Intranasal antihistamines in the treatment of idiopathic non-allergic rhinitis: a systematic review and meta-analysis.

BACKGROUND: Idiopathic rhinitis (IR), previously known as vasomotor rhinitis (VMR), is the most common type of non-allergic rhinitis (NAR) which affects around 100 million people worldwide. The treatment of patients with IR is not standardized. Intranasal antihistamines (INAH) are potent drugs in the treatment of allergic rhinitis but are frequently prescribed in the treatment of IR. This systematic review of the literature and meta-analysis aims to assess the effects of INAH on IR. METHODOLOGY: A comprehensive review of the literature was conducted on Medline, Embase and Cochrane library. Randomized, controlled trials and non-randomized comparative parallel group trials comparing INAH to placebo or different INAHs were included. The primary outcome was the change in disease specific quality of life questionnaires, total nasal symptom score (TNSS). The secondary outcomes were other reported nasal symptom scores, individual symptom scores and adverse events. RESULTS: Six trials out of 987 assessing a total of 675 participants were deemed relevant for inclusion. Compared to placebo, INAH decreased total nasal symptom scores. One study also reported reduction of symptoms recorded on a visual analogue scale. There was no difference between the INAHs in terms of efficacy. Bitter taste sensation was the most frequently reported adverse event. CONCLUSIONS: INAHs seem to have benefit over placebo on nasal symptoms improvement in the treatment of NAR. No superiority between INAHs was identified.

Pediatric hard palate foreign bodies: Case report and Systematic review of the literature.

INTRODUCTION: Foreign body impaction in the pediatric hard palate is a rarely described otolaryngologic entity. It is often misdiagnosed as a neoplastic or an inflammatory lesion causing much stress to parents. The aim of this paper is to report a case managed in our department and to present a systematic review of the literature on pediatric hard palate foreign body impaction. CASE REPORT: We present the case and the management of an impacted plastic screw cap in the hard palate of a 9 month-old boy. MATERIAL AND METHODS: Following the PRISMA guidelines, a systematic review was conducted in August 2019 using Medline and Embase databases. Included articles were reviewed for mean age at presentation, gender, presumptive diagnosis, time to removal, foreign body type, average size, anesthesia type and complications. RESULTS: 32 reported cases were included. Foreign bodies were mistaken for other diagnoses in 24 cases. Mean duration from first presentation till removal was 56.9 days. Circular plastic covers were found in 20 cases. General anesthesia was used in 68% of the cases. No major complications were reported. CONCLUSIONS: Foreign body impaction should be kept in the differential diagnosis of hard palate lesions in children. Up to date, this entity is still frequently misdiagnosed.

Foreign body inhalation in the pediatric population: lessons learned from 106 cases.

OBJECTIVES: To review the cases encountered in a tertiary care center so as to assess the incidence of foreign body aspiration in the pediatric population and to draw on our experience to improve prevention and early diagnosis. PATIENTS AND METHODS: Retrospective study of 106 children under the age of 15 years, admitted to the Hôtel-Dieu de France hospital for flexible and/or rigid bronchoscopy between November 1998 and January 2010, for suspected foreign body aspiration (FBA). RESULTS: Among the children, 56.6% were aged between one and three years. Peanuts or pistachios were found in 48% of cases. In 73% of cases, the FB was bronchial, and slightly more frequently on the right side (60%); 17.8% of cases presented in emergency immediately after inhalation; 12% presented with life-threatening symptoms; 29% presented within 24 hours and 49% were seen later than 72 hours. In 81% of subjects, a typical penetration syndrome was found on interviewing the parents. Physical pulmonary examination was normal in 21% of patients and chest X-ray in 21.8%. Rigid bronchoscopy was preceded by flexible bronchoscopy in 12% of cases. Parental underestimation of the gravity of the situation was a significant factor in delayed diagnosis. Among the patients, 64% examined 24 hours after inhalation were initially treated for another pathology. Delay in diagnosis and organic vs inorganic FB did not significantly correlate with duration of bronchoscopy. The rate of complications did not significantly increase after a 24-hour diagnostic delay threshold. CONCLUSION: FB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology.

Risk factors for thyroglossal duct remnants after Sistrunk procedure in a pediatric population.

To evaluate recurrence after surgery for thyroglossal duct cyst (TDC) we performed a retrospective chart review. Seventy four patients between 0.5 and 8.5 years of age presenting with a midline neck cyst underwent a Sistrunk procedure for a preoperative diagnosis of TDC. Fifty-seven had histologically confirmed TDC (mean age of the population: 4+/-1.5 years, mean follow-up: 6 years and 8 months). Recurrence occurred in 15% of the cases of histologically confirmed TDC. Four individual risk factors have been identified: number of infection before surgery [more than 2 episodes (P<0.05)]; preliminary surgical procedure (P<0.05); age [less than 2 years (P<0.05)] and multicystic lesion on histopathology (P<0.01). The two first factors being correlated, the risk of relapse might be lowered by a wide excision performed before any infection in children over 2 years.

Group behavioral therapy of obsessive-compulsive disorder: seven vs. twelve-week outcomes.

Previous research has demonstrated that individualized behavioral exposure and response prevention therapy is an effective treatment for Obsessive-Compulsive Disorder. In our prior preliminary report, 7-week group exposure and response prevention therapy was also found effective in reducing obsessions and compulsions. The present report describes a larger sample (N=113) of treatment seeking obsessive-compulsives who received group behavioral therapy. As before, group exposure and response prevention significantly improved ratings of obsessions, compulsions, and depression. These improvements were maintained at 3-month and long-term follow-up. A sub-sample of patients who received 12 weeks of treatment had outcomes at the end of the group and at follow-up that did not significantly differ from those who received 7 weeks of treatment. These results confirm the efficacy of a 7-week behavioral treatment program administered in a group format.

[Otosclerosis: experience at the Hotel-Dieu in France. 71 surgical cases]. / Otospongiose: expérience de l'Hôtel-Dieu de France. A propos de 71 cas opérées.

Otosclerosis is one of the common causes of hearing loss. The incidence varies between 0.1% and 2%. In Lebanon otosclerosis is a common entity that has not been well evaluated. To the best of our knowledge there is no epidemiologic analysis of the incidence or outcomes of otosclerosis in Lebanon. We collected the number of stapedectomies performed for otosclerosis in different hospitals between Jan. 1994 and Dec. 1995. We also retrospectively reviewed the charts of 71 cases who underwent stapedectomy at Hôtel-Dieu de France-St Joseph University Hospital Medical Center, Beirut, Lebanon. Between 1992 and 1996 the incidence of otosclerosis in Lebanon as revealed through stapedectomy is 5/100,000. We report also on the pathology, technique, complications and outcomes of stapedectomy surgery for otosclerosis in Hôtel-Dieu Hospital. Further epidemiologic studies and screening is required to reveal the exact incidence of this common entity that could be underdiagnosed or untreated in our country.

[Chronic suppurative otitis media. Experience with 140 cases at the Hotel-Dieu of France]. / Otite moyenne chronique suppurative. Expérience de l'Hôtel-Dieu de France à propos de 140 cas.

OBJECTIVES: Chronic suppurative otitis media (CSOM) is a common disease especially in developing countries. In Lebanon, CSOM is a frequent complaint. This retrospective study is an objective evaluation of the cases we operated in HDF. METHODS: One hundred and forty cases of CSOM were collected between 1993 and 1997: 88/140 cases were simple CSOM and the others 52/140 cases had cholesteatomas. RESULTS: There were no immediate postoperative complications reported (< 6 weeks). Beyond 6 weeks, with a mean follow-up of 20 months, 15% of the patients were lost for follow-up and we had 93.4% of success rate in CSOM and 88% in cholesteatomas. The recurrence rate of cholesteatoma was 14%. Children's cholesteatoma (below 15 years of age) were more aggressive than adult's cholesteatomas. In CSOM without cholesteatoma, the hearing gain was 5 dB. In CSOM with cholesteatoma the mean hearing gain was 4 dB. In conclusion the study revealed the importance of this pathology in our country with the relative high incidence of cholesteatoma compared to simple CSOM, this could be explained by the chronicity of the disease and the lack of preventive measures.

Ablaçäo transcateter por radiofrequência. Tratamento curativo da taquicardia por reentrada nodal

A taquicardia por reentrada nodal (TRN) corresponde, aproximadamente, 50 a 70 por cento dos tipos de taquicardia paroxística supraventricular (TPSV). Existe certa prevalência favorável ao sexo feminino e em menores de 40 anos de idade. A frequência cardíaca (FC), durante o paroxismo taquicárdico, pode oscilar de 100 a 280bpm, com valores médios em torno de 170bpm. A arquitetura complexa do nódulo atrioventricular (NAV), com sua característica de anisotropia tissular e heterogeneidade de conduçäo dompulso elétrico, com dissociaçäo longitudinal, levando ao chamado comportamento dual de conduçäo atrioventricular (AV) ou ventrículo-atrial, predispöes ao microcircuito de reentrada intranodal -base fisiopatológica da TRN. A seguir, as características eletrofisiológicas da estrutura do sistema de conduçäo, desde aspectos eletrofisiológicos até modalidades de abordagem terapêutica, visando o esclarecimento do mecanismo da taquicardia e o procedimento técnico utilizado para sua erradiaçäo.