RESUMEN
INTRODUCTION: Pediatric functional endoscopic sinus surgery (FESS) is now commonly performed for chronic rhinosinusitis therapy. The surgery is necessary when symptoms of sinusitis persist after maximal medical treatment. Apart from anatomic and technical issues the main difference between adult and pediatric FESS is related to postoperative care. In earlier reports a second-look endoscopy in general anaesthesia was recommended to inspect, debride and clean the operative site in young patients. MATERIAL AND METHODS: The aim of the study was to estimate the results of FESS surgery in children and to propose a relevant way for postoperative care. FESS surgery was performed in 64 children (mean age 13, 2 years) and postoperative follow-up was available in 47 children (33 girls, 14 boys). The protocol for postoperative follow-up based on our notes and literature is suggested. All patients after surgery were instructed to use saline solution or Ringer solution for nose cleaning. Seven days after surgery nasal steroids were implemented. Second look endoscopy with wound debridement in general anaesthesis was necessary in 8 children (13%) after major procedures, where a lot of crust and blood clots in postoperative site were noted. RESULTS: It is suggested that formation of synechiae and granulation tissue in the early postoperative period is one of the adverse prognostic factors in FESS outcome. In spite of not aggresive approach to follow-up, wound inspection and postoperative site cleaning the synechiae were found in 2 (3%) patients only. 30 children (64%) were symptoms--free after surgery. CONCLUSIONS: Functional endoscopic sinus surgery (FESS) is efficient treatment for chronic rhinosinusitis in children. Aggresive post operative site debridement is rarely necessary. Postoperative general anaesthesia "second-look procedure" is indispensable in a few patients only but it needs an individual approach for each child.
Asunto(s)
Endoscopía/métodos , Complicaciones Posoperatorias/cirugía , Rinitis/cirugía , Sinusitis/cirugía , Adolescente , Adulto , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Estudios Retrospectivos , Rinitis/etiología , Sinusitis/etiología , Resultado del TratamientoRESUMEN
A rare case of congenital cholesteatoma as a cause of acute labyrinthitis is presented in the report. 14-years old boy was operated due to labyrinthitis caused by a huge cholesteatoma discovered behind intact tympanic membrane. On the first examination the symptoms indicated lack of right inner ear function, so unfortunately the referral was to late and the patient resulted in the dead ear. The diagnosis of congenital cholesteatoma as well as treatment of the entity and its subsequent complications is discussed in the report.
Asunto(s)
Colesteatoma del Oído Medio/congénito , Colesteatoma del Oído Medio/complicaciones , Laberintitis/etiología , Laberintitis/cirugía , Enfermedad Aguda , Adolescente , Colesteatoma del Oído Medio/diagnóstico por imagen , Humanos , Laberintitis/diagnóstico por imagen , Masculino , Radiografía , Resultado del TratamientoRESUMEN
Otologic problems are infrequent in HIV patients. Authors present the case of chronic otitis media in the HIV infected child. The patient with significant hearing loss, and prolonged aural discharge, resistant to local and systemic antibiotic treatment was treated surgically. Mastoidectomy with myringoplasty was performed. The substantial hearing improvement has been obtained, ear discharge never returned. However due to episodes of chronic otitis media with effusion ear drainage with tympanostomy tubes, after initial surgery have been performed two times. The controversies regarding surgery decision-making in this group of patients are discussed.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Pérdida Auditiva/cirugía , Otitis Media con Derrame/cirugía , Timpanoplastia , Niño , Pérdida Auditiva/etiología , Humanos , Masculino , Miringoplastia , Otitis Media con Derrame/complicaciones , Resultado del TratamientoRESUMEN
BACKGROUND: Due to the difficulties involved in assessing adenoidal tissue and the nasopharyngeal airway in children, it is necessary to find an accurate pre-operative method of measuring these structures. MATERIAL/METHODS: We used acoustic rhinometry and endoscopy both to the evaluate results of surgical and medical treatment in allergic children with adenoid hypertrophy and to evaluate the influence of pollination on adenoid size in children with seasonal allergic rhinitis. Three separate groups of children were examined. The first group consisted of nine children with adenoid hypertrophy and positive skin-prick test results of year-round allergens. In this group we examined the influence of adenoidectomy on the rhinometric curve. The second group consisted of sixteen children with adenoid hypertrophy and perennial allergic rhinitis. In this group we examined the influence of medical treatment (topical nasal steroid and antihistaminic) on the adenoid size and rhinometric curve. The third group consisted of twelve birch pollen-sensitive children who had symptoms of seasonal allergic rhinitis. In this group we examined the influence of pollination on the nasopharyngeal period of rhinometric curve. RESULTS: In the two first groups we observed a significant increase of the nasopharyngeal cavity after surgical removal of the adenoids and medical treatment of the allergy. In the third group most of the children experienced a significant decrease in nasopharyngeal cavity volume during pollination. CONCLUSIONS: Acoustic rhinometry seems to be a very promising method of assessment of the amount of adenoid, and allergy can play an important role in adenoid hypertrophy in hypersensitive children.
Asunto(s)
Tonsila Faríngea/patología , Alérgenos/efectos adversos , Rinometría Acústica/métodos , Adenoidectomía , Tonsila Faríngea/efectos de los fármacos , Tonsila Faríngea/cirugía , Betula , Niño , Preescolar , Endoscopía , Estudios de Evaluación como Asunto , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Hipertrofia/tratamiento farmacológico , Hipertrofia/etiología , Hipertrofia/patología , Hipertrofia/cirugía , Nasofaringe/patología , Polen/efectos adversos , Rinitis Alérgica Estacional/tratamiento farmacológico , Rinitis Alérgica Estacional/etiología , Rinitis Alérgica Estacional/patología , Esteroides/uso terapéuticoRESUMEN
The role of enlarged adenoids and tonsils in upper airway obstruction has become well-established earlier, thus, adenoidectomy with or without tonsillectomy is one of the most commonly performed surgical procedures in the paediatric population. Direct assessment of adenoidal size is difficult and no definitive method is so far available to complement clinical assessment. The most important diagnostic techniques are recording of obstructive symptoms, transoral posterior rhinoscopic examination, radiological evaluation, such as lateral radiography of the adenoid and nasopharyngeal magnetic resonance imaging, transnasal fiberoscopic examination, acoustic rhinometry and others. In this study we compare acoustic rhinometry, fiberoscopy and Cohen and Konac radiological method. Spearman's correlation test was used to evaluate the degree of correlation between these three methods. We concluded that acoustic rhinometry and radiology are good and objective methods for measuring adenoid sizes in allergic children.