Lateral Neck Radiograph Research Articles

Migrating fish bone in neck

<p>Foreign body ingestion is very common in Asian population among which most common ingested foreign body is fish bone (FB). It usually presents with foreign body sensation, odynophagia or pricking sensation during deglutition. Usually diagnosis is achieved on basis of lateral radiograph of neck, videolaryngoscopy and oesophagoscopy. Sometimes FB migrates extraluminally and causes deep neck abscess, vascular complications including vascular esophageal fistula, puncture of carotid artery, thromboembolism, thyroid gland retention. Here we report a case where fish bone migrated extraluminally into neck piercing the carotid sheath and jarred between external carotid artery and internal carotid artery. Initial laryngoscopy and oesophagoscopy were both negative. Urgent Surgical exploration was planned due to severe pain and discomfort to patient and 4 cm fish bone was retrieved. Fish bone ingestion is the most common ingested foreign body encountered in otorhinolaryngology practice. Fish bones are most commonly impacted at base of tongue, palatine tonsil or vallecula. Sometimes fish bone extraluminally and causes various complications. Extraluminal migration of fish bone is very rare and very few cases have been reported and the only case reported from our region. </p>

Factors associated with the true location of ingested fishbones.

Fishbone ingestion is a common problem worldwide, and the first step for managing this condition is to locate the fishbone precisely. However, until now, no study has analysed the true location of fishbone and its associated factors. Thus, this study identified the factors predicting the true location of fishbone and subsequently attempted to provide a management algorithm for fishbone ingestion. This retrospective study was carried out at St Martin De Porres Hospital, Taiwan, between January 2015 and January 2016. All patients were diagnosed as having fishbone ingestion within the pharynx and underwent fishbone removal. This study included 198 consecutive patients with a mean age of 43.1 years (range: 1-84 years). The sensitivity of lateral neck radiography in the diagnosis of fishbone in the pharynx was only 22%. The fishbone locations were as follows: the tonsil in 72 (36.4%) patients, the tongue base / vallecula in 112 (56.6%) and the hypopharynx in 14 (7.0%). Multiple logistic regression analysis showed that patient age and fishbone length were significant independent risk factors associated with the true location of fishbone ingestion. Among all patients, fishbone was removed transorally under direct vision in 73 (36.9%) patients and using flexible nasopharyngoscopy in 125 (63.1%) patients. Patient age and fishbone length are important independent factors associated with the location of ingested fishbone. Lateral neck radiography is not beneficial for diagnosing fishbone ingestion within the pharynx. Flexible nasopharyngoscopy, by contrast, is an important method for the diagnosis and treatment of fishbone ingestion within this location.

Features of course and surgical treatment of tonsillogenic neck phlegmons and mediastinitis

Background. The problem of adequate treatment for deep neck and mediastinal suppuration is one of the most difficult in surgery. It leads to such complications as mediastinitis, sepsis, arrosive bleeding, etc. The purpose was to investigate clinical, diagnostic and treatment features in patients with neck phlegmons and mediastinitis caused by pharyngeal suppurations. Materials and methods. The results of treatment of 31 patients with parapharyngeal phlegmons were presented. The average age of them was 48.24 ± 15.60 years, men were 18 (58 %), women — 13 (42 %). All persons suffered from severe endogenous intoxication. The time from the onset of the disease to surgery was about 4 days (from one to seven). Results. Most frequently, parapharyngeal suppuration was detected — in 16 (51.6 %) patients, then paratonsillar abscesses — in 11 (35.5 %), retropharyngeal suppurations — in 3 (9.7 %), and laryngeal cancer — in 1 (3.2 %). Lateral neck radiographs were performed in all patients preoperatively. Sensitivity of this investigation was 100 %. At the same time, chest X-ray to detect mediastinitis showed low rates of sensitivity — 60 %. Surgical approaches included extensive cervicotomy (often bilateral) and penetrative polydrainage of prevertebral space. Mediastinitis was found in 15 cases (48.4 %). It was enough to use blind drainage for upper posterior mediastinitis (11 cases, or 73.3 %). Right-sided thoracotomy was performed in one case of total posterior mediastinitis. Four patients died (13 %). Descending mediastinitis and sepsis were found in all lethal cases. Mortality rate in the group of patients with mediastinitis was 26.7 %. Conclusions. Neck phlegmons as a result of parapharyngeal suppuration are characterized by an aggressive course with significant endogenous intoxication and spread to the mediastinum in 48.4 % of cases with a lethality of 13 %. The lateral neck X-ray must be performed to all patients with suspicion of a deep neck phlegmon. In most cases (80 %), suppuration spreads from the parapharyngeal spaces to posterior mediastinum, which should be taken into account when opening purulent abscesses.

Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea

Childhood obstructive sleep apnea (OSA) has important implications for growth, learning, behavior, cognition and cardiovascular health as well as snoring and OSA in adulthood. In this study, we elucidated the sex differences in polysomnographic (PSG) findings and pharyngeal radiographic data in pediatric OSA patients. Sixty three children (age between 3 and 15 years old) with OSA [defined as apnea-hypopnea index (AHI) ≥1/h by polysomnography] were enrolled. Lateral neck radiographs were obtained from the patients. All subjects were separated by age: pre-adolescent group (3-8 years old) and adolescent group (9-15 years old). Overall, 45 patients in the pre-adolescent group (33 boys and 12 girls) and 18 patients in the adolescent group (10 boys and 8 girls) were enrolled, and sex differences were compared in each group. We found sex differences in craniofacial features and severity of OSA in the adolescent group, in which girls with OSA had more upper airway space, in addition to lower AHI, lower 3% oxygen desaturation index (ODI), higher minimum SO2 and better sleep efficiency than the boys. The present study found revealed sex differences in pediatric OSA patients in the adolescent group. Girls in the adolescent group had more upper airway space in addition to lower AHI, lower 3% ODI, higher minimum SO2 and better sleep efficiency than boys.

Displacement of the hyoid bone by muscle paralysis and lung volume increase: the effects of obesity and obstructive sleep apnea.

Study ObjectivesAnimal studies suggest a pivotal role of the hyoid bone in obstructive sleep apnea (OSA). We aimed to explore the role of the hyoid bone in humans by testing the hypotheses that muscle paralysis and lung volume (LV) changes displace the hyoid bone position particularly in people with obesity and/or OSA.MethodsFifty patients undergoing general anesthesia participated in this study (20 participants with nonobese, non-OSA; 8 people with nonobese OSA; and 22 people with obese OSA). Three lateral neck radiographs to assess the hyoid position (primary variable) and craniofacial structures were taken during wakefulness, complete muscle paralysis under general anesthesia, and LV increase under general anesthesia. LV was increased by negative extrathoracic pressure application and LV changes were measured with a spirometer. Analysis of covariance was used to identify statistical significance.ResultsMuscle paralysis under general anesthesia significantly displaced the hyoid bone posteriorly (95% CI: 1.7 to 4.6, 1.5 to 5.2, and 1.1 to 4.0 mm in nonobese non-OSA, nonobese OSA, and obese OSA groups, respectively), and this was more prominent in people with central obesity. LV increase significantly displaced the hyoid bone caudally in all groups (95% CI: 0.2 to 0.7, 0.02 to 0.6, and 0.2 to 0.6 mm/0.1 liter LV increase in nonobese non-OSA, nonobese OSA, and obese OSA groups, respectively). Waist–hip ratio was directly associated with the caudal displacement during LV increase.ConclusionsThe hyoid bone plays an important role in the pathophysiology of pharyngeal airway obstruction due to muscle paralysis and LV reduction, particularly in people with obesity.Clinical TrialUMIN Clinical Trial Registry, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=cR000022635&language=E, UMIN000019578

Accuracy of objective parameters in acute epiglottitis diagnosis: A case-control study.

Lateral neck radiography is often used as a screening tool in emergency departments for suspected acute epiglottitis. The qualitative radiographic signs have been mainly used. The aim of this study was to evaluate the accuracy of objective radiographic parameters to aid diagnosis of acute epiglottitis.Patients who were diagnosed with acute epiglottitis from January 2006 to December 2016 were included in this case–control study. Control subjects with normal lateral neck radiograph findings were included at a 1:4 ratio during the same period. The clinical findings of the patients were assessed from electronic medical records and radiographs were interpreted by a board-certified radiologist and a board-certified emergency medicine physician. The widths of the 3rd cervical vertebral body, epiglottis base (EWB), epiglottis tip (EWT), aryepiglottic fold (AFW), and hypopharynx, as well as the dimensions of the retropharyngeal and retrotracheal soft tissues, were retrospectively measured. The sensitivity, specificity, and receiver operating characteristic (ROC) curves were analyzed for the measured parameters, and cutoff values were determined to predict acute epiglottitis. The predictive cutoff values of radiologic parameters were evaluated using 5-fold cross-validation.A total 260 epiglottitis patients and 1166 controls were included in the study. In the ROC curve analysis, the EWB had an area under the ROC curve (AUROC) of 0.99 for a cutoff value of 5.02 mm (sensitivity, 96.2%; specificity, 98.2%). The EWT had an AUROC of 0.97 for a cutoff value of 4.84 mm (sensitivity, 91.2%; specificity, 97.3%). The AFW had an AUROC of 0.88 for a cutoff value of 6.59 mm (sensitivity, 86.5%; specificity, 78.8%). The 5-fold cross-validation achieved AUROCs of 0.97 for EWB, 0.94 for EWT, and 0.83 for AFW.The objective radiographic parameters in lateral neck radiography may be useful in diagnosing acute epiglottitis. Further prospective studies may be warranted to evaluate the diagnostic performance in actual clinical practice.

Cricoid ridge ossification mimicking ingested fish bone on plain radiography: prevalence in Singapore.

Ossification of the cricoid ridge mimicking impacted upper aerodigestive tract fish bone has been described in several case reports. We performed this study to determine the prevalence of such ossification in an adult population from Singapore and to identify specific imaging features that may aid in differentiating patients with cricoid ridge ossification from those with an upper aerodigestive tract impacted fish bone. We retrospectively evaluated 442 lateral neck radiographs of patients aged 16 years and above that were taken at the adult emergency department at National University Hospital, Singapore, during the four-month period between 1 September 2014 and 31 December 2014. Ossification of the cricoid ridge mimicking fish bone appeared in 3.2% of our adult patients and was more common among patients aged above 40 years (n = 11/227; 4.8%). The ossified cricoid ridge was usually located at the C6 level (n = 9) and had a mean length of 5.5 (range 2-9) mm. Ossified cricoid ridges may be misinterpreted on lateral neck radiography as ingested fish bones. While ossification of the cricoid ridge mimicking fish bones is rare, awareness of such ossification would reduce unnecessary further investigations of the upper aerodigestive tract in patients suspected of having an impacted foreign body.

The role of lateral neck radiographs for fish bone impaction - A pointless pain in the neck?

The role of lateral neck radiographs for fish bone impaction - A pointless pain in the neck?

Comparison of adenoid size in lateral radiographic, pathologic, and endoscopic measurements.

BackgroundOtitis media (OM) is a major health problem that usually results from adenoid hypertrophy. Diagnosis is based on symptoms like mouth breathing and imaging studies like lateral neck radiography (LNR). Adenoid-nasopharyngeal ratio (A/N ratio) is one of the most important and most widely used criteria in LNR study that could estimate the real size of adenoid gland measurements. However, there are huge controversies regarding LNR rules in the management of patients with OM.ObjectiveThis study aimed to determine Adenoid Nasopharyngeal Ratio (A/N ratio) in children with otitis media with effusion (OME) and its relation with different factors.MethodsThis was a cross-sectional study on OME suspected children who needed adenoidectomy. The study was conducted from the fall to winter of 2016 on patients referred to ENT clinics of Mashhad University of Medical Sciences. Before surgery, all children underwent standard LNRs and indirect laryngoscopy to assess adenoidal size, and nasopharyngeal length, and A/N ratio. After adenoidectomy, pathologic analysis was performed for assessment of pathologic size. SPSS 21 was used for data analyzing using Pearson’s correlation, independent t test and Mann-Whitney U test (p<0.05 was considered significant).ResultsA total of 27 children were enrolled. Most of the patients were male (70.4%, mean age=7.81±2.52 year). All patients in the study were symptomatic and the most frequent symptom was mouth breathing (100%). The mean A/N ratio, pathologic adenoid size, and laryngoscopic adenoid size were 0.825±0.099, 18.22±5.97, and 5.33±19.15 mm. There was a significant correlation between the A/N ratio laryngoscopic adenoid size (r=+0.46, p=0.01) and pathologic adenoid size (r=+0.44, p=0.02).ConclusionsThe results of this study showed that A/N ratio can be used to estimate the actual size of the adenoid gland and the necessity of adenoidectomy. Considering the reasonable costs and availability of this diagnostic method, researchers recommend using this procedure in assessment of patients with OME.

Utility of Soft Tissue Lateral Neck Radiographs in the Emergency Department: The 5-Year Experience of a Large Tertiary Care Pediatric Hospital.

Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more common, we decided to assess the clinical utility of lateral neck radiography. The aim of this study was to review the experience of a large tertiary care pediatric emergency department (ED) in using lateral soft tissue neck radiographs in the diagnosis of suspected RPI. A retrospective analysis of all lateral soft tissue neck radiograph reports from 2011 to 2015 in conjunction with a review of patients' charts to describe clinical and laboratory findings, disposition, and final diagnosis was performed. Patients aged 31 days to 18 years who presented to the ED with suspicion of RPI were included. Review of 366 radiographic reports revealed that 46 were positive for RPI, 286 were negative, and 34 indeterminate. A final discharge diagnosis of RPI was made in 38 patients. Lateral neck radiographs had a sensitivity of 84.3% and a specificity of 93.7% for diagnosing RPI. In triage, most patients had no fever (264, 72.1%), stridor (356, 97%), drooling (348, 95%), or voice change (342, 93%). Surgical intervention occurred in 15 patients (39.5%) with a final diagnosis of RPI. Lateral neck radiography is useful for diagnosis of RPI in the ED with good sensitivity and specificity. Additional imaging is to be considered at the behest of physician's clinical judgment.

Variation in Inpatient Croup Management and Outcomes.

Croup is a clinical diagnosis, and the available evidence suggests that, except in rare cases, ancillary testing, such as radiologic imaging, is not helpful. Given the paucity of inpatient-specific evidence for croup care, we hypothesized that there would be marked variability in the use of not routinely indicated resources (NRIRs). Our primary study objective was to describe the variation and predictors of variation in the use of NRIRs. This was a retrospective cohort study that used the Pediatric Health Information System database of generally healthy inpatients with croup aged 6 months to 15 years who were admitted between January 1, 2012 and September 30, 2014. We measured variability in the use of NRIRs: chest and lateral neck radiographs, viral testing, parenteral steroids, and antibiotics. Risk-adjusted analysis was used to compare resource utilization adjusted for hospital-specific effects and average case mix. The cohort included 26 hospitals and 6236 patients with a median age of 18 months. Nine percent of patients required intensive care services, and 3% had a 30-day readmission for croup. We found marked variability in adjusted and unadjusted utilization across hospitals for all resources. In the risk-adjusted analysis, hospital-specific effects rather than patient characteristics were the main predictor of variability in the use of NRIRs. We observed an up to fivefold difference in NRIR utilization attributable to hospital-level practice variability in inpatient croup care. This study highlights a need for inpatient-specific evidence and quality-improvement interventions to reduce unnecessary utilization and to improve patient outcomes.

Urine cysteinyl leukotriene levels in children with sleep disordered breathing before and after adenotonsillectomy

ObjectivesObstructive sleep apnea (OSA) is a common problem in children and is associated with increased cardiovascular, neurobehavioral and somatic growth consequences. Cysteinyl leukotrienes (CysLTs) play a major role with local and systemic relations to the pathophysiology of OSA. The level of CysLTs in urine, blood, exhaled breath and adenotonsillar tissue of OSA children are increased. However it remains unclear whether inflammatory marker levels are alleviated after adenotonsillectomy. Therefore, we compare the urine leukotriene E4 (uLTE4) levels in children before and after adenotonsillectomy and evaluate clinical outcomes on resolution of OSA. MethodsChildren under 15 years who suspected OSA with planned adenotonsillectomy were recruited. Sleep questionnaires, quality of life assessment by OSA-18, physical examination, lateral neck radiographs, overnight SpO2 monitoring and uLTE4 levels were collected. 4 ± 2 weeks post-surgery, OSA-18 was reevaluated and urine was collected again. ResultsThirty-three children with sleep disordered breathing (SDB) were included (mean age 8.1 ± 2.8 years). After adenotonsillectomy, the uLTE4 levels decreased from 961.9 (684.8–1438.2) to 708.6 (538.2–1038.8) pg/mg Cr (P = 0.009). The post-surgery score from sleep questionnaire, OSA-18 questionnaire were significant improved (P < 0.001). Obese children demonstrated an improved quality of life post-surgery, but results were poorer than normal-weight children (P = 0.01). The uLTE4 no obvious improved in obese children. ConclusionsAdenotonsillectomy remains an effective treatment for SDB children that not only alleviated the severity of SDB and improved quality of life; it also decreased levels of the systemic inflammatory marker, uLTE4. However, benefits were more obvious in non-obese children.

Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls.

Foreign-body (FB) ingestion is less common in adults than in children, but still occurs. Diagnostic management of patients with suspected FB ingestion in emergency departments depends on FB type and location, both of which are related to the patient profile. In adults, fish and chicken bones are the most common FB types, and the oropharynx and cricopharyngeal muscle are the most common locations. Once accidentally swallowed, an FB may become lodged in the oropharynx, and in such cases indirect or fiberoptic laryngoscopy is the first clinical management option. For FBs that have passed beyond this location, radiologic study is recommended, including anteroposterior and lateral neck radiographs (LNRs) using the soft-tissue technique. This is a quick and simple imaging method that in emergency departments achieves detection rates of 70%-80% in assessing FBs in the hypopharynx and upper cervical esophagus. Careful initial evaluation using LNRs can determine the presence and nature of an FB, which helps with predicting the location and risk assessment, making further imaging-including computed tomography-unnecessary. Prevertebral soft-tissue swelling is a nonspecific indirect sign, which in the appropriate clinical context raises suspicion of a radiolucent FB or related complications. LNRs can sometimes be difficult to interpret due to the presence of multiple overlapping soft-tissue structures and variable patterns of laryngeal cartilage calcification in adults. Adequate performance in interpreting LNRs along with familiarity with the full diagnostic process in these patients will enable radiologists to use the right imaging technique for the right patient, as described in the clinical algorithm proposed by the authors. ©RSNA, 2017.

Evaluation of the effects of montelukast, mometasone furoate, and combined therapyon adenoid size: a randomized, prospective, clinical trial with objective data

Background/aim: The incidence of adenoid hypertrophy is 2%-3% in children. Adenoidectomy is a commonly performed procedure in children that may cause complications such as early or late bleeding (4%-5%), recurrence of adenoid tissue (10%-20%), and postoperative respiratory problems (27%). Therefore, medical therapy alternatives to adenoidectomy are important and must be tried before surgery. In this study, we investigated the efficacy of mometasone furoate, montelukast, and a combination of these drugs in pediatric patients with adenoid hypertrophy who were scheduled for reduction with medical therapy after not being recommended for surgery.Materials and methods: The study included 120 children with adenoid hypertrophy aged between 4 and 10 years. The patients were randomized into 4 separate groups, with 30 in each group. Group 1 received 100 μg of mometasone furoate per day, group 2 received 4/5 mg (for age) montelukast per day, and group 3 received mometasone furoate + montelukast. Medical therapy continued for 3 months in the treatment groups. Group 4, which comprised patients with mild symptoms, received no treatment and was the control group. The pre- and posttreatment adenoid tissue ratios in lateral neck radiographs were recorded in the four groups. Results: When radiologic measurements of adenoid-to-air passage were calculated, an improvement of 21.76% was observed in group 1 after treatment. The rate of improvement was 22.51% in group 2. There was a 21.79% reduction in adenoid size in group 3 after 3 months? treatment and 12.46% in the control group. There were statistically significant differences between pre- and posttreatment values in every single group administered corticosteroids, montelukast, and combined therapy (P < 0.05).Conclusion: According to our results, both montelukast and mometasone furoate therapies were similarly successful in treating adenoid hypertrophy. Combined therapy has no superiority over single-therapy treatment.

The impact of adenotonsillectomy on pulmonary arterial pressure in West African children with adenotonsillar hypertrophy

ObjectivesTo assess the improvement or otherwise, in the mean pulmonary arterial pressure (mPAP) among children with adenotonsillar hypertrophy (ATH) after adenotonsillectomy (AT), and to examine the impact of timing of surgery as well as the patients' characteristics on the mPAP changes. MethodsWe included 39 children with ATH in this study. The adenoidal enlargement was evaluated radiologically with adenoid nasopharyngeal ratio (ANR) parameter from lateral neck radiograph, whereas the clinical assessment of adeno-tonsillar obstruction was conducted with the ‘symptom score’. Pulmonary arterial pressure (PAP) measurement was performed noninvasively by Doppler echocardiography. All patients underwent adenotonsillectomy (AT). After 6 weeks, they were subjected again to clinical and echocardiographic assessments, and the mean pulmonary arterial pressures (mPAP) were then compared. The mPAP changes after AT were further related to the grades of ANR, symptom scores, tonsillar size, and timing of AT. ResultsThe preoperative mPAP was 23.46 mmHg and was 18.98 mmHg post-operatively (P = 0.003). Seventeen of subjects (43.6%) had pulmonary hypertension (PH) (mPAP ≥ 25 mmHg) preoperatively, out of which 14 (82%) decreased to normal range 6 weeks after AT. Non-reversal of pulmonary hypertension was associated with ANR > 0.75 (P = 0.043), but was not related to the timing of surgery, tonsillar size, and symptom score. Significant reduction in mPAP was more likely with ANR ≤ 0.75 and pre-operative mPAP ≥ 25 mmHg. All the symptoms also improved significantly after AT. ConclusionElevated PAP due to ATH in children was mostly reversible by AT irrespective of the timing of surgery, symptom severity, and tonsillar size, but gross enlargement of adenoids seem to be associated with non-reversal of PH.

Diagnostic accuracy of radiographs for detecting supraglottitis: a systematic review and meta-analysis.

AimTo assess the diagnostic performance of lateral radiograph of the neck for supraglottitis in adults and children.MethodsElectronic database searches (including PubMed, EMBASE, CINAHL, Web of Science, and WHO International Clinical Trials Registry Platform) were carried out through July 2014. Citations of included studies and recent narrative reviews were searched. Studies that compared lateral radiograph of the neck with a reference standard of direct/indirect laryngoscopy were included. Two reviewers independently assessed the methodological quality of included studies by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2).ResultsOf 2,088 potentially relevant citations, two single‐gate (cohort) studies and six two‐gate (case–control) studies were identified. These included studies of design are at the moderate or high risk of bias in QUADAS‐2. The pooled sensitivity from bivariate random‐effects regression was 92.9% (95% confidence interval [CI], 88.5–95.9%) and the pooled specificity was 89.2% (95% CI, 85.9–91.9%), but the diagnostic value would be overestimated because of selection bias in the six two‐gate studies. The sensitivity and specificity of the single‐gate studies were 100.0% (95% CI, 92.2–100.0%) and 30.6% (95% CI, 15.5–35.6%) in children and 81.0% (95% CI, 78.2–93.2%) and 85.7% specificity (95% CI, 78.2–93.2%) in adults.ConclusionThis study determines that there are insufficient studies of lateral neck radiograph for detecting supraglottitis. Lateral radiograph of the neck seems to have moderate accuracy for detecting supraglottitis. Further approximately unbiased studies are needed to obtain more valid and reliable estimates of test accuracy.

Acquired megaoesophagus in a Suffolk ram

A one-year-old Suffolk ram was evaluated after a four-month history of intermittent left-sided bloating and regurgitation. The ram had been slowly losing condition while other sheep in the cohort were...

Chronic stridor in a nine-month-old—Consider esophageal foreign body

Abstract We present the case of a 9-month-old female with seven weeks of stridor. Initial lateral neck radiograph showed widening of the retropharyngeal space with significant mass effect displacing the cervical and thoracic trachea. She was taken emergently by ENT to the operating room for intubation. In the OR, flexible fiberoptic nasotracheal intubation was achieved. Through multimodality imaging and several procedures, she was found to have ingested part of a Christmas ornament, which lodged in the esophagus, causing a perforation with retropharyngeal phlegmon. This compressed the airway, causing respiratory distress. She improved on intravenous antibiotics and the ornament was retrieved endoscopically.

Obstructive sleep apnea in preschool-aged Japanese children – efficiency of screening using lateral neck radiography

Conclusions The prevalence of obstructive sleep apnea (OSA) in preschool-aged children diagnosed by the International Classification of Sleep Disorders (ICSD) version 3 criteria was relatively higher than that diagnosed by ICSD-2. Although the assessment of the upper airway by lateral neck radiography was effective for detecting OSA in this age group, this assessment is not recommended for all children as a screening method because of parental concern related to radiation exposure. Objective This study investigated the prevalence of OSA and the screening capacity of lateral neck radiography in community-based preschool-aged children. Methods Parents of 211 children aged 3–6 years were requested to complete the sleep-related questionnaire. Subjects who agreed to further investigations were invited to undergo home type 3 portable monitoring and clinical examination, including radiography. We estimated the prevalence of OSA and evaluated the detection power of radiography for predicting OSA. Results One hundred and eighty-eight (89.1%) subjects completed the questionnaire and 67 (31.8%) agreed to further examinations. The weighted prevalence was 7.3% and 12.8% by ICSD-2 and 3, respectively. Area under the receiver operator curve for the adenoidal/nasopharyngeal and tonsil/pharyngeal ratios measured using radiography was slightly larger than that for tonsil size graded by visual inspection.

Missed hypopharyngeal foreign body: A case report

Foreign body ingestion has been a dilemma to many physicians including Otolaryngologist. Naturally, patient turns up at the out-patient department first prior to being referred to the otolaryngologist, which may lead to possibility of missed or neglected foreign body. We report a case of a missed foreign body which turned out to be his one-month dislodged denture. The unfortunate patient visited several different clinics within this one-month period, however he was dismissed as the lateral soft tissue neck radiograph done showed no abnormality.