RESUMEN
OBJECTIVE/BACKGROUND: Most children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters. METHODS: Children aged 2-10 years with oSDB were selected for ATO based uponclinical findings according to current standards of care in Denmark. Each childunderwent standardized assessment before and 3 months after surgery, including aPSG, tonsil size assessment, and the Pediatric Sleep Questionnaire -Sleep RelatedBreathing Disorder (PSQ) to quantify symptom burden. Obstructive sleep apnea (OSA)was defined as an obstructive apnea-hypopnea index (oAHI) ≥2/h. Successfultreatment was defined as post-surgery oAHI ≤5/h, and complete cure as oAHI ≤2/h. RESULTS: Fifty-two children were included. Mean age was 5.0 years (SD ± 1.76). Thirteen children were identified with baseline oAHI <2/h. Significant improvement inOSA severity was observed in children with moderate-to-severe OSA, in whom oAHI decreased from 15.7/h to 2.6/h (p < 0.001). Treatment success was obtained in 85% and cure was obtained in 42% of children. PSQ-score significantly improved from 0.52 (CI 0.47-0.56) to 0.26 (CI 0.21-0.32) (p < 0.001). Baseline OSA severity was notcorrelated to baseline symptom burden nor to symptom relief after ATO. There were noserious adverse events. CONCLUSIONS: Adeno-tonsillotomy significantly reduced symptom burden in otherwise healthy children with oSDB symptoms. Significant improvement in oAHI was observedonly in children with moderate-to-severe OSA. We recommend combining clinicalevaluation with PSQ and oAHI.
Asunto(s)
Polisomnografía , Apnea Obstructiva del Sueño , Tonsilectomía , Humanos , Masculino , Femenino , Apnea Obstructiva del Sueño/cirugía , Preescolar , Tonsilectomía/métodos , Niño , Resultado del Tratamiento , Encuestas y Cuestionarios , Dinamarca , Adenoidectomía/métodos , Tonsila Palatina/cirugía , Tonsila Palatina/patología , Índice de Severidad de la EnfermedadRESUMEN
INTRODUCTION: Otogenic brain abscess (OBA) is a rare complication to otitis media, but one with a potentially devastating outcome. Early diagnosis of OBA is crucial for successful treatment. The objective of this study was to determine the incidence of OBA in a Danish population and to describe its clinical manifestation, management and outcome. MATERIAL AND METHODS: A total of 93 patients were retrospectively enrolled by diagnosis codes for brain abscess from 1999 to 2010. Records were reviewed to register age, symptoms, clinical findings, co-morbidity, imaging, microbiology and treatment. RESULTS: Seven were found to have had an otogenic focus of infection. The incidence of OBA was 1/million, and the mean age was 43 years, ranging from ten to 81 years. Five patients had acute otitis media and two had infectious cholesteatoma. Four had previously suffered a head trauma. The young patients presented with symptoms indicative of meningitis and the elderly patients with symptoms resembling a stroke. None of the patients were treated with antibiotics before admission to hospital. No mortalities occurred, but three had sequelae in the form of hearing loss and/or neurological impairment. CONCLUSION: The OBAs manifested with symptoms mimicking meningitis in young patients and stroke in elderly patients. Absence of fever does not rule out OBA; and regardless of any present ear symptoms, an ear, nose and throat examination should be performed without delay to locate the focus of infection and to facilitate targeted treatment. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.
Asunto(s)
Absceso Encefálico/diagnóstico , Absceso Encefálico/epidemiología , Otitis Media/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Absceso Encefálico/etiología , Absceso Encefálico/terapia , Niño , Dinamarca/epidemiología , Diagnóstico Diferencial , Drenaje , Dolor de Oído/etiología , Femenino , Cefalea/etiología , Humanos , Incidencia , Masculino , Meningitis/diagnóstico , Persona de Mediana Edad , Otitis Media/epidemiología , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Adulto JovenRESUMEN
INTRODUCTION: The periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a non-hereditary idiopathic febrile syndrome belonging to the group of autoinflammatory diseases. PFAPA does not cause long-lasting sequelae. An early diagnosis provides treatment possibilities for the patient and comfort to the family. MATERIAL AND METHODS: This study is a retrospective review of the medical records of patients diagnosed with PFAPA and admitted to our clinic from January 1999 to January 2010 (n = 31). RESULTS: The study population (n = 31) consisted of 21 males and ten females: 30 Caucasians and 1 Asian. Normal growth was seen in 30 patients. The median age at onset was 33 months. The mean duration of fever episodes was 4.45 days (95% confidence interval (CI): 3.92-4.98 days), and the mean duration of intervals between fever episodes was 29.66 days (95% CI: 25.31-34.01 days). Concomitantly with the fever, all patients had characteristic symptoms. All patients were asymptomatic in between their fever episodes. Prodromal symptoms were seen in 12 patients. Oral prednisolone was used in 24 patients and caused immediate fever reduction in 87.5%. A reduction in the duration of the asymptomatic interval after treatment was seen in 75.0%. Tonsillectomy was performed in 20 of the 31 patients causing cessation of fever episodes in 70%. Fever episodes continued in 15%, and the postoperative status remained unknown in the last 15%. Spontaneous resolution was seen in four patients. The diagnostic delay had a median duration of 28 months (range 2-160 months). CONCLUSION: The long diagnostic delay of PFAPA gives cause for concern and it indicates a need for greater awareness of the disease so that the diagnosis may be made earlier. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.
Asunto(s)
Fiebre/diagnóstico , Linfadenitis/diagnóstico , Faringitis/diagnóstico , Estomatitis Aftosa/diagnóstico , Antiinflamatorios/uso terapéutico , Niño , Preescolar , Intervalos de Confianza , Diagnóstico Tardío , Femenino , Fiebre/terapia , Humanos , Lactante , Linfadenitis/terapia , Masculino , Periodicidad , Faringitis/terapia , Prednisolona/uso terapéutico , Estudios Retrospectivos , Estomatitis Aftosa/terapia , Síndrome , TonsilectomíaRESUMEN
A case of a neck abscess caused by Salmonella Enteritidis in a 48 year-old diabetic patient is presented. Salmonella neck abscesses are rare and often occur in association with infection in other parts of the body. The condition is treated with drainage and antibiotics. It should be included in the differential diagnosis of abscesses of the head and neck - especially in immunosuppressed patients.
Asunto(s)
Absceso/diagnóstico , Cuello , Salmonella enteritidis , Absceso/microbiología , Absceso/terapia , Antiinfecciosos/uso terapéutico , Microbiología de Alimentos , Gastroenteritis/diagnóstico , Gastroenteritis/tratamiento farmacológico , Gastroenteritis/microbiología , Humanos , Masculino , Productos de la Carne/microbiología , Persona de Mediana Edad , Intoxicación Alimentaria por Salmonella/microbiología , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/tratamiento farmacológico , Infecciones por Salmonella/microbiología , Salmonella enteritidis/aislamiento & purificaciónRESUMEN
INTRODUCTION: The aim was to evaluate prognostic factors and outcome parameters related to otogenic pneumococcal meningitis (OPM). MATERIALS AND METHODS: Retrospective analysis of patients with OPM in Aarhus County from 1994 to 2003. RESULTS: Seventy patients were included, corresponding to an annual incidence of 11.7/mill. The mean age was 36.6 years (range: four days - 80 years) and the mean duration from debut of acute otitis media (AOM) to admission was three days. Twenty three percent had received antibiotics prior to admission. The most common symptoms were fever and affected consciousness. The mortality was 11%, and 40% of the surviving population developed permanent sequelae, of which 88% suffered loss of hearing. Sixty one percent was not evaluated audiologically after hospitalization. CONCLUSION: Pre-admission antibiotics were associated with a decreased risk of death and sequelae. Affected consciousness was a significant prognostic factor. The mortality rate was four times higher among adults than among children. Mastoidectomy was performed in 56% of adults without any significant influence on the outcome. Based on the presented results it appears relevant to treat cases of AOM, especially in adults with early antimicrobials due to their higher relative risk of developing OPM and the related risk of a poor outcome. In addition, maintenance of the previously established treatment regimen in OPM followed by audiological control is recommended.