Pediatric Otolaryngology Department Research Articles

Association of Residual Low-frequency Hearing Loss in Children and Type of Ventilation Tube Placed During Myringotomy With Tympanostomy Tube Placement

Objective: Assess whether titanium Tytan tympanostomy tubes result in a larger air-bone gap (ABG) at lower frequencies compared to Armstrong and Paparella tubes. Study Design: Retrospective cohort study. Setting: Pediatric otolaryngology department of a 1000-bed academic center. Patients: A cohort of 110 children, aged 4–16 years, who had no sensorineural hearing loss or congenital syndromes and underwent tympanostomy tube placement between August 2018 and February 2021. Interventions: Tympanostomy procedures using Tytan, Armstrong, or Paparella tubes. Main Outcome Measure: Evaluation of pure tone average (PTA) and ABG at frequencies of 500 and 250 Hz. Results: Tytan tubes enhanced PTA and ABGs across studied frequencies. Nonetheless, post-Tytan tube placement exhibited significantly worse PTA and 500 Hz ABG compared to Armstrong and Paparella tubes (P < 0.05; P < 0.0001). Additionally, 250 Hz ABG post-Tytan was inferior to post-Armstrong (P < 0.0001). Relative risks of persistent ABG ≥ 15 dB with Tytan versus Armstrong tubes were 2.36 (1.62–3.44) at 500 Hz and 1.49 (1.09–1.99) at 250 Hz. Against Paparella tubes, these were 2.11 (1.28–3.72) at 500 Hz and 1.12 (0.81–1.67) at 250 Hz, the latter being not significant. Conclusion: While Tytan tubes optimize PTA, they are linked to enduring ABG ≥ 15 dB at lower frequencies. Notably, they perform less favorably in terms of 500 Hz PTA and ABG compared to both Armstrong and Paparella and demonstrate poorer 250 Hz ABG when juxtaposed with Armstrong tubes.

Subglottic stenosis as an early presentation of DiGeorge Syndrome

<b><br>Introduction:</b> DiGeorge Syndrome, a microdeletion on chromosome 22q11.2, encompasses a myriad of congenital abnormalities. These often include cardiac malformations, velopharyngeal insufficiency, immune deficiency, parathyroid hypoplasia, and hypocalcemia. Although congenital defects of the larynx are quite well acknowledged in the literature, their presence and prevalence in this syndrome remain unknown.</br> <b><br>Aim:</b> We present a case report describing an infant whose initial presentation and symptoms were not suggestive of DiGeorge Syndrome. We also discuss the prevalence of subglottic stenosis among young patients diagnosed with DiGeorge Syndrome.</br> <b><br>Case report:</b> A two-month-old infant was admitted to the Pediatric Otolaryngology Department after difficulties with intubation and extubation during surgical repair of intestinal malrotation. Laryngoscopic examination revealed stage III subglottic stenosis. Laryngotracheoplasty with anterior costal cartilage graft was performed, followed by a series of balloon dilation procedures due to postoperative adhesions and recurrent subglottic stenosis. A comprehensive postsurgical evaluation of the patient confirmed the diagnosis of DiGeorge Syndrome.</br> <b><br>Conclusions:</b> The presented case underscores the broad clinical presentation of DiGeorge Syndrome and emphasizes the importance of maintaining a high index of suspicion in patients demonstrating an unusual confluence of symptoms. Detailed investigation and early diagnosis can significantly contribute to appropriate management, thereby potentially improving outcomes in this patient population.</br>

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy.

Persistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy. A retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management. University of California, San Francisco Pediatric Otolaryngology Department. Among the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management. The majority of pediatric PACLis benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow-up with neck ultrasound can be used to safely monitor patients.

HYPERTROPHY OF THE LOWER CORNEA OF THE NOSE: COMPARISON OF SURGICAL TECHNIQUES BY ASSESSMENT OF POSTOPERATIVE COMPLICATIONS

Background. Nasal congestion is one of the most commonly reported symptoms in clinical practice. The second most common cause of nasal congestion is hypertrophy of the lower concha, a pathology of the nose that often requires surgical treatment. The purpose of this study is to determine the most effective surgical method in patients with hypertrophy of the inferior turbinate.&#x0D; Materials and methods. The study was conducted from November 2019 to January 2023 at the Pediatric Otolaryngology Department of the Emilian Cotaga Republican Children's Clinical Hospital in Chisinau, Republic of Moldova. The study population included 205 patients who underwent surgery and were under observation in the hospital. Radiofrequency ablation was the method used in 73 patients, 68 patients were treated with microdebrider turbinoplasty, and the remaining 64 patients were treated with electrocautery. After surgery, postoperative complications were assessed and quantified.&#x0D; Results. A total of 205 patients were operated on. The first group (n=73) underwent radiofrequency ablation and had a complication rate of 30.1%. Out of 73 patients, 51 recovered without complications. The remaining 22 had complications, including 16 patients with bleeding and 6 with postnasal drip. The second group (n=68) was treated by the microdebrider method. The complication rate was 26.5%, with 50 patients having no postoperative symptoms and 18 having symptoms. In particular, postnasal drip was more common with this method, as all 18 patients experienced postnasal drip as a complication. The third group (n=64) received electrocautery. Patients in this group had the most complications (n=24), with 16 associated with postnasal drip and eight with infections that were treated promptly with oral antibiotics. The frequency of complications with this method was 37.5%.&#x0D; Conclusion. In our study, microdebrider turbinoplasty provided the lowest complication rate, followed by radiofrequency ablation and electrocautery. However, all three methods were successful in relieving nasal congestion and treating inferior turbinate hypertrophy. More research is needed, as there is still no consensus on the optimal surgical technique for inferior turbinate hypertrophy.

Analysis of the Clinical Status and Treatment of Facial Cellulitis of Odontogenic Origin in Pediatric Patients.

The most common cause of the development of odontogenic infection is untreated dental caries, which initially leads to pulpitis. If an odontogenic infection is left untreated, it will pass through the limiting bone plate and will infiltrate deeper structures. Odontogenic infections are different in adults and children. The study was conducted at the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of Upper Silesian Children's Health Center in Katowice in the 2020-2022. We included 27 patients aged 2-16 in the study. Patients were diagnosed with an active, acute odontogenic inflammatory process in the head and neck area. We assessed pain, trismus, extraoral and intraoral swelling and the level of CRP [C Reactive Protein], WBC [White Blood Cells], NLR [Neutrophil Lymphocyte Ratio], D-dimers and Prealbumins. The results were analyzed in terms of the location of the source of inflammation: maxilla or mandible and the type of source of infection: deciduous tooth or permanent tooth. Deciduous teeth are more often the cause of odontogenic infection in the maxilla, while permanent teeth in the mandible. Trismus, extraoral, and intraoral swelling occurred in all infections caused by permanent teeth. The CRP and NLR ratio is statistically higher in infection, which originates from permanent teeth. The mean hospitalization time was also longer for infections from permanent teeth 3.42 days than for deciduous teeth 2.2 days. The varied clinical picture of odontogenic infections in children requires periodic analyzes of statistical data related to epidemiology, etiology, and symptomatology in order to update diagnostic and therapeutic procedures.

Analysis of Clinical Symptoms and Biochemical Parameters in Odontogenic Cellulitis of the Head and Neck Region in Children.

Many cases of cellulitis in the head and neck region among hospitalized pediatric patients are related to odontogenic infections. C-reactive protein (CRP), white blood cell (WBC) count, neutrophils to lymphocytes ratio (NLR), D-dimer, and prealbumin can be used to assess the severity of odontogenic inflammation. The aim of the study is to evaluate the biochemical parameters as a predictor factor of the severity of odontogenic cellulitis in children. This study was conducted from 2020 to 2021 on patients admitted to the Department of Pediatric Otolaryngology and Pediatric Head and Neck Surgery of the Upper Silesian Children's Health Center in Katowice. We included 40 patients aged 2-16 in the study, who were divided into two groups: research (SS-Study subject) (n = 20) and control (CS-Control subject) (n = 20). The patients underwent an interview and physical examination to assess the presence of intraoral and extraoral swelling and the presence of trismus. The patients who qualified for the study had blood taken to determine the level of CRP, WBCs, NLR, D-dimers, and prealbumin. Differences in biochemical test results in the SS and CS were statistically significant (p &lt; 0.05). In the SS group, the mean values of biochemical parameters exceeded the clinical norm. A statistically significant positive relationship was found between CRP and extraoral swelling. The NLR correlates significantly with extraoral swelling and the length of hospitalization. D-dimer statistically correlated with trismus, extraoral swelling, and the number of anatomical spaces involved. The NLR and CRP ratio can be considered a prognostic marker of the course of infection and hospitalization time.

Increase in middle ear infections of Streptococcus pyogenes etiology among patients of the Department of Pediatric Otolaryngology of the Medical University of Warsaw in correlation with world reports

Introduction. Beta-hemolytic streptococcus is one of the most common causes of out-of-hospital infections. It can cause local or general infections of varying severity, most commonly in the throat, paranasal sinuses, ear and skin. Some infections are invasive in nature. In the last months of 2022, an alarming increase in infections caused by Streptococcus pyogenes, including invasive infections, has been observed in many countries in Europe and around the world compared to previous years. Aim. The purpose of this study was to compare the number of hospitalized patients with acute otitis media and acute mastoiditis of S. pyogenes etiology in the first six months of 2023 with hospitalizations for the same reason in the previous 5 years, and to assess the correlation with the observed worldwide trend of an increase in the number of observed beta-hemolytic streptococcus type A infections. Material and methods. A retrospective analysis of the data of patients diagnosed with acute otitis media and acute mastoiditis of S. pyogenes etiology hospitalized in the Department of Pediatric Otolaryngology in the first six months of 2023 was carried out, and their number was compared with patients hospitalized for the same reason in the previous 5 years. Results. Between January 2023 and the end of June 2023, 15 patients with acute otitis media were hospitalized in the Department of Pediatric Otolaryngology, in which S. pyogenes was isolated by bacteriological examination. Purulent leakage from the ear was observed in 10 patients. Isolated otitis media was diagnosed in 4 patients. In 10 children, AOM was complicated by acute mastoiditis, which was confirmed by CT scan. The most severe complication was sepsis of GAS etiology. Intravenous antibiotic therapy and surgical treatment were implemented in all patients, achieving a cure. From 2018 to 2022, the number of patients hospitalized for the same reason was significantly lower each year. Conclusions. The number of patients hospitalized in the Department of Otolaryngology in the last two months of 2022 and in the first six months of 2023 due to AOM, as well as AOM complicated by mastoiditis, in which the etiologic agent turned out to be S. pyogenes confirmed the observed worldwide trend towards an increase in the incidence of GAS. GAS-induced AOM is characterized by greater local aggressiveness, manifested by a higher incidence of tympanic membrane perforation, as well as mastoiditis with bone destruction. The primary antibiotic used to treat GAS infections is penicillin, with sensitivity to penicillin also implying sensitivity to all beta-lactam antibiotics. The treatment of GAS with intratemporal complications in the form of acute mastoiditis caused by S. pyogenes, especially progressing with bone destruction, requires combined antimicrobal therapy with surgical treatment.

Utilization of intranasal ipratropium bromide in the prevention of recurrent croup events: Is it effective?

Recurrent croup (RC) is a common problem in the pediatric population. We theorize that reduced rhinorrhea and post-nasal drip as well as suppressed cough receptor activity by the anticholinergic, intranasal ipratropium bromide (IB), may lead to reduced inflammation and edema of the subglottis, decreasing RC symptoms. The aim of this study is to determine the effectiveness of IB in improving symptoms of RC and in reducing the need for alternative forms of management. A retrospective chart review combined with survey data of patients with RC was conducted to assess demographic data, comorbidities, and treatment outcomes. Pediatric patients less than 10 years of age diagnosed with RC through the department of pediatric otolaryngology between 2018 and 2020 were included. Results were compared between one group treated with IB for RC and a second group treated with medications other than IB. Among the 67 patients treated for RC, 34 completed survey data and were included in the study. Overall, patients who were treated with IB for RC had 1.83 less croup episodes per year (p=0.046), a 0.5-point improvement in child symptoms (p=0.017) and 1.3 fewer doses of steroids per year than the patients not treated with IB (p=0.018). Patients treated with IB were significantly more likely to answer "yes," that the use of medication helped improve symptoms (p<0.01). Intranasal IB is a novel therapeutic option that may reduce RC events, improve patient symptoms and reduce steroid use. Further prospective studies are needed to definitively characterize the benefits of IB in the treatment of RC.

Acute Rhinosinusitis in Children with Inhalant Allergies.

Rhinosinusitis is an essential medical problem in pediatric populations. Due to a lack of studies considering allergy impact on pediatric rhinosinusitis, it seems legitimate to investigate this subject. The aim of this paper was to assess the influence of inhalant allergy on acute rhinosinusitis in children. The study involved 100 pediatric patients aged between 3 and 17 years who were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology of the Medical University of Lublin due to acute rhinosinusitis. The control group consisted of 50 children without allergy, and the study group consisted of 50 children suffering from inhalant allergy. The methodology employed in this study involved medical history and laryngological examination, as well as laboratory and radiological testing. Dust mite allergy was the most common allergy among patients in the study group. Patients with allergies presented at the hospital later than patients without allergy, and their hospitalization lasted longer due to more severe sinus disease, higher inflammatory parameters, multiple sinus involvement, more frequent fever or rhinosinusitis complications, especially orbital occurrence. Most children in the control group required only pharmacological treatment. Inhalant allergy, especially dust mite allergy, contributes to more severe acute rhinosinusitis in children.

Retropharyngeal abscess as an example of a deep neck infection in children

Deep neck infections are severe complications of the inflammatory processes in the upper respiratory tract. They can be divided into retropharyngeal, parapharyngeal, peritonsillar and submandibular abscesses, depending on the affected region. Deep neck infections are considered as acute bacterial complications with a progressive course and life-threatening character and that’s why they require immediate wide-range, intravenous antibiotic therapy. A 7-year-old female patient presented to her general practitioner with persistent, recurrent fever lasting for 3 days. Fever subsided after 2 days of antibiotic therapy, but she developed trismus, severe sore throat, especially on the right side, radiating to the right ear and dysphagia. The patient was referred to the Pediatric Otolaryngology Department as a matter of urgency. On examination she had enlarged lymph nodes on the right side of the neck with limited head and neck movements to the right side and posteriorly. There was also an asymmetry of the pharynx behind the right palatopharyngeal arch observed. Laboratory blood tests showed high CRP level (3.84 mg/dl, n &lt; 0.5). CT scan was performed and showed multiloculated abscess in right retropharyngeal space. Our patient was qualified for the surgical procedure – drainage of the abscess under general anaesthesia together with wide spectrum antibiotic therapy in a form of cefuroxime and clindamycin. During procedure a large amount of pus was evacuated, and a sample was sent for microbiological results. It showed growth of Staphylococcus hominis, probably multiplication of local physiological colonization. She also received anti-inflammatory drugs and has had physiotherapy throughout the hospitalization period to prevent torticollis. We observed gradual local and general improvement, together with normalization of the inflammatory markers. She was discharged from the hospital after 7 days of intravenous treatment. Accurate diagnosis and immediate proper treatment of deep neck infections are essential in prevention of further local (to the surrounding regions) and general expansion (like thrombosis, sepsis, meningitis) of the inflammatory process and of persistent changes (like stenosis of the respiratory tract). Fortunately, in the post-antibiotic era most patients are fully healed, further complications are almost unseen and mortality rates are low.

Case study of a 7-years old patient with central auditory processing disorder on the autism spectrum disorder – Department of Pediatric Otolaryngology, Medical University of Warsaw

Central Auditory Processing Disorder (CAPD) is a condition in which sounds are not processed well by the auditory cortex. This disorder is often associated with others, such as dyslexia or autism spectrum disorder. Nowadays, there are many therapeutic methods for CAPD. One of them is active auditory training Neuroflow. Seven-years old boy on the autism spectrum disorder underwent the CAPD diagnostics using Neuroflow tests. He reported troubles with concentration, aural memory, understanding speech and hyperacusis. He also has significant problems in school due to that disturbances. After starting Neuroflow therapy, significant, but gradual progress was noticed in his both everyday and school life. Two more diagnostic sessions were performed and the results were getting better every time. Neuroflow is a tool used in various therapeutic disciplines. It is distinguished by its versatility, online conducting and parental participation. This type of therapy can be helpful in the treatment of not only CAPD, but also similar disorders, such as ASD.

Rigid Bronchoscopy in Foreign Body Aspiration Diagnosis and Treatment in Children.

Foreign body aspiration in children is a common condition and can bring about serious undesired results. Fast and accurate diagnosis and foreign body extraction from airways are essential. We performed a retrospective study on rigid bronchoscopy outcomes due to suspected foreign body aspiration. A total of 66 children were admitted to the Chair and Department of Pediatric Otolaryngology, Phoniatrics and Audiology, Medical University of Lublin between 2015 and 2020 and underwent rigid bronchoscopy in general anesthesia due to suspected foreign body aspiration. We analyzed the data, including patients age and sex, reported complaints, and bronchoscopy findings. Analyzed children were aged from 8 months to 17 years old; 74.24% of them were under 3 years old during the procedure, and most of the operated patients were males. In 36.36% cases, no foreign body was identified, and 57.14% foreign bodies were located in right main bronchus. A total of 80.95% of foreign bodies extracted from airways were organic, mostly nuts. Diagnosis and treatment of suspected foreign body aspiration requires consistent cooperation between pediatricians, pulmonologists, anesthesiologists, and otolaryngologists.

Case study of a patient with Cornelia de Lange syndrome – Department of Pediatric Otolaryngology, Medical University of Warsaw

Cornelia de Lange syndrome (CdLS) is a genetic disorder characterized by facial dysmorphia, growth failure, otolaryngological and cardiovascular problems. Due to its multi-organ occurrence, it is crucial for a multidisciplinary team to cooperate and provide regular check-ups for these patients. 3-month old girl with CdLS was admitted to Pediatric Otolaryngology Clinic to diagnose hearing loss. The child prenatal and neonatal life was complicated with IUGR, heart defect, respiratory insufficiency, infection and feeding problems. In our clinic hearing examination has been conducted and bilateral hearing loss was diagnosed. Further tests are being conducted. Most of the children with CdLS experience otolaryngological problems which result in hear loss. Objective hearing examination is crucial in this group of patients due to mental retardation and early onset of symptoms. Some of these patients have severe speech development problems. That is why it is essential for specialists to examine these patients regularly and provide early medical interventions, which can result in better outcomes for them.

Children’s head and neck infections caused by Streptococcus intermedius in the Pediatric Otolaryngology Department of Warsaw Medical University

Introduction. Streptococci are commonly known pathogens of the normal bacterial flora of the mouth, pharynx, gastrointestinal tract and genitourinary system. The most common infections are beta-hemolyzing streptococci causing pharyngitis, streptococcal angina, otitis and paranasal sinusitis. But not all streptococcal infections are easy to treat. They are those that forming abscesses in the deep tissues of the body and caused life-treating complications. Aim. The aim of the study is to draw attention to the pathogen of the Streptococcus viridans group, i.e. Streptococcus intermedius, which, being a saprophyte of the upper respiratory tract, may cause life-threatening complications during an infection. Material and methods. The age, sex of children, underlying disease, complications, conservative and surgical treatment of children treated in the Pediatric Otolaryngology Department of the Medical University of Warsaw due Streptococcus intermedius infections were analyzed. Results. 6 children in age from 14 months to 15 years were treated in the ENT Department of Warsaw Medical University due to Streptococcus intermedius infections. There were 5 boys and 1 girl. All children were diagnosed with abscesses in deep tissue as a complication of acute sinusitis in 4 children, pharyngitis in 1 and post trauma nasal bone in 1 child. All children were immunocompetent. The treatment of choice was antibiotic therapy and drainage of abscesses. All children were successfully treated. Conclusions. The isolation of Streptococcus intermedius in cultures taken from infection’s site in the upper respiratory tract is associated with the risk of complications in the form of deep head and neck and central nervous system abscesses. Each patient with an infection of Streptococcus intermedius etiology requires CT or MRI imaging of the craniofacial and brain due to the possibility of deep abscesses. The treatment of choice is antibiotic therapy with ceftriaxone, clindamycin and together with surgical drainage of the abscess. The sensitivity of Streptococcus intermedius to popular antibiotics is the reason for effective treatment despite serious complications.

The use of impedance audiometry in the diagnosis of children in the 6-month period in the Department of Pediatric Otolaryngology of the Medical University of Warsaw

Introduction. Impedance audiometry is one of the best objective tests available to assess the function of the middle ear. It can be performed in patients of any age. Based on the results of impedance audiometry, you can draw the first conclusions about the condition of the middle ear and further diagnostics. Aim. The aim of the study was a retrospective assessment of the results of impedance audiometry carried out over a period of 6 months among children staying in the Department of Pediatric Otolaryngology of the Pediatric Clinical Hospital in Warsaw. Material and methods. In the period from May to the end of November 2021, in the Department of Pediatric Otolaryngology of the Pediatric Clinical Hospital of the Medical University of Warsaw, impedance audiometry was carried out on 319 children using Interacoustics Titan equipment. The results were analyzed for each patient and the age at which the patient was examined. Results. The most common type of tympanogram was type A (norm). The smallest number of results was obtained with the Ad type. We noted an increased number of pathology on the left side. Conclusions. Analysis of the results confirmed the important role of impedance audiometry in hearing tests. Extensive audiological diagnostics allow to minimize the risk of making mistakes, unnecessary hospitalizations, as well as unnecessary involvement of the operating theatre.

Gradenigo’s syndrome as a rare complication of acute otitis media in a child – case study

Gradenigo’s syndrome (GS) is a rare complication of otitis media and is defined as a concomitant unilateral acute inflammation of the middle ear, facial pain in the region supplied by the trigeminal nerve and abducens nerve palsy. It occurs in less than 2 in 100 thousand cases of acute otitis media. Cavernous sinus thrombosis (CST) is a rare complication usually accompanying sinusitis, however a few cases of CST in the course of GS were described before. We present a case of a 11-year old boy with a history of otitis media admitted to the Department of Pediatric Otolaryngology of a tertiary care center with vomiting, headache, unilateral paresthesia of the face and diplopia. Cavernous sinus thrombosis as well as inflammation of the temporal bone including the petrous apex with formation of a subperiosteal abscess was shown in CT and MRI scans. The patient was treated with ceftriaxone, metronidazole and vancomycin, as well as enoxaparin and warfarin. Antromastoidectomy of the right temporal bone was performed. The patient recovered gradually over the course of treatment with a complete resolution of CST in MRI and abducens nerve palsy after in clinical examination after 11 weeks of treatment. Even though both Gradenigo’s syndrome and cavernous sinus thrombosis are rare entities the knowledge of their clinical manifestations is very helpful for both laryngologists, pediatricians and general practitioners. Early diagnosis and prompt introduction of treatment are crucial for successful treatment and avoiding dangerous sequelae.

295 children’s bronchoscopy due to choking episode with suspected foreign body in the of pediatric ent department – analysis of choking risk factors

Introduction. Aspiration of foreign body by children is a common cause of respiratory failure and an indication for urgent bronchoscopy. This procedure under general anesthesia is very difficult, stressful and dangerous in children due to their small diameter of the respiratory tract with a symptom of dyspnea. The tendency to put everything in to the mouth for cognitive purposes, incomplete dentition, immature swallowing mechanism are all the factors of high risk of choking episodes in very young children. Over the years still has been discussions on how to limit the number of bronchoscopies performed in children. Aim.The authors of this analysis try to find an answer to the question of whether and which way the number of bronchoscopy of the lower respiratory tract in children can be limited. Material and methods. 295 children underwent a bronchoscopy in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in 2015-2020 after an episode of choking with suspected foreign body of the lower respiratory tract. The procedure was done after an appropriate pediatric examination and X-ray of the chest. In the analysis, particular attention was paid to the type of foreign bodies, pathology in clinical examination and tests. Results. 295 patients underwent rigid bronchoscopy under general anestesia. The indications for this procedure was single episode of choking. All children presented some patology in physical examination or on chest X-ray. Only in 142 (48%) patients a various foreign bodies were found and removed. That were 110 (77.5%) organic and 32 (22.5%) inorganic foreign bodies. Among all 142 cases only 9 (6%) were visible on X-ray. Peanuts and seeds were the most common foreign bodies, identified in 81% patients. The median age was 2 years. Conclusions. There are not characteristic symptoms of foreign body in respiratory tract in clinical investigation after single episode of choking. The suspicion of aspiration is still the main indicates for urgent bronchoscopy in children. It seems that the number of performed bronchoscopies could be reduced by prevention. Extensive education for young parents should be providing to inform them about choking hazard. We should pay special attention to them not to give small hard organic food to their children; especially nuts and grains. Parents’ attention should also be paid to toys, which for toddlers must be free of small, moving parts. Also companies producing food and toys for children should be obliged to place information on the risk of chocking on their products.

Tachypnea and Epistaxis in a Full-term Infant.

1. Daniela Titchiner, MD* 2. Priya Dukes, MD* 3. Rebecca Speier, MD* 4. Sharla Rent, MD* 1. *Duke University Hospital, Durham, NC 1. Address correspondence to Daniela Titchiner, MD, Department of Neonatology, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27710. E-mail: daniela.titchiner{at}duke.edu A 3.8-kg male infant is born at 40 weeks’ gestation to a 30-year-old primigravida woman via normal spontaneous vaginal delivery. The pregnancy is uncomplicated, with appropriate prenatal care. Delivery is uneventful; the patient receives routine delivery care with Apgar scores of 7 at 1 minute and 9 at 5 minutes. The infant is transferred to newborn nursery with no complications. At 19 postnatal hours, he develops persistent tachypnea and stertor. The patient’s nares are suctioned bilaterally, followed by frank epistaxis and 2 episodes of bloody emesis. As a result, he is admitted to the NICU due to concern for respiratory distress and evaluation of bloody emesis. Initial examination in the NICU reveals an appropriate for gestational age term infant with mild tachypnea with RR 80, no increased work of breathing, saturating > 97% on room air. Chest radiograph demonstrates no abnormalities. The results of a complete blood cell count and coagulation studies are within normal limits. The examining NICU physician notes a soft-tissue mass in the left nasal meatus, without facial asymmetry or visible oropharynx abnormality noted. Pediatric otolaryngology (ENT) department is consulted and via flexible fiberoptic laryngoscopy visualizes a “soft, pink, mass in the …

Клиническая характеристика острых средних отитов и мастоидитов у детей

Objectves. To study the prevalence of acuta otitis media and mastoiditis in children according to data from the pediatric otolaryngology department of state budgetary health care institution “Regional Clinical Hospital No 2”. Tyumen city. Materials and methods. A retrospective analysis of the case histories of children who were hospitalized in the period from 2009 to 2017, the prevalence of various forms of otitis media and mastoiditis was studied. Results and discussion. The article analyzes the prevalence of clinical forms of otitis and mastoiditis in children. The number of children with otitis was 33% (4984 /15,087), of wich 68% with nonperforated form, 32% with perforated form, 6% complicated forms. Boys are more often sick, the younger and preschool age groups of children is the main risk group (85%) for the development of otitis media and mastoiditis. Conclusions. The high prevalence of otitis media and mastoiditis, their steady growth testifies to the urgency of the problem in pediatric practice.

Gentamicin and its ototoxicity

Introduction. The use of gentamicin in the neonatal period is categorized as a risk factor for hearing loss. Gentamicin belongs to a group of aminoglycoside antibiotics that mainly act on Gram-negative bacteria. Due to its high efficacy, low drug resistance, and low production and treatment costs, aminoglycosides are widely used, especially in developing countries. This drug damages both the cochlear and vestibular parts of the inner ear. Hearing damage after gentamicin administration is irreversible. Aim. The purpose of this study was to retrospectively evaluate gentamicin ototoxicity in children based on comprehensive hearing tests. Material and methods. Between January 2019 and June 2020, 33 children were hospitalized in the Department of Pediatric Otolaryngology at UCK WUM who were treated with gentamicin in the perinatal period. All children underwent comprehensive audiological diagnostics: acoustic otoemission, tympanometry and auditory brainstem evoked response (BERA).