ORL Department Research Articles

Tracheostomies in the Management of Aspirated Foreign Bodies in Children at the University Hospital Center of Dakar

Objective: To share our experience in the management of foreign body inhalation in children, describing our indications for tracheostomy and making a review of literature. Design: Retrospective study. Setting: Department of ORL and Head and Neck Surgery, University Hospital Center of Dakar, Senegal Patients and Method: From 1997 to 2010, 232 children < 15 years were admitted to our ENT department with a diagnosis of aspirated foreign body, confirmed by bronchoscopy. Sixty three (63) children (population study size) underwent tracheostomies in the management of foreign body aspiration. Following data were recorded for each infant: age, sex, geographic origin, time from aspiration to hospital admission, foreign body aspiration syndrome and/or stridor, our indications of tracheostomies, endoscopic findings, decannulation delay, complications related to aspiration itself and to tracheostomy and the hospital stay. Results: Among 232 cases of aspirated foreign bodies taken care of in our ENT department, rigid bronchoscopy removed objects from the larynx in 57 cases (24.5%), the trachea in 36 cases (15.5%) and bronchus in 139 cases (60%). The most common type of foreign body was organic (146 cases, 63%) and peanuts (81 cases, 35%) were predominent. Tracheostomies were performed in 63 cases (27%). Within this group (population study), the median age was 3 years ranged from 5 months to 12 years. The male female ratio was 1.4 (37 boys and 26 girls). Median time to admission was 10 days ranged from 24 hours to 4 months. Rigid bronchoscopy had located foreign bodies in the larynx in 29 cases (46%), in the trachea in 13 cases (21%) and in the bronchus in 21 cases (33%). According to the type of foreign bodies, there were food items in 47 cases (74%) and inorganic objects in 13 cases (21%). Indications of tracheostomies were stridor for 50 cases (86%), intubation in 4 cases (6%) and laryngeal edema in 9 cases (14%). Median decannulation delay was 7 days ranged from 1 day to 2 months. Median hospital stay was 26 days ranged from 1 day to 4 months. Complications of tracheostomies like tracheal stenosis and emphysema were present respectively in one. Complications related to foreign body like bilateral pneumothorax, recurrent pneumonia and bronchitis occurred respectively in one case. Open surgical retrieval of foreign body like bronchotomy was required in 2 cases. We regretted 8 cases of death, a rate of 3.5% in relation to all foreign bodies managed in the chart. Conclusion: Foreign body aspiration is a life-threatening emergency. Early diagnosis and foreign body removal through bronchoscopy is required to avoid complications. In our conditions, tracheostomy had a critical place. We reported the highest rate of tracheostomies performed in the management of aspirated foreign bodies in the literature. The reduction of this rate could be a good mean to appreciate the improvement of management of foreign body aspiration in our countries.

Investigation of the association of hRRM1 and p53R2 gene polymorphisms in head and neck squamous cell carcinomas.

Head and neck squamous epithelial cell cancer (HNSCC), the world's fifth most common type of cancers, is associated with short life expectancy and high death rates if not detected in early stages. The aim of this study was to investigate hRRM1 and p53R2 gene polymorphisms by using real-time PCR technique in patients with head and neck cancer. In total, 87 patients with head and neck malignancies and 87 control group who have not any malignancies were included in the study between January 2011 and February 2012 in Istanbul University Faculty of Medicine Department of ORL. In the study, real-time PCR was used to detect hRRM1 (rs12806698 C/A) and p53R2 (rs2290707 G/T) gene polymorphisms in Turkish HNSCC patients and healthy individuals. Genomic DNA isolation was performed according to the kit protocol with spin column. LightCycler 1.5 system was used to perform SNP genotyping using hybridization probes consisting of 3'-fluorescein and a 5'-LightCycler Red labeled pair of oligonucleotide probes. There were significant differences in the distribution of hRRM1 genotypes. Frequency of individuals with hRRM1 AA genotype was higher in patients with less differentiation when compared with well differentiation [p 0.025, Fisher's exact test, odds ratio (OR) 0.140, 95 % confidence intervals (CI) 0.024-0.797]. It is observed that A allele carriers have nearly twofold risk for development of the disease (p = 0.022; χ (2) 5.24; OR 2.02, 95 % CI 1.10-3.72).

Tonsilar haemorrhage and re-admission: a questionnaire based study

The aim of our study was to investigate the accuracy of haemorrhage rate in the community (i.e., actual rate versus hospital recorded rate) for tonsil operations. Bleeding episodes were investigated for 695 consecutive patients undergoing tonsillectomy, adenotonsillectomy and tonsillotomy at the Department of ORL, H&NS, MU of Graz, Austria, between January 1 2007 and June 30 2008 by questionnaire. Main purposes of our study were the evaluation of the incidence of postoperative haemorrhage, need for revision surgery, medical care of patients experiencing postoperative bleeding and multiple bleeding episodes. Haemorrhage was defined as any bleeding, be it minimal or significant, after extubation. The study group comprised 407 patients who answered the questionnaire: 61.7% adults, 22.1% school children between 6 and 15years and 16.2% children aged less than 6years. Exactly 100 patients (24.6% of 407) showed some kind of postoperative bleeding, but only 79 of them (19.4% of 407) were recorded at hospital. A return to theatre due to haemorrhage was required in 4.7% of all 407 cases. Combining hospital records and data from the questionnaire allowed us to estimate an overall haemorrhage rate of 21.4% for all 695 patients. Every fifth patient experiencing postoperative haemorrhage did not return to the hospital he or she was operated in. We would have missed 21.0% of all bleeding episodes by assessing re-admitting patients suffering postoperative bleeding only. We conclude that haemorrhage rate is considerably higher than assumed by investigating hospital records only and strongly related to the definition of postoperative bleeding and to the study design.

Adenoidectomy and tonsillectomy: is clotting profile relevant?

Background: Adenoidectomy and tonsillectomy are common surgical procedures performed mostly in paediatric population. They have the risk of haemorrhage in an area that may not be easily accessible. Thus the need to preoperatively do coagulation screening and this has remained controversial. Hence, the purpose of this study was to retrospectively evaluate our experience in Ibadan.Method: The records of sixty-eight patients that underwent adenoidectomy/tonsillectomy from 1998 to 2002 in the Department of ORL, UC H were evaluated for demographic data, history and physical findings that could suggest bleeding disorders, values of prothrombin/activated partial thromboplastin time and occurrence of peri-/postoperative haemorrhage.Results: There were 41 males and 27 females with M: F ratio of 1.5: 1. The age range was 6 months to 38 years, while the common age group involved was 0 – 10 years (75%). Four patients (5.9%) had history of risk factor of bleeding. Eight patients (11.8%) and 23 patients (33.5%) had prolonged PT and aPTT respectively. One patient with normal coagulation study had postoperative haemorrhage due to remnant of tonsillar tissue. There was no documentation of further confirmatory coagulation investigation in those that were prolonged. No correlation was observed between the coagulation tests and intraoperative blood loss and duration of surgery generally.Conclusion: Although these tests are routinely done in our centre, there was no clear evidence in support of their relevance. However, we advocate a flexible approach to this issue and each patient must be individually assessed and effort must be made to standardise the approach to adequate history taking with proper documentation of all relevant information before one decides to perform any investigation.

Torbiele i przetoki szyi w materiale Oddziału Otolaryngologii Wojewódzkiego Szpitala Specjalistycznego im L. Rydygiera w Krakowie w latach 1997–2007

The retrospective study describes 118 patients treated for congenital cysts and fistulas of the neck between 1997 and 2007 in ORL Department of Rydygier District Hospital in Cracow. Malformation was divided into midline and laterocervical region anomalies. Malformation of midline included thyreoglossal duct and dermoid cyst. The most common malformation of laterocervical were cysts followed by fistulas. The theory of development, method of diagnosis and operative management were presented. Complication and recurrences were rare. Proper differential diagnosis and radical operation led to successful cure.

About the 1977 world congress of pediatric otorhinolaryngology in Sirmione

Back in the 1970s in Europe, but also in the United States, Latin America and Australia, pediatric otorhinolaryngologysts were scattered in specialized hospitals, university clinics and institutes and hadmostly occasional contacts with colleagues in their own or not too distant countries. Pediatric ORL was not considered officially a speciality of its own (such as surgery, orthopedics and – obviously – internal medicine). I have been able to find evidence of organized meetings with participation of an international faculty in USA, the United Kingdom and – with more frequency and a larger attendance – in countries of Eastern Europe which, in these years, were still separated from Western Europe by the Iron Curtain. These colleagues worked in larger networks with more departments covering their countries, many had academic status with regular postgraduate teaching, leading to an official diploma in pediatric ORL. For them, contact with thewest was difficult but not impossible and – in some cases – quite regular and here we come to the point. In Italy, Carlo Gatti Manacini was in charge of a large pediatric ORL department in Brescia, Northern Italy. He was an outstanding personality, full of enthusiasm and had already organized small east–west meetings but had come upon the idea of realizing an event on a large scale, a world congress. He was quite aware of the necessity – considering the planned scale and complexity of such an enterprise – of collaboration for planning a scientific program, finding possible speakers and spreading the newsworldwide. So he contacted me in Trieste and Giulio Pestalozza in Milan. Although being long-time friends and becoming gradually infected by his idea, it was not easy to convince him that

Napoleon C. Ejercito, MD (1921 – 2007)

&#x0D; A Strong Pillar&#x0D; &#x0D; After completing his residency training program in the United States, Dr. Napoleon Ejercito came back to join the faculty of the then combined Department of Eye Ear Nose and Throat (EENT) at the Philippine General Hospital. Unhappy with the fact that ORL in the Philippines was not yet a separate and distinct specialty with no existing standard and organized form of training, Dr. Ejercito and seven other optimistic and young ENT surgeons gathered together to form the Otolaryngology Society of the Philippines under the leadership of Dr. Tierry Garcia. These men became the historic pillars of the society.&#x0D; &#x0D; With the birth of this society, the development and maturation of the&#x0D; specialty was simply a matter of time.&#x0D; &#x0D; Fifteen years later, Dr. Ejercito spearheaded the founding of the Philippine Board of Otolaryngology and Bronchoesophagology in order to standardize and professionalize the practice of ORL. Initially composed of diplomates and candidates of the American Board of Otorhinolaryngology, the rigorous process of accreditation and qualification was patterned after the American Board. This organization was subsequently incorporated and evolved into what is now known as the Philippine Board of Otolaryngology Head and Neck Surgery. This board became his youngest child whose growth he fostered and whose interests he promoted and protected.&#x0D; &#x0D; A Dedicated Leader&#x0D; &#x0D; Dr. Ejercito was Chairman of the Department of ORL of the UP-PGH from 1970 to 1974, when Martial Law was declared. He was a staunch critic of the Marcos regime, but the repression did not deter him from leading the department in achieving its goals.&#x0D; &#x0D; During his time as chair of the department, only a total of 12 residency slots were available. It was Dr. Ejercito who pioneered the restructuring of the residency training program into three ORL residents per year level. Furthermore, it was during Dr. Ejercito’s term that a post-residency graduate was chosen as the chief resident.&#x0D; &#x0D; His integrity was beyond question. Rather than face the possibility of naming his eldest son as chief resident, he compelled his son to seek further fellowship&#x0D; abroad.&#x0D; A Trailblazer&#x0D; &#x0D; Dr. Napoleon Ejercito can be called the father of head and neck surgery in the Philippines. While Dr. Tierry Garcia initiated the expansion of the specialty of Otorhinolaryngology to include head and neck surgery, it was Dr. Ejercito who nurtured and strengthened it to what it is today. As a testament to Dr. Ejercito’s legacy, the stipend of the fellow of the Head and Neck Program of the Department of ORL –PGH was made available by an alumnus of the department, and was named after him.&#x0D; &#x0D; His dedication to the discipline was beyond comparison. Even when he was the Chair, Dr. Ejercito continued to operate on charity patients and demonstrated operative procedures to residents on a regular basis.&#x0D; &#x0D; His retirement did not dampen his zeal to further the cause of ORL. He continued to support the different programs of the society and attended society conventions and departmental conferences whenever possible, which gained the admiration of younger generation of residents. Dr. Napoelon Ejercito: A strong pillar, a dedicated leader, a trailblazer. Such a man will truly be missed.

Manuel G. Lim, MD (1930 – 2007)

Dr. Manuel Lim was Chairman (1991-1994) during one of the most tumultuous times in the UP College of Medicine. Being part of the administration, he had no other recourse but to follow the dictates of the UP Administration. The faculty and staff of the Department, having decided to side with the Dean of the UPCM refused to teach during the period. Dr. Lim, although publicly stating the demands of the UP officials, did not impose nor apply any sanctions on any of the “striking” faculty members. Such was the resiliency of the man that he was able to maintain the steadfastness and cohesiveness of the department during this tempest.&#x0D; &#x0D; While it can be claimed that it was the late Dr. Vicente L. Santos who conceived the formation of the Temporal Bone Dissection Laboratory, it was Dr. Lim who formalized its structure. The Ear Institute, initially envisioned during the term of Dr. Armando Chiong, Sr., took a more concrete form during his watch. He made representations with then PGH director Dr. Felipe Estrella to allocate to the proposed Ear Institute the clinical spaces it occupies now. He even made arrangements with Dr. Suzuki to donate some of the required instruments the the institute might need. But foremost of all, he made representations with then Senator Francisco Tatad to sponsor a bill before the Philippine Senate for the creation of the Philippine National Ear Institute. This was the same bill that was re-filed in later congresses by Senator Loren Legarda. Thus, it can be said that it was Dr. Lim who took the initial steps towards making the Ear Institute a reality.&#x0D; &#x0D; His love and zest for life is something that is beyond question. He knew how to live and really made every moment worth living in his heydays. But his love for Otology was something beyond compare. His dates with Otology could never be broken. Wednesdays at 7 AM were always reserved for the Ear rounds that he religiously conducted until his retirement. Thursday mornings would find him at the OPD presiding over the Ear clinic.&#x0D; &#x0D; Such was the perseverance, dedication and commitment of the man, but he was such a smooth operator that only a few of us were aware of the things that he did for his love of Otology. Fewer still can even recall that it was during his term that the textbook BASIC OTOLARYNGOLOGY became a reality and was finally published.&#x0D; &#x0D; Like Dr. Ejercito, he helped found the Philippine Board of ORL-HNS and even served as its secretary for a time. He was a man of delicadeza and was the first member of the board to inhibit himself from its activities when his children Margaret and Manuel, Jr. took the certifying examinations. He also proposed the adoption of a retirement age for members of the board who were hitherto members for life. Thus, he was also considered a sort of a maverick by his peers. He had always proven himself capable of going against the popular stance for what he deemed right in serving the long term interests of the department and the specialty.&#x0D; &#x0D; Unknown to most of the beneficiaries of his actions, he was the person responsible for the formation and early development of a separate department of ORL at St. Luke’s Medical Center. Moreso, by sheer force of his personality, he single-handedly won accreditation of its residency training program by the PBOHNS. In exchange, he had to give up his chairmanship at St. Luke’s when the board adopted a policy restricting chairmanship to only one institution.&#x0D; &#x0D; He retired from the department after his term as UP-PGH ORL chair and was practically unheard of since then. Why and what transpired is beyond our knowledge. We may only conjecture that having lived a full life, he may have come full circle and adopted an ascetic life.&#x0D; &#x0D; This was, in a nutshell, Dr. Manuel G. Lim, a hard bargainer who knew how to compromise, resilient and fun-loving, a smooth operator but an effective one at that!

Esvaziamento radical versus seletivo (supraomohióideo) no tratamento do carcinoma epidermóide do andar inferior da boca

O paradigma terapêutico para o CEC do andar inferior da boca sofreu modificações em decorrência da sobrevida. OBJETIVO: Estudo comparativo do esvaziamento cervical radical e seletivo. MATERIAL E MÉTODO: Análise de 460 pacientes atendidos no Depto. de CCP e ORL do Hospital Heliópolis, de 1978 a 2002. Para esvaziamento radical foram avaliados os padrões de metastatização dos níveis IV e V, para o seletivo a ocorrência e localização das recidivas. O método estatístico utilizado foi o teste do qui-quadrado. RESULTADOS: Nos esvaziamentos radicais a taxa de metastatização nos níveis IV e V foram 5,8% e 4,6%, nos pacientes cNO e de 9,9% (nível IV) e 5,9% (nível V) para cN+, enquanto o nível I isolado estava comprometido em 11,0% nos cN0 e 5,5% nos cN+. Nos esvaziamentos seletivos ocorreram 4 recidivas (4,1%) em 97 esvaziamentos nos pN0 e 2 (10,0%) em 20 esvaziamentos. Nos casos pN+, não houve vantagens na indicação de radioterapia sobre os não irradiados (5,6% e 5,7% respectivamente). CONCLUSÃO: É possível realizar esvaziamento seletivo no tratamento das metástases do andar inferior de boca.

Radical versus supraomohyoid neck dissection in the treatment of squamous cell carcinoma of the inferior level of the mouth

SummaryThe therapeutic paradigm for neck metastasis of squamous cell carcinoma (SCC) in the lower level of the mouth has changed due to survival. Aim: A comparative study between radical (RND) versus selective neck dissection (SND). Material and Method: An analysis of mouth SCC in the lower level of the mouth in 460 files from the Head & Neck and ORL Department of the Heliopolis Hospital, from 1978 to 2002. In the RND the metastathic rate in levels IV and V was assessed; in the SND the presence and site of recurrence was identified. The chi square test with the Yates correction was the chosen statistical method. Results: In the RND the metastatic rates were 5.8% (level IV) and 4.6% (level V) for cNO cases, and 9.9% (level IV) and 5.9%(level V) for cN+ cases; for level I only the rates were 11,0% for cNO cases and 5.5% for cN+ cases. In the SND the number of recurrences was 4 (4.1%) in 97 neck dissections (pNO) and 2 (10%) in 20 neck dissections (pN+). There was no advantage in using radiation compared to non-irradiated cases (5.6% and 5.7%). Conclusion: The SND may be used for SCC of the lower level of the mouth.

Endonasal endoscopic repair of the orbital floor defect in the silent sinus syndrome

Otolaryngology–Head and Neck SurgeryVolume 135, Issue 5 p. 800-802 Case Report Endonasal endoscopic repair of the orbital floor defect in the silent sinus syndrome Paulo Borges Dinis MD, Corresponding Author Paulo Borges Dinis MD [email protected] Department of Otorhinolaryngology, Hospital de Pulido Valente, Lisbon, PortugalReprint requests: Dr P. Borges Dinis, Hospital de Pulido Valente, ORL Department, Alameda das Linhas de Torres 117, 1769-001 Lisbon, Portugal. E-mail address: [email protected].Search for more papers by this authorCarla Branco MD, Carla Branco MD Department of Otorhinolaryngology, Hospital de Pulido Valente, Lisbon, PortugalSearch for more papers by this authorJoão Subtil MD, João Subtil MD Department of Otorhinolaryngology, Hospital de Pulido Valente, Lisbon, PortugalSearch for more papers by this author Paulo Borges Dinis MD, Corresponding Author Paulo Borges Dinis MD [email protected] Department of Otorhinolaryngology, Hospital de Pulido Valente, Lisbon, PortugalReprint requests: Dr P. Borges Dinis, Hospital de Pulido Valente, ORL Department, Alameda das Linhas de Torres 117, 1769-001 Lisbon, Portugal. E-mail address: [email protected].Search for more papers by this authorCarla Branco MD, Carla Branco MD Department of Otorhinolaryngology, Hospital de Pulido Valente, Lisbon, PortugalSearch for more papers by this authorJoão Subtil MD, João Subtil MD Department of Otorhinolaryngology, Hospital de Pulido Valente, Lisbon, PortugalSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/j.otohns.2005.02.008Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume135, Issue5November 2006Pages 800-802 RelatedInformation

Indications for surgery in acute mastoiditis and their complications in children

To review the clinical charts of 45 paediatric patients treated for acute otomastoiditis at the ORL Department of the University of Brescia (Italy) between January 1994 and March 2005 and to discuss the diagnostic workup and the outcome of treatment. Twenty-six males and 19 females were admitted with acute mastoiditis and subperiosteal abscess. Thirteen of them (28.9%) presented an intracranial complication. Only three of them were not operated upon; one received a ventilation tube (VT); all the others underwent a mastoidectomy within 48-72 h. Twenty out of 32 uncomplicated mastoiditis were treated conservatively and the remaining 12 underwent myringotomy+/-VT, associated with a mastoidectomy in 9 cases. Antibiotics alone or with VTs achieved a full recovery in 28 out of 32 uncomplicated cases. Mastoidectomy resolved the disease in 13 patients (9 with complications). In severe complications, a canal wall down (CWD) (n=2) or an intact canal wall (ICW) mastoidectomy (n=7) were preferred, based on the extent of the lesions and the degree of hearing loss. All children recovered completely at 1 year follow-up. In the uncomplicated cases that were operated upon, the mean hospital stay was 7.8 days (versus 4.3 days for the conservative group). In children with intracranial complications the mean hospital stay was 12.8 days, significantly less than the four non-surgical patients, who remained hospitalized for an average of 18 days. Acute mastoiditis can fully recover with conservative treatment or myringotomy+VTs. Immediate surgical treatment is indicated for intracranial complications, if the neurological conditions are not critical. A simple mastoidectomy+/-tympanoplasty is warranted in: (1) exteriorization, if the child is older than 30 months or >15 kg of weight, (2) intracranial complications (combined with a neurosurgical procedure as needed) and (3) cholesteatoma or granulation tissue.

Impact to the head increases cochlear implant reimplantation rate in children

Objective: To describe the outcome of cochlear implantation in children and to discuss the cause and management of cochlear reimplantation. Study design: Retrospective chart review. Methods: The medical records of 110 patients younger than 18 years of age, who underwent cochlear implantation at the Department of ORL, Head and Neck Surgery, of the University of Kiel, Germany, were reviewed for demographics, complications, and history of revision surgery. The patients had previously had implantation with either Nucleus (including the Contour) devices or MED-EL devices. Results: Length of use before cochlear explanation ranged from 4 days to 3.9 years. Reimplantation was caused by traumatic device failure, wrong electrode insertion and infection of implanted area. Results indicated a reimplantation rate of 5.4% in children compared to 0.8% in adults, mostly resulting from the greater risk of children receiving an impact to the head. Postoperative performance data showed no decrease in scores taken before failure. Conclusions: Though young children who are developing their motor skills are probably at greater risk of a cochlear reimplantation resulting from device failure following head trauma, surgical revision with reimplantation can be performed safely and without decrement to performance.

Deep neck abscess: a prospective study of 54 cases

Deep neck abscesses (DNAs) continue to be commonly encountered in developing countries like India. This study was conducted to determine the changing trends within our population with respect to presentation, aetiology, location and microbiology of DNAs. Fifty-four patients with DNAs who were managed at the Department of ORL and H&N Surgery in our hospital between May 2002 and December 2002 formed the basis of the study. We observed that the high incidence of DNAs could be attributed to lack of awareness, illiteracy and poverty among patients, along with the poor primary health infrastructure. We also recommend early surgical intervention in these cases to decrease the prevalence of complications.

Cartilage tympanoplasty: audiological and otological outcome

Forty-six patients with chronic suppurative otitis media were operated upon (using cartilage graft to close tympanic membrane perforation) at ORL Department, Mansoura University Hospital. Otological and audiological results were compared with the results of 30 tympanoplasties operated at the same period of time (using temporalis fascia graft to close tympanic membrane perforation).Successful closure of the tympanic membrane perforation was achieved in 91.3% of the cartilage group as compared to 73.3% of the fascia group. The postoperative air-bone gap (ABG) was smaller in the fascia group than the cartilage group, but the difference was statistically insignificant.According to our results, we concluded that cartilage is a reliable graft material for reconstruction of tympanic membrane perforations, especially in large perforations as well as in revision cases.

Complications of Chronic Suppurative Otitis Media AA Type-3 Years Experience at TUTH

This retrospective study was carried out in the Department of ORL and Head &amp;Neck Surgery, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu.Three hundred patients having atticoantral type of chronic suppurative otitis mediaunderwent emergency or routine mastoid exploration from 14 April 1997 to 12April 2000. Of the 300 patients, 64 (21.33%) had complications. Age of the patientswith complications ranged from 5-38 years. Thirty eight (59.38%) patients were malewhile 26 (40.62%) were female. Forty eight (75%) had extracranial and 15 (23.44%)had intracranial complications while 1 (2.08%) had both extra and intracranialcomplications. Cholesteatoma was present in 233 (77.66%) patients and of these 48(20.60%) had complications. Sixty seven (22.33%) patients had granulation tissue, ofthese 16 (23.88%) had complications.In cholesteatomatous cases 34 (70.83%) hadextracranial complications. Intracranial complications were present in 14(29.17%)cholesteatomatous cases. In patients with granulation tissue extracranial complicationwas present in 14 (87.50%) patients and only one patient had intracranialcomplication.Combination of extra and intracranial complications were found in 1patient with granulation tissue. When compared with types of pathology extracranialcomplications were higher in patients with granulation tissue (87.50% vs 70.83%)and intracranial complications were found more in cholesteatomatous cases (29.17%vs 6.26%). Both these findings were , however, statistically not significant. Reasonsbehind these findings may be presence of granulation tissue beneath the epitheliumof choleateatoma, and association of both types of pathology with infection andinflammatory process.Key Words: Chronic Suppurative Otitis Media, Atticoantral Type, Mastoid Exploration, Complications.

Tonsillectomy: cold dissection versus bipolar electrodissection

Objectives: to compare the technique and post-operative morbidity of two different tonsillectomy methods: cold dissection and bipolar electrodissection. Material and methods: prospective study including children (3> age <14) undergoing tonsillectomy in ORL Department of the main hospital in Azores, Portugal, from September 2000 to March 2001. Patients alternately selected to cold dissection tonsillectomy group (CDT) or bipolar electrodissection tonsillectomy group (BET). Duration of surgery; amount of blood loss; duration of hospitalization; aspect of tonsillar fossa on 10th post-operative day and intensity of pain after surgery were recorded and compared. Results: Sixty tonsillectomies were performed. Blood loss and duration of surgery were significantly decreased in BET group ( P<0.001), but the healing process, directly assessed by the aspect of tonsillar fossa on the 10th day was markedly delayed. The intensity of pain was slightly higher in the BET group compared with the CDT group, and no difference on duration of hospitalization was found between the two groups. Two post-operative hemorrhages occurred (one in each group), and no major complications were registered. Conclusions: BET reduces the duration of surgery and amount of blood loss when compared with cold dissection, but post-operative morbidity is increased. We believe the best patient indication for this method are small children where total circulating blood volume is reduced and patients with bleeding disorders.

What Is Useful in Vestibular Testing?

This review compares the efficiency of currently available test for diagnosing patients suffering vertigo based upon our experience since 1991 in the ORL Department of the Robert Debré Pediatric Hospital in Paris. A battery of instrument-based tests were adapted for children including testing the canal system (caloric bithermal test, earth vertical axis rotation and pendular rotation), testing the otolith system (off-vertical axis rotation, subjective vertical and horizontal measurement, vestibular myogenic potentials). This battery of tests was always preceded by a complete neurovestibular examination which included many tests that attempt to reproduce the same vestibular stimulation as the instrument-based tests. The usefulness of the respective instrument-based tests depends upon the investigative priorities determined by the characteristics of each case: beside the priority for determining the etiology of the vertigo, it can also be essential to date the onset of the inner ear disease, to evaluate the degree of fluctuation of vestibular function, to assess of completeness of a vestibular lesion, or establish a report of lesions for insurance or legal purposes. For 80–85% of cases of equilibrium problems in children, the minimum testing required for diagnosis is confined to a complete clinical vestibular and neurological examination as well as a caloric test. The more specialized tests become necessary for evaluations of variability or progressiveness of a vestibular impairment, comparisons of results between successive examinations, and assessment of the completeness of a vestibular lesion.

Congenital cysts and fistulas of the neck

This retrospective study describes a series of 191 children treated for congenital cysts and fistulas of the neck between 1984 and 1999 in the pediatric ORL Department of La Timone Children's Hospital. Preauricular fistulas and cystic hygromas were not included. The anomalies in this series were classified as either malformations of the midline or malformations of laterocervical region. Malformations of the midline included the thyroglossal duct cysts ( n=102) and dermoid cysts ( n=21). The most common malformations of the laterocervical region were cysts and fistulas of the second cleft ( n=37) followed by those of the first cleft ( n=20),those of the fourth pouch ( n=7), and thymic cysts ( n=4). Diagnosis of malformations of the midline is usually straightforward. However, diagnosis of malformation of the laterocervical region can be problematic. Misdiagnosis often leads to inadequate treatment with recurrence and functional as well as cosmetic sequelae.

Long distance travel by children for tonsillectomy: experience of the ORL department at Princess Alexandra Hospital (PAH), Royal Air Force, Wroughton, Swindon

An audit was carried out to assess the acceptability of long distance travel for elective tonsillectomy and adenoidectomy. Seventy nine children travelled 70 miles with their father or mother to P.A.H. from Mid Glamorgan where the E.N.T. waiting list delay for tonsillectomy was some two years. Most of the families who were offered the travel arrangements agreed and from the results of the questionnaires answered by the first 50 families, it was shown to be a successful exercise as both the children and parents were very happy with the arrangements and there were no complications.