speakers showed numerically larger measures of perturbation in the vocal signal, and greater laryngeal airway resistance than their normal controls. Subgroups of cleft palate speakers, based on their vocal dynamics, were proposed. Implications for medical and behavioral management for these subgroups are discussed.

Medial meatal fibrosis: the University of Western Ontario experience.

Medial meatal fibrosis is an uncommon but surgically treatable cause of conductive hearing loss. A review of 10 years experience with this entity at The University of Western Ontario revealed a total of 15 cases involving nine patients. Each of them was treated by one of four otologists. This disease may arise from either recurring or chronic infection or from chronic dermatitis, and it frequently presents with bilateral involvement. It may occur at virtually any age, and to our knowledge, this series includes the first cases of this disease to be described in children. The medical and surgical management of this condition is described in detail and the results are summarized.

Changes in vocal resonance and nasalization following adenoidectomy in normal children: preliminary findings.

The purpose of this study was to evaluate changes that occur in certain aspects of vocal resonance and nasalization following adenoidectomy. Fourteen normal children were assessed prior to adenoidectomy and then at one month, three months, and six months following surgery. A unique combination of aerodynamic, acoustic, and perceptual measures were made. The aerodynamic component of the evaluation involved the use of posterior rhinomanometry to calculate nasal airway resistance (Rnaw) during relaxed nasal breathing. Acoustical measures consisted of "nasalance" scores (oral/nasal acoustic ratio) obtained during production of various speech stimuli. In addition, perceptual measures of change in vocal quality included listener judgments of severity and categorical ratings of nasality. Consistent patterns of change in vocal resonance and nasalization following adenoidectomy were identified. Clinical implications of these preliminary findings suggest that the maximum increase in nasality after tonsillectomy and adenoidectomy occurs at about one month, and referral to a speech-language pathologist should be considered if the hypernasality persists beyond three months.

Toxic shock syndrome.

Toxic shock syndrome (TSS) is a severe multi-system disorder resulting from a Staphylococcus aureus exotoxin. Primary presenting features consist of fever, hypotension, vomiting and diarrhea, and a diffuse macular erythroderma with later desquamation. Treatment is supportive accompanied by drainage and debridement of infection and antibiotics. TSS may occur following any infection with Staphylococcus aureus and is a well-documented complication of nasal surgery. Otolaryngologists should be aware of the manifestations of this disorder and its treatment. A case is presented, along with a review of the literature and management of TSS.

Recurrent meningitis secondary to perilymph fistula in young children.

All young children treated for meningitis should have post-treatment evoked potential audiometry. If neurosensory hearing loss is identified, the clinician should be alerted to the possibility of a perilymph fistula as the cause of the meningitis. Radiology of the inner ear and possibly exploratory tympanotomy may be necessary to rule out a perilymph fistula. Two young children with meningitis secondary to perilymph fistula are presented to illustrate the problems of diagnosis and management.

Orbital pseudotumors.

Orbital pseudotumor is a clinical entity characterized by features of a space-occupying, non-specific inflammatory condition of the orbit. Diagnosis can be difficult, and the patient will often initially present to the otolaryngologist as an orbital complication of sinus disease, or as a severe upper respiratory tract infection. The recent experience of orbital pseudotumors at our center is presented with emphasis on the diagnosis and management of the disease process.

Management of the cleft palate child.

The rehabilitation of the child with cleft lip and cleft palate is a complex process requiring the interaction of many health professionals. Utilizing the team approach, a good cosmetic and functional result may be obtained, allowing the child to participate normally in society.

Head and neck pain in the elderly.

Pain in the head and neck region is a common symptom in elderly people, with degenerative disease and neoplasms being the most frequent causes. Pain of neuralgic, orbital and vascular origin requires a multidisciplinary approach. Adequate suppression of pain by appropriate medical or surgical methods is of paramount importance to the patient's well-being even when the underlying disease cannot be cured.

Pediatric tracheotomy.

The indications and complications of tracheotomy in 93 children between 1970-82 were studied and recorded. There has clearly been a shift in indications for pediatric tracheotomy while the early postoperative complication rate has improved. Longterm tracheotomy is on the increase due to a larger number of children with neurological problems and of infants requiring tracheotomy for chronic obstructive airway disease.