ENT manifestations of gastro-oesophageal reflux in children

Gastro-oesophageal reflux is common in children and is associated with morbidity rates that justify increasing interest in early diagnosis and appropriate medical or surgical treatment. In children ENT manifestations of gastro-oesophageal reflux mainly affect the larynx, ears, nose, paranasal sinuses and oral cavity. Main manifestations are laryngo-tracheal stenosis, laryngomalacia, otitis media with effusion, rhinosinusitis

Inflammatory bowel disease: an increased risk factor for recurrent laryngeal nerve palsy in thyroid surgery

Transient or permanent recurrent laryngeal nerve palsy is a well known complication in thyroid surgery with reported incidences of 5-8% and 1-3%, respectively 1. Diplegia has an incidence of 0.4% 2. Inflammatory bowel disease (IBD) is an important cause of peripheral neurosensitivity, particularly autonomic neuropathy, which can lead to transient or permanent laryngeal nerve palsy when neural structures are involved during surgery. Several mechanisms have been implicated in the physiopathology of these neurological disorders, but the actual mechanism is still unknown. Herein we report on two patients with IBD presenting with transient bilateral recurrent laryngeal nerve palsy after total thyroidectomy without any evident mechanical or traumatic manoeuvres on apparently preserved nerves

The role of balloon sinuplasty in the treatment of sinus headache

Headache attributed to rhinosinusitis, commonly called sinus headache (SH), is probably one of the most prevalent secondary headaches. The purpose of our study was to examine further sinus headache comparing the effect of conventional functional endoscopic sinus surgery and the balloon sinuplasty

The impact of allergic rhinitis in clinical practice: an italian survey

Allergic rhinitis (AR) is a very common disorder. The current Survey was conducted on a sample of about 5,000 adult subjects in 5 Italian cities. A questionnaire, containing 15 questions, was administered on the road. AR affects about 20% of the general population. The most common diagnostic test was the skin prick test, but only 12% of patients performed an allergy test to confirm the diagnosis. About 50% of patients did not take any medicine. Even about 40% of treatments were suggested by friends or pharmacists. In conclusion, the current Survey demonstrated that AR is a common disorder in Italy, the diagnostic work-up is still incorrect, and the therapeutic approach does not adhere to the guidelines. Therefore, there is a need to implement adequate information on this topic in Italy

An overview on upper respiratory tract infections and bacteriotherapy as innovative therapeutic strategy

OBJECTIVE: The aim of this review is to describe the most common recurring and chronic upper respiratory tract infections (URTI) in children and discuss the role of bacterial interference and bacteriotherapy in their prevention and treatment. MATERIALS AND METHODS: A literature review has been performed on the following topics: acute otitis media, adenoiditis, tonsillitis, rhinosinusitis, microbiotics and the role of bacterial interference, and bacteriotherapy in the prevention and treatment of URTI. RESULTS: Research studies into the characteristics of the microbiological flora and its role in the pathogenesis of URTI have focused on a single pathogen, on resistance to and ineffectiveness of antibiotic therapies, or on the persistence of bacterial biofilm. Recent evidence supports a central role of the existing microbial ecosystem in the pathogenesis of respiratory disease. In light of this, new therapeutic approaches include the implantation and persistence within the normal microflora of relatively innocuous “effector” bacteria that can competitively exclude or prevent the outgrowth of potentially disease-causing bacteria. Recently, a retrospective and observational study demonstrated that S. salivarius 24SMB and S. oralis 89a nasal spray could be effective in the prevention of recurrent otitis media in a real-life setting. Other studies have focused on the role of bacteriotherapy in children with beneficial effects in the prevention of URTI. CONCLUSIONS: The results of previous studies on the role of bacteriotherapy in paediatric URTI suggest that the use of bacterial interference phenomena through bacteriotherapy is a feasible, safe approach and deserves proper consideration as a promising therapeutic strategy against URTI

Complications of adenotonsillectomy in pediatric age

Although in recent years adenotonsillectomy procedures have shown an overall reduction in number, this surgery continues to be the most frequently performed in our speciality, especially in pediatric age. The progressive improvement in both surgical techniques and devices and anaesthesia has made adenotonsillectomy a less risky manoeuvre, but this does not mean that it is free from potential adverse events or even an easy, routine and risk-free procedure, as presented by some para scientific literature and mass media. Here we address issues related to the complications that can arise when performing this surgical procedure, which can be very serious

Obstructive sleep apnea syndrome in the pediatric age: the role of the otorhinolaryngologist

OBJECTIVE: Obstructive sleep apnea (OSA) is the primary indication for tonsillectomy, one of the most common pediatric surgical procedures, commonly performed in association with adenoidectomy. The objective of this review article is to evaluate the role of the otorhinolaryngologist in pediatric OSA. MATERIALS AND METHODS: A literature review has been performed on the following topics: peculiarities of sleep-disordered breathing in pediatric age; discrimination of sleep disorders; adenotonsillar hypertrophy; surgical techniques; adjuvant surgical procedures. RESULTS: The role of the otorhinolaryngologist in pediatric OSA is important for the evaluation of the upper airways and of essential biometric and polysomnographic data and for indication and execution of appropriate surgical treatment. In the majority of healthy children, adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography. When post-surgical residual OSA occurs, it is essential to monitor patients by means of drug-induced sleep endoscopy (DISE). CONCLUSIONS: Otolaryngologic assessment is of paramount importance to correctly classify a child with OSA. Correct inspection of the upper airway and quantification of the quality of sleep through polysomnography lead to the right therapeutic choice. Knowledge of different surgical techniques helps to deal with residual OSA after studying the obstruction sites by drug-induced sedation endoscopy

Foreign Bodies Causing Asphyxiation in Children: The Experience of the Buenos Aires Paediatric ORL Clinic

Inhalation or aspiration of a foreign body (FB) occurs relatively frequently in young children. The size, shape, type and site of arrest of the FB lead to variability in the clinical picture. The present study included data from 65 cases of FB inhalation presenting over 1 year at the Children's Hospital Gutierrez, Buenos Aires, Argentina, compared with information from four well-known published case series chosen as representative of other cultural and geographical backgrounds: the USA, Europe, North Africa (Egypt) and Asia (India). The mean age of children studied was 4.03 years. Injuries happened mainly at home (53 cases [81.54%]) and under adult supervision (59 cases [90.77%]). The most frequently inhaled FB was nuts, however, in contrast to previous reports, the majority of incidents involved inhalation of an inorganic, rather than an organic (food) FB. Complications included pneumonia (three cases), atelectasis (two cases) and pneumonitis (one case). No deaths were recorded. These data suggest that children play with objects inappropriate for their age, such as pins and nails, that adults may not be aware of the choking risks, and that more effort is required in educating caregivers about these risks

Stress ossidativo nei pazienti con diagnosi di sindrome delle apnee ostruttive notturne

La Sindrome delle Apnee Ostruttive Notturne (OSAS) è una patologia caratterizzata da alterazioni metaboliche e da un elevato rischio di sviluppo di patologie cardiovascolari. Lo scopo dello studio è stato quello di identificare dei markers precoci predittivi di rischio cardiovascolare con la valutazione dello stress ossidativo misurato attraverso esami di laboratorio in soggetti normali e pazienti con diagnosi di sindrome delle apnee ostruttive notturne. È stato effettuato uno studio prospettico per confrontare i risultati di laboratorio ottenuti dalla valutazione dei biomarkers dello stress ossidativo in 20 pazienti adulti con OSAS e 20 soggetti sani. Le tecniche di analisi utilizzate avevano l’obiettivo di identificare e quantificare i danni dei radicali liberi attraverso la misurazione di anti-ossidanti e pro-ossidanti in modo da valutare l’equilibrio ossidativo presente nei due gruppi di studio. I due gruppi di pazienti sono risultati omogeni per sesso, età ed indice di massa corporea (p < 0,05). Una differenza statisticamente significativa è stata individuata tra i livelli di indice di apnea-ipopnea valutata alla polisonnografia e di isoprostani, produzione di proteine di ossidazione e proteine non legate al ferro nei due gruppi in esame. Nessuna differenza significativa è stata trovata nel livello dei tioli tra i soggetti sani e i pazienti con sindrome delle apnee ostruttive. I tioli, a differenza degli altri markers, sono molecole anti-ossidanti, i restanti sono invece espressione di danno ossidativo. I risultati dello studio indicano che i biomarkers potrebbero essere utilizzati come indici di ostruzione delle vie aeree superiori (VAS) e come marcatori precoci di ipossiemia causando processi flogistici ricorrenti e danno locale da radicali liberi a carico delle VAS