Efficacy of Sucralfate in the Early Postoperative Improvement of Pediatric Thermal Welding Adenotonsillectomy Morbidity

Objective:Many surgical techniques and solutions have tried to improve the morbidity of pediatric adenotonsillectomy. Pain is mainly treated with analgesics, steroids and anaesthetics. However, various topical solutions such as sucralfate have been used for pain relief.Methods:We investigated the efficacy of sucralfate together with the TW technique on post-tonsillectomy morbidity in children. Our hypothesis was that the advantages of the TW technique might be improved by the protective coating effect of sucralfate on post-tonsillectomy morbidity. Patients were examined and scored clinically by their parents on the day of the operation and at the end of the day for the next 7 days. Throat pain was estimated by parents using the Faces Pain Scale-Revised from 0 to 10 with 0 representing the absence of pain and 10 maximal pain on postoperative days 1 to 7 while swallowing, speaking and resting.Results:The daily pain scores over the entire 7-day postoperative period were consistently lower in the sucralfate group than in the placebo group. The reduction of throat pain was significantly lower in the sucralfate group compared to the placebo group from the 1st to the 3rd postoperative day.Conclusion:Our study demonstrates that sucralfate is safe and improves post-tonsillectomy analgesia in combination with the TW technique in children

Histological Evaluation of the Nasal Swell Body in Allergic Patients

Objective:To evaluate the histopathology of the nasal swell body (NSB) mucosa in allergic patients in comparison with non-allergic patients.Methods:Our study evaluated 25 allergic and 25 non -allergic patients who underwent septoplasty and bilateral inferior turbinate reduction. The NSB was evaluated via tomographic images and histopathologically. The thickness of the NSB and the glandular structures, arterial structures, capillary and venous sinusoids was measured in both groups. The data were then summarized as the relative proportion of each tissue type, given in percentage form.Results:The histopathological examination of the nasal mucosa revealed glandular and vascular structures in the NSB, inferior turbinate and septal mucosa. Although the NSB mucosa was thicker in allergic patients than in non-allergic patients, the incidence of glandular cells was increased primarily at the NSB in both allergic and non -allergic patients. There were no significant differences between the allergic and non-allergic groups (p>0.05). Venous sinusoids were more common in the inferior turbinate than in the NSB. There was no difference in the predominance of venous sinusoids between allergic and non-allergic patients.Conclusion:The NSB is thicker in allergic patients than in non-allergic patients. However, the NSB is rich in glandular cells in both allergic and non-allergic patients. Therefore, any changes in this region may lead to changes in humidification, dysfunction and nasal obstruction

The Effect of Nasal Packing on Oxidative Stress in Septoplasty Operation

Objective:To evaluate the effects of nasal septal surgery and type of nasal packing used on local and systemic oxidative stress.Methods:Fifteen patients who were scheduled for septoplasty under local anaesthesia with isolated septal deviation were included in the study. Venous blood samples were collected preoperatively, postoperatively upon anterior nasal packaging, immediately after nasal packaging was removed and 2 hours following removal of nasal packaging. At the start of the incision and just after removal of the nasal packaging 2x2-mm sized nasal mucosal samples were taken. Malonylaldehyde (MDA) was measured as a parameter of local oxidative stress, and glutathione (GSH) and superoxide dismutase (SOD) as parameters of the local antioxidant system. Systemic MDA, catalase and nitric oxide were measured.Results:GSH and SOD levels decreased postoperatively in the septal mucosa just after nasal package removal, whereas MDA increased significantly (p<0.001). Systemic MDA levels decreased in comparison to preoperative levelsbetween the phases, however NO and catalase levels increased (p<0.05, p<0.01).Conclusion:Local oxidative stress occurs after septoplasy operation but no biochemical effect is observed systemically. Local oxidative stress is influenced by surgical intervention, surgical technique and packing material. New comparative studies are required between study groups with no nasal packaging

Nontypeable Haemophilus influenzae Otitis Media: Mastoiditis and Meningitis Complicated with Central Venous Thrombosis in an Immunocompetent Child

Implementation of the Haemophilus influenzae type B (Hib) conjugate vaccine brought about a reduction in the number of cases and morbidity from type B but an increase in nontypeable strain infections. Nontypeable Haemophilus influenzae (NTHi) commonly colonizes children’s upper respiratory tract and causes otitis media, sinusitis, and bronchitis. Invasive NTHi diseases, such as meningitis and septicemia, have rarely been reported. Herein, we discuss a previously healthy, fully immunized 3-year-old girl presented with otitis media and mastoiditis leading to meningitis caused by NTHi complicated with central venous thrombosis. She was treated with antibiotics, mastoidectomy and ventilation tube insertion, and anticoagulation therapy and recovered uneventfully. Through this case, we wish to share our unique clinical experience that NTHi should be born in mind as a potential pathogen that can cause meningitis in previously healthy children, which may be helpful in future cases