Liječenje prirođenih cista grkljana u novorođenčadi

Congenital laryngeal cysts are rare lesions that may occur in newborns, characterized by symptoms of respiratory obstruction and severe dyspnea. The aim of this study was to indicate optimal surgical treatment of congenital laryngeal cysts in newborns. We present a case series of five neonates treated for congenital laryngeal cysts during the 2011-2017 period at our pediatric tertiary care hospital. Patient age ranged from one day to 14 days. All patients had unilateral cysts. After surgical excision, burning of the walls of the cysts was performed by a CO2 laser. In one case, after four months, a recurrent cyst appeared, and re-operation was performed. Our relatively small case series indicates that symptoms such as stridor and labored breathing can occur already during the first days of life and potentially endanger the patient’s life. Complete excision of the cyst and burning of its walls with CO2 laser leads to complete cure and prevent recurrence of the lesion.Prirođene laringealne ciste rijetke su lezije koje se mogu pojaviti kod novorođenčadi, a obilježene su simptomima respiracijske opstrukcije i teškom dispnejom. Cilj ove studije bio je ukazati na optimalno kirurško liječenje prirođenih cista na grkljanu kod novorođenčadi. Predstavljamo seriju slučajeva od pet novorođenčadi liječenih zbog prirođene ciste grkljana tijekom razdoblja od 2011. do 2017. godine u našoj dječjoj bolnici tercijarne skrbi. Najmlađi bolesnik bio je jednodnevni, a najstariji 14 dana. Svi su bolesnici imali jednostrane ciste. Nakon kirurške ekscizije izgaranje zidova cista izvedeno je CO2 laserom. U jednom slučaju, nakon 4 mjeseca, pojavila se rekurentna cista i učinjena je ponovna operacija. Naša relativno mala serija slučajeva ukazuje na to da se simptomi kao što su stridor i naporno disanje mogu pojaviti već prvih dana života i potencijalno ugroziti život bolesnika. Potpuna ekscizija ciste i paljenje zidova CO2 laserom dovodi do potpunog izlječenja i sprječava ponovni nastanak lezije

Risk factors for recurrent otitis media with effusion

Background/Aim. Otitis media with effusion (OME) is a common disease among the children aged from 6 months to 4 years, but recurrences are common after the extraction of ventilation tubes. The aim of the study was to determine the risk factors for recurrent OME after extraction of ventilation tubes. Methods. The research was a prospective study with 305 children aged 0 to 10 years with OME. Forty three (14%) of them had recurrent OME. We analyzed the factors that could lead to the redevelopment of the disease after extrusion of the tubes. Results. It was found that the majority of children with recurrent disease was between the ages of 5 to 7 years (56%) and had allergy in significantly higher rate than children without recurrence. In most cases (37.7%), the retention time of ventilating tube was above 10 months and the recurrent disease was diagnosed in 46.5% cases within a period of 10 to 12 months after extrusion of tubes. Conclusion. Children with OME and after ventilation tube extrusion need to be followed up for 1 year after the removal of tubes. It is necessary to inform the parents that the disease can recur. Children in the kindergarten, in preschool age and with a respiratory allergy had higher possibility for recurrent OME

Chronic suppurative inflammation of the middle ear in children

INTRODUCTION Chronic suppurative inflammation of the middle ear (HGO) in children represents one of the most frequent infections in childhood, even in children from developed industrial countries. We can distinguish two types of chronic suppurative inflammation: first - HGO without cholesteatoma and second HGO with cholesteatoma. OBJECTIVE The objective of the paper was to point out the characteristics of chronic suppurative inflammation of the middle ear in children and possible methods of treatment. METHOD From 2000 to 2005, our retrospective study involved 92 children, aged 2 to 16 years, treated for chronic suppurative inflammation of the middle ear and subsequent otogenic complications. The diagnosis was established based on clinical symptoms, otoscopic and otomicroscopic findings. Treatment included the removal of the pathological process, reconstruction of the hearing chain and prevention recurrence. RESULTS We performed 111 surgical interventions. Children were divided into two groups: in the first group, we performed 56 surgical interventions in 48 children diagnosed with chronic suppurative otitis without cholesteatoma, and in the second group we performed 55 surgical interventions in 44 children who were diagnosed with chronic otitis with cholesteatoma. In the first group we performed mastoidectomy in 17 (32.5%) children, mastoidectomy and posterior aticotomy in 5 (9.5%), miringoplasty in 22 (35.8%), timpanoplasty type II in 5 (9.5%), timpanoplasty type III in 3 (5.6%) and timpanomastoidectomy in 4 (7.1%) children. In the second group, consisting of children diagnosed with cholesteatoma of the middle ear, we performed 47 first act surgeries, using closed technique in 17, and open in 30 cases. We performed timpanoplasty type III in 17 (30.9%) and timpanomastoidectomy in 17 (30.9%), and timpanoplasty type II in 9 (16.4%), timpanoplasty type IV in 10 (18.2%) and mastoidectomy in 2 (3.6%) children. In the group treated by closed surgical technique recurrence occurred in 5 (29.4%), and in those treated by open technique in 3 (10.3%). Two children had bilateral cholesteatoma. CONCLUSION Further research should be directed toward the identification of different types of factors and pathogenesis of HGO. Treatment of this decease is still considered controversial. Hinolon drops could represent a promising option in the treatment of HGO. The main objective in the treatment of cholesteatoma should be the improvement of the open technique to prevent retraction pockets, decrease of the rate of residual or atelectatic process and the improvement of hearing results

External ear canal cholesteatoma after ventilation tube insertion and mastoidectomy

Introduction. Etiopathogenetically, there are two types of chollesteatomas: congenital, and acquired. Numerous theories in the literature try to explain the nature of the disease, however, the question about cholesteatomas remain still unanswered. The aim of the study was to present a case of external ear canal cholesteatoma (EEC) developed following microsurgery (ventilation tube insertion and mastoidectomy), as well as to point ant possible mechanisms if its development. Case report. A 16-yearold boy presented a 4-month sense of fullness in the ear and otalgia on the left side. A year before, mastoidectomy and posterior atticotomy were performed with ventilation tube placement due to acute purulent mastoiditis. Diagnosis was based on otoscopy examination, audiology and computed tomography (CT) findings. CT showed an obliterative soft-tissue mass completely filled the external ear canal with associated erosion of subjacent the bone. There were squamous epithelial links between the canal cholesteatoma and lateral tympanic membrane surface. They originated from the margins of tympanic membrane incision made for a ventilation tube (VT) insertion. The position of VT was good as well as the aeration of the middle ear cavity. The tympanic membrane was intact and of normal appearance without middle ear extension or mastoid involvement of cholesteatoma. Cholesteatoma and ventilation tube were both removed. The patient recovered without complications and shortly audiology revealed hearing improving. Follow-up 2 years later, however, showed no signs of the disease. Conclusion. There could be more than one potential delicate mechanism of developing EEC in the ear with VT insertion and mastoidectomy. It is necessary to perform routine otologic surveillance in all patients with tubes. Affected ear CT scan is very helpful in showing the extent of cholesteatoma and bony defects, which could not be assessed by otoscopic examination alone

Congenital cholesteatoma of mastoid origin: A multicenter case series

Background/Aim. The mastoid is the rarest site for the onset of congenital cholesteatoma (CC). The symptoms are atypical and minimal. The aim of this multicenter retrospective descriptive study was to define this extremely rare condition and its clinical presentation, diagnosis and management. Methods. We analyzed data files for a 15- year period in 4 tertiary otology centers and discovered 6 patients with the diagnosis of CC of the mastoid. Results. The clinical presentation of CC varied from incidental findings in patient to patient with otogenic meningitis. The most common findings during surgical procedures were mastoid cortex erosion, sigmoid plate dehiscence, dural exposure and external canal wall destruction. Conclusion. CC of mastoid origin tends to occur in adult patients probably because of minimal symptoms and the delayed diagnosis. It can exist for years in a nonaggressive state and develop to giant sizes. In children it is almost incidentally diagnosed. Early imaging is necessary in order to prevent serious complication