RESUMO
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred. Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit. Salmonella Heidelberg was identified in six of seven stool specimens and coagulase-positive S. aureus in three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection with Salmonella Heidelberg, but additional factors, such as dual aetiology that included S. aureus or the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.
Assuntos
Surtos de Doenças , Doenças Transmitidas por Alimentos/epidemiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella enterica/fisiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/fisiologia , Adolescente , Adulto , Idoso , Alabama/epidemiologia , Criança , Pré-Escolar , Colorado/epidemiologia , Feminino , Microbiologia de Alimentos , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação Alimentar por Salmonella/microbiologia , Infecções Estafilocócicas/microbiologia , Adulto JovemRESUMO
PURPOSE: Describe a novel technique for superior-based pharyngeal flaps allowing restoration of bulk to the soft palate and intraoperative fine-tuning of lateral port size, while avoiding midline palate-splitting. Validated speech assessment tools are employed for quantitative analysis. METHODS: Retrospective review of all patients who underwent superior-based pharyngeal flap in a 10-year period by a single surgeon. Pittsburgh Weighted Values for Speech Symptoms Associated with VPI and the Goldman-Fristoe Test of Articulation were used for formal speech assessment. RESULTS: 78 patients met inclusion criteria with clinical data up to 10years postoperatively. 31 patients had congenital velopharyngeal insufficiency (VPI), and the remainder acquired VPI after cleft palate repair or adenoidectomy. 37 patients had a recognized syndrome. All patients noted subjective improvement in nasality, and evaluation with the validated speech assessment tools demonstrated statistically significant improvement in speech. Only one flap takedown was required in a patient with severe midface hypoplasia who developed sleep apnea several years postoperatively. CONCLUSIONS: This technique is successful in congenital and acquired VPI, and in patients with complex craniofacial syndromes. Customization of lateral ports based on preoperative nasopharyngoscopy, and avoidance of a midline palate splitting incision, make this an attractive option for superior-based flap surgery.
Assuntos
Previsões , Palato Mole/cirurgia , Faringe/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Fala/fisiologia , Retalhos Cirúrgicos , Insuficiência Velofaríngea/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Faringe/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Insuficiência Velofaríngea/congênito , Insuficiência Velofaríngea/fisiopatologia , Adulto JovemRESUMO
Background: Peritonsillar abscess (PTA) is a common occurrence in adult patients, and an important question in such often-seen disease processes is whether we are treating these patients effectively, efficiently, and economically. We sought to determine if a diagnostic computed tomography (CT) scan was associated with a difference in clinical intervention in adult patients with PTA and if CT was associated with delaying this intervention. Methods: We conducted a retrospective case-control study examining therapeutic interventions in adults with PTA. Patients were divided into a control group (those diagnosed without CT, n=159) and a case group (those diagnosed with CT, n=203). Patients were examined for 3 outcomes: admission, bedside procedure (needle aspiration, incision/drainage), and surgical procedure (incision/drainage, tonsillectomy). In addition, we calculated times to admission, otolaryngology consultation, bedside procedure, and surgical procedure. Results: We found a significant association between CT and intervention, with the CT group more likely to be admitted (P< 0.001), the non-CT group more likely to undergo a bedside procedure (P<0.001), and the CT group more likely to undergo operative intervention (P=0.02). Mean times to otolaryngology consultation, admission, and bedside procedure were significantly longer in the CT group than in the non-CT group, determined by calculating the difference of the means with 95% confidence intervals for each comparison (P<0.001). Conclusion: We found that CT scans appear to be useful in the workup and treatment of adult patients with PTA, evidenced by significant differences in interventions between groups with and without CT scans. We also found that CT scans have the potential to delay these interventions, as the time to each intervention examined was significantly longer in patients who had a CT scan. Given the need to reduce cost, enhance efficiency, and eliminate harmful side effects (in this case, radiation exposure and delays in care), we question whether CT is the gold standard imaging method for diagnostic work up of PTA.
RESUMO
The extreme sensitivity of turkeys to aflatoxin B(1) (AFB(1)) is associated with efficient hepatic cytochrome P-450 (P450)-mediated bioactivation, and deficient glutathione S-transferase (GST) mediated detoxification. Butylated hydroxytoluene (BHT) protects against AFB(1) toxicity in turkeys through mechanisms that include competitive inhibition of P450-mediated AFB(1) bioactivation. To test whether dietary BHT alters hepatic AFB(1)-DNA adduct formation, excretion, and bioavailability of AFB(1)in vivo, turkeys were given diets with BHT (4000ppm) for 10 days, given a single oral dose of [(3)H]-AFB(1) (0.05microg/g; 0.02microCi/g), then sampled at intervals up to 24h. Radiolabel in serum, red blood cells, liver, and breast meat was frequently lower in BHT-treated compared to control. Hepatic AFB(1)-DNA adducts in BHT-treated turkeys were significantly lower at 12 and 24h. BHT-fed birds had significant higher bile efflux, though biliary radiolabel excretion was not different from control. The amount of aflatoxin M(1) (AFM(1)) excreted in the bile was lower than in control, but BHT had no effect on the biliary excretion of AFB(1), aflatoxin Q(1) or glucuronide and sulfate conjugates. Thus, the chemopreventive properties of BHT may also occur through a reduction in AFB(1) bioavailability in addition to inhibition of bioactivation.
Assuntos
Aflatoxina B1/farmacocinética , Aflatoxinas/toxicidade , Bile/metabolismo , Hidroxitolueno Butilado/uso terapêutico , Adutos de DNA/efeitos dos fármacos , Conservantes de Alimentos/uso terapêutico , Fígado/metabolismo , Perus/metabolismo , Aflatoxinas/antagonistas & inibidores , Animais , Disponibilidade Biológica , Peso Corporal/efeitos dos fármacos , Hidroxitolueno Butilado/farmacologia , Conservantes de Alimentos/farmacologia , Fígado/efeitos dos fármacos , Masculino , Tamanho do Órgão/efeitos dos fármacos , Distribuição TecidualRESUMO
OBJECTIVE: We sought to evaluate the role and efficacy of intraoperative fistulograms in visualizing branchial apparatus (fistula/sinus) abnormalities in the pediatric age group (3 months-12 years). METHODS: This was a retrospective analysis of 20 pediatric patients who underwent fistula and/or sinus excision during a period of 18 years (1988-2006). RESULTS: The male:female ratio was 11:9. Eighteen of the 20 patients presented with unilateral abnormalities, 2 with bilateral abnormalities. An intraoperative fistulogram was utilized in every instance. The fistulogram clearly differentiated the sinus tracts from complete fistulas in all cases. It was also highly useful in delineating the exact length and course of the sinus/fistula tracts. CONCLUSIONS: Intraoperative fistulograms are easy to do in the operating room on the day of the scheduled surgery. They are a very useful tool in the management of branchial apparatus abnormalities.
Assuntos
Região Branquial/anormalidades , Fístula Cutânea/diagnóstico por imagem , Cuidados Intraoperatórios , Região Branquial/diagnóstico por imagem , Criança , Pré-Escolar , Meios de Contraste , Feminino , Humanos , Lactente , Iohexol , Masculino , Radiografia , Estudos RetrospectivosRESUMO
In this retrospective case series, we report clinical factors associated with pediatric peritonsillar abscess (PTA), with hopes of contributing to the design of an evidenced-based, economic treatment approach. Charts were examined for presenting symptoms and signs. Each of these were analyzed for association with the presence of PTA and for association with treatment. We found that, with the exception of leukocytosis, the signs/symptoms that prompted treatment correlate with those that indicate the presence of PTA. However, there are several signs/symptoms, namely, referred otalgia, cervical lymphadenopathy, and decreased oral intake, that were associated with PTA but unassociated with treatment. Treatment can be aided by establishing an algorithm that accounts for the symptoms/signs most correlated with true, drainable abscess.
Assuntos
Medicina Baseada em Evidências/métodos , Abscesso Peritonsilar/terapia , Adolescente , Algoritmos , Criança , Feminino , Humanos , Masculino , Abscesso Peritonsilar/fisiopatologia , Abscesso Peritonsilar/cirurgia , Guias de Prática Clínica como Assunto , Estudos RetrospectivosRESUMO
Neonatal nasal septal deviations can occur as a result of trauma in utero or during birth. They are associated with significant clinical implications, including respiratory distress and failure to thrive. The incidence and classification of these deformities are varied in the otolaryngology literature. Some authors advocate conservative observation, but no consensus on management has been reached. We present 2 cases of neonatal septal deviation that occurred during difficult deliveries. We repaired the defects with closed reduction in the operating room within the first 2 weeks of life to good effect.
Assuntos
Traumatismos do Nascimento/cirurgia , Obstrução Nasal/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Traumatismos do Nascimento/etiologia , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Recém-Nascido , Obstrução Nasal/etiologia , Deformidades Adquiridas Nasais/etiologia , FotografaçãoRESUMO
Importance: There is not a consensus on the best diagnostic algorithm for children with a potential peritonsillar abscess. The association of computed tomographic (CT) scanning in children with a pertonsillar abscess and intervention chosen by the treating physician, or the potential delay of treatment associated with such imaging, has not yet been explored. Objectives: To determine if use of a CT scan is associated with a difference in clinical intervention for peritonsillar abscess and to determine if use of a CT scan is associated with delay of this intervention. Design, Setting, and Participants: A retrospective case-control study examined therapeutic interventions, based on the presence or absence of a diagnostic CT scan, in children diagnosed with peritonsillar abscess from November 1, 2006, to November 1, 2015. Children who presented either to the emergency department or to their pediatrician with a peritonsillar abscess were divided into 2 groups: those diagnosed without the use of a CT scan (controls; n = 38) and those diagnosed with the use of a CT scan (cases; n = 30). Main Outcomes and Measures: Patients were examined for 2 outcomes: admission or no admission. The groups were also examined for type of intervention performed: bedside procedure (needle aspiration or incision and drainage), surgical procedure in the operating room (needle aspiration, incision and drainage, or tonsillectomy), no procedure, or both bedside and surgical procedure. In addition, the time to an otolaryngology consultation and to each of the above interventions was calculated. Results: Thirty children underwent a CT scan, while 38 did not. The mean age of children who underwent a CT scan was 14.3 years (range, 3-18 years) and 11.3 years (range, 1-18 years) for those who did not, for an absolute difference of 3 years (95% CI, 0.38-5.62). Among 68 patients (27 boys and 41 girls), there was no significant association between CT scan and admission or between CT scan and type of procedural intervention. However, there was a clinically significant association between CT scan and time to intervention. Mean time to an otolaryngology consultation was 369 minutes in the CT scan group and 63.4 minutes in the control group for an absolute difference of 305.6 minutes (95% CI, 208-404). Mean time to admission was 340 minutes in the CT scan group vs 166 minutes in the control group for an absolute difference of 174 minutes (95% CI, 65.3-283). Mean time to bedside procedure was 493 minutes in the CT scan group compared with 175 minutes in the control group for an absolute difference of 368 minutes (95% CI, 130-606). No significant association was found between use of CT scan and mean time to surgical intervention: mean time to surgical intervention in the CT scan group and the control group was 1.71 days and 1.64 days, respectively, for an absolute difference of 0.06 days (95% CI, -1.54 to 1.66). Conclusions and Relevance: Use of a CT scan is not associated with a difference in intervention in children with peritonsillar abscesses. It is, however, associated with a clinically significant delay in treatment; namely, time to an otolaryngology consultation, time to admission, and time to bedside procedure.
Assuntos
Abscesso Peritonsilar/diagnóstico por imagem , Abscesso Peritonsilar/terapia , Tomografia por Emissão de Pósitrons , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fatores de TempoRESUMO
For the past century, standard (total) tonsillectomy has been the preferred method for treating illness resulting from tonsillar infection and hypertrophy. With the advent of antibiotics, however, more cases of tonsillitis are treated medically. As a result, tonsillectomies are being performed less frequently for infection than for obstructive symptoms associated with tonsillar hypertrophy and sleep-disordered breathing. This shift has led to the re-emergence of the tonsillotomy, and more specifically the partial or intracapsular tonsillectomy, as an option for treating tonsillar hypertrophy, mainly in an effort to reduce the post-operative complications of pain, subsequent dehydration from lack of oral intake, and, potentially, delayed postoperative bleeding. The following is a review of the literature comparing intracapsular tonsillectomy to standard tonsillectomy for tonsillar hypertrophy associated with sleep-disordered breathing.
Assuntos
Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Tonsilectomia/métodos , Humanos , Hipertrofia/complicações , Hipertrofia/cirurgia , Síndromes da Apneia do Sono/etiologiaRESUMO
Velopharyngeal insufficiency (VPI) is an uncommon pediatric disorder often associated with congenital syndromes. After speech therapy, surgery is the standard management. Many surgical approaches to VPI repair have been reported and the complications of these procedures are well documented. To date, there have been no published cases of respiratory failure secondary to pneumomediastinum, pneumopericardium, and bilateral pneumothoraces with associated subcutaneous emphysema after superior-based pharyngeal flap. We present the first case in the literature. Our proposed etiology for the respiratory failure is air tracking from the flap donor site to the pleural spaces of the thoracic cavity via the visceral or prevertebral fascia following positive pressure ventilation.
Assuntos
Faringe/cirurgia , Complicações Pós-Operatórias , Insuficiência Respiratória/etiologia , Retalhos Cirúrgicos , Insuficiência Velofaríngea/cirurgia , Pré-Escolar , Feminino , Humanos , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Pneumopericárdio/diagnóstico por imagem , Pneumopericárdio/etiologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Respiração com Pressão Positiva/efeitos adversos , Radiografia , Enfisema Subcutâneo/etiologiaRESUMO
We followed 108 patients presenting to the emergency department with atypical chest pain and triaged with stress echocardiography. One-year cardiac event-free survival was 100% with a negative stress echocardiogram and 25% with a positive study.
Assuntos
Dor no Peito/etiologia , Doença das Coronárias/diagnóstico , Ecocardiografia , Triagem/métodos , Idoso , Angiografia Coronária , Doença das Coronárias/complicações , Eletrocardiografia , Emergências , Serviço Hospitalar de Emergência , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , PrognósticoRESUMO
Organophosphorus (OP) insecticides have the potential to cause behavioral effects in children. This study was designed to determine if repeated oral exposure of preweanling rats to chlorpyrifos would produce behavioral changes at both pre- and postweanling ages. Treatment occurred every second day beginning on post-natal day (PND) 1, and continued through PND 21. The rats received one of the following regimens: a low-dosage (3 mg/kg) from PND 1-21; a medium dosage (mg/kg from PND 1-5, and then 6 mg/kg from PND 7-21; or a high-dosage schedule of 3 mg/kg on PND 1-5, then 6 mg/kg from PND 7-13, and 12 mg/kg from PND 15-21. There were no differences in body weights among the control-, low-, and medium-dosage groups but the high-dosage group had significantly lower body weights on PND 13-21. An open field was used to measure locomotor activity on PND 10, 12, 14, 16, 18, 20, 25, and 30. There were no differences in locomotor activity levels or treatment effects between males and females. On PND 10, 12, 14, 16, 18, and 20 there was no effect on locomotor activity with any dosage. On days 25 and 30, locomotor activity was significantly decreased with the medium- and high-dosage groups. Brain cholinesterase (ChE) inhibition was about 25-38% on PND 25 and 14-34% on PND 30. On PND 25 but not 30, lung and diaphragm ChE and serum butyrylcholinesterase (BChE), with the high-dosage animals, and heart ChE with the medium- and high-dosage groups were significantly inhibited. There was no significant inhibition of skeletal muscle ChE or serum acetylcholinesterase (AChE) on PND 25 and 30. These data suggest that early postnatal chlorpyrifos exposures will depress locomotor activity in juvenile rats, with the effects most pronounced after brain ChE activity has substantially recovered.
Assuntos
Animais Recém-Nascidos/crescimento & desenvolvimento , Clorpirifos/toxicidade , Inibidores Enzimáticos/toxicidade , Comportamento Exploratório/efeitos dos fármacos , Inseticidas/toxicidade , Acetilcolinesterase/sangue , Animais , Animais Recém-Nascidos/metabolismo , Peso Corporal/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Encéfalo/enzimologia , Butirilcolinesterase/sangue , Clorpirifos/administração & dosagem , Colinesterases/metabolismo , Relação Dose-Resposta a Droga , Inibidores Enzimáticos/administração & dosagem , Feminino , Coração/efeitos dos fármacos , Inseticidas/administração & dosagem , Longevidade/efeitos dos fármacos , Pulmão/efeitos dos fármacos , Pulmão/enzimologia , Masculino , Atividade Motora/efeitos dos fármacos , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/enzimologia , Miocárdio/enzimologia , Ratos , Ratos Sprague-DawleyRESUMO
OBJECTIVE: To describe partial adenoidectomy using a powered microdebrider and review the experience with the procedure. STUDY DESIGN: Prospective study and review. METHODS: To perform a power-assisted partial adenoidectomy, the surgeon directs the window in the microdebrider blade tip toward the tissue, which is drawn in by suction; the rotating blade then shaves the tissue. Studies have compared this adenoidectomy technique with curette procedures. RESULTS: In a comparative prospective study, we found that operating time and time required for hemostasis were significantly shorter (P =.001) with power-assisted partial adenoidectomy than with curettage. There was no significant difference between the two procedures in blood loss or complication rate. These results were similar to those of previous studies. Overall, we have performed more than 1000 power-assisted partial adenoidectomies. No long-term complications have occurred, blood loss remains low, and surgeons are satisfied with the technique because of its speed, improved visibility during resection, and precision. CONCLUSION: We and other authors have found power-assisted partial adenoidectomy to provide a faster, more precise operation than curette techniques, with benefits for both patient and surgeon.
Assuntos
Adenoidectomia/métodos , Curetagem/métodos , Adenoidectomia/instrumentação , Perda Sanguínea Cirúrgica/prevenção & controle , Criança , Pré-Escolar , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Seguimentos , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Estudos Prospectivos , Sensibilidade e Especificidade , Instrumentos Cirúrgicos , Resultado do TratamentoRESUMO
Isolated uvulitis is a rarely reported disease. Known etiologies include bacterial infection and trauma following the use of instrumentation in the airway. Three cases of isolated uvulitis secondary to heavy marijuana smoke inhalation are reported. Specific recommendations regarding diagnosis and treatment of this disorder are made.
Assuntos
Fumar Maconha/efeitos adversos , Úvula , Adolescente , Adulto , Feminino , Humanos , Inflamação , Masculino , Faringite/etiologiaRESUMO
Recurrent epistaxis can be a serious problem in children with coagulation disorders. We present a case of severe, recurrent nosebleeds in a 3-year-10-month-old boy with Glanzmann's thrombasthenia. The nature of Glanzmann's disease and medical treatment of epistaxis in children is reviewed. A method of controlling recurrent epistaxis with a very simple and limited septoplasty is described. This technique should be applicable to patients with recurrent nosebleeds and other more common coagulation disorders.
Assuntos
Transtornos Plaquetários/cirurgia , Epistaxe/cirurgia , Septo Nasal/cirurgia , Trombastenia/cirurgia , Pré-Escolar , Humanos , Masculino , MétodosRESUMO
OBJECTIVE: To confirm our clinical impression that the powered microdebrider is superior to curettes for performing partial adenoidectomy (removal of the superior one half to three fourths of the adenoid pad). DESIGN: Observational study of 100 children undergoing partial adenoidectomy with the powered microdebrider compared with 40 children undergoing conventional partial adenoidectomy with curettes. SETTING: Private and public tertiary care centers. PATIENTS: All patients younger than 20 years undergoing partial adenoidectomy at the respective institutions during the study period. INTERVENTIONS: Partial adenoidectomy as indicated for chronic otitis media, airway obstruction, or chronic or recurrent tonsillitis with either the powered microdebrider or curettes. MAIN OUTCOMES MEASURES: Operative time (with specific quantification of the time required for tissue removal and hemostasis), blood loss, complications, and subjective ease of use. RESULTS: Operative time was 59% shorter for the microdebrider group (mean, 3 minutes 22 seconds; range, 1 minute 6 seconds to 12 minutes 45 seconds) than for the conventional group (mean, 8 minutes 8 seconds; range, 1 minute 2 seconds to 22 minutes 0 seconds) (P<.001). Blood loss was comparable for both groups (powered group: mean, 2.0 mL/kg; range, 0.4 to 9.4 mL/kg; conventional group: mean, 2.0 mL/kg; range, 0.3 to 6.7 mL/kg; P=.34). There were no intraoperative or postoperative complications in either group. Surgeon satisfaction with the microdebrider was high. CONCLUSIONS: The powered microdebrider for partial adenoidectomy is quicker and is not associated with blood loss or complications above that of conventional partial adenoidectomy. The degree of control afforded by the microdebrider technique is of utmost value in preventing complications such as velopharyngeal insufficiency, and this is now our procedure of choice.
Assuntos
Adenoidectomia/métodos , Adenoidectomia/efeitos adversos , Adolescente , Obstrução das Vias Respiratórias/cirurgia , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Doença Crônica , Feminino , Humanos , Lactente , Masculino , Otite Média/cirurgia , Recidiva , Fatores de Tempo , Tonsilite/cirurgia , Resultado do TratamentoRESUMO
We report a case of pneumocephalus following a water jet injury to the nose incurred during a water-skiing fall. Pneumocephalus due to this type of injury has not been previously reported, to our knowledge. Since this unusual injury may be associated with serious complications, it must be promptly recognized and treated.
Assuntos
Traumatismos em Atletas , Nariz/lesões , Pneumocefalia/etiologia , Adulto , Traumatismos em Atletas/diagnóstico por imagem , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , ÁguaRESUMO
Occasionally severe esophageal strictures will develop in children that will not allow the passage of standard Jackson or bougie dilators. These small strictures can be successfully treated using a standard intubating laryngoscope for visualization and Rush urethral Filiform dilators.
Assuntos
Estenose Esofágica/terapia , Laringoscopia/métodos , Criança , Dilatação/métodos , HumanosRESUMO
A chronic dry perforation in a child presents a dilemma with regard to timing of intervention or whether intervention is appropriate at all. Many studies have looked at elements associated with eustachian tube function in hopes of finding prognostic factors. Adenoidectomy has been shown to be very effective in the treatment of chronic and recurrent otitis media. Intuitively, it would seem to play a role in pediatric tympanoplasty; however, no study has thoroughly investigated this issue to date. To evaluate the role of adenoidectomy in pediatric tympanoplasty, we performed a retrospective review of all patients younger than 18 years who had a simple dry perforation and underwent a Wullstein's type I tympanoplasty. Thirty-six patients were identified for review during the 7-year study period. The patients were grouped into those who had previous adenotonsillectomy (n = 12), those who had prior adenoidectomy alone (n = 10), and those who had neither (n = 14). Initial success of tympanoplasty was noted to be high in all three groups. However, at 6-month follow-up, the success for the group who had not had prior adenoidectomy or tonsillectomy dropped dramatically (14.3%), whereas the other two groups maintained success rates in excess of 75% (p = 0.002). This relationship remained fairly constant throughout the 2 years of follow-up. Although our population under study is somewhat small, the results support a potentially advantageous role of adenoidectomy for pediatric tympanoplasty. These results and their implications will be discussed.
Assuntos
Adenoidectomia , Timpanoplastia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Otopatias/cirurgia , Tuba Auditiva/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Miringoplastia , Otite Média/cirurgia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Tonsilectomia , Membrana Timpânica/cirurgia , Timpanoplastia/métodosRESUMO
Retropharyngeal space infection, now a rare entity since the introduction of modern antibiotic chemotherapy, has traditionally been described to occur in children less than 4 years of age with suppurative disorders of the ear, nose, and throat. Recent reports suggest a changing trend in the epidemiology, bacteriology, diagnostic imaging, treatment, and clinical course of this entity. However, the medical literature concerning this topic over the last two decades has consisted mainly of case reports. We reviewed eight cases of retropharyngeal space infection at our institutions over a 15-year period, representing one of the largest clinical series of its kind in the last 20 years. Patient ages ranged from 3 months to 41 years. Findings of these cases and 13 cases from similar reports obtained by a MEDLINE computer search of the recent literature were analyzed. Results show a trend toward occurrence in older age groups, polymicrobial infections, successful use of CT scan as a diagnostic modality, and fewer patients requiring incision and drainage. These findings will be discussed and contrasted to conventional wisdom.