Role of fine needle aspiration in isolating the core bacteria in children with recurrent tonsillitis

Fine needle aspiration [FNA] of the tonsil as a diagnostic tool in evaluating the micro flora in recurrent tonsillitis has not been popularized. A prospective study of 52 patients with recurrent tonsillitis undergoing tonsillectomy was undertaken. Their age ranged from 3 to 11 years. Surface swab and FNA were taken followed by tonsillectomy and the core tissue was sent for culture. No complications were recorded from the procedure of FNA. The correlation between culture results [for each of core, FNA and swab] and clinical or laboratory data [age, sex, number of attacks per year, HB%, TLC, ESR and CRP] were all insignificant with p value always >0.05. The reliability of the culture by Swab and FNA of the tonsil core was validated with the reference [gold] standard which is the dissected tonsil core. The sensitivity of FNA and swab cultures as compared to core culture was 83.3% and 62.1% respectively. The positive predictive value of FNA and swab cultures as compared with core cultures were 96.2% and 85.7% respectively. No significant correlation was observed between culture results and clinical and laboratory variables. No significant correlation was observed between age and type of organism. Our study showed that FNA of the tonsil core is reliable, safe and valid in identifying the bacterial organism within the infected tonsil for appropriate antibiotic therapy. The next step in evaluating this technique is to attempt it as an outpatient setting on children with recurrent tonsillitis under sedation/local anesthesia. As investigators become more experienced, sensitivity may increase. Accordingly; FNA of the tonsil core could revolutionize the management of patients with chronic tonsillitis

Radiofrequency volumetric tongue base reduction as a treatment for OSA

Localization of the site of obstruction in patients with obstructive sleep apnea [OSA] is the cornerstone of the treatment. Physiologic studies have shown the base of the tongue and hypo pharynx to be the major site of obstruction in up to 50% of patients with OSA. Non-surgical methods including continuous positive airway pressure [CPAP], unfortunately, have variable patients' compliance. Surgical treatment for hypopharynx and tongue base of OSA patients is a great challenge because of associated airway compromise, apart from airway risk inherent to OSA patients. Radiofrequency [RF] volumetric tissue reduction is a recently applied technology with unique biophysics. It is performed on divided treatment sessions under local anesthesia. The aim of this work is to evaluate the efficacy of radiofrequency volumetric tongue tissue reduction in the treatment of OSA due to enlarged tongue base. Our results revealed that RF volumetric tongue base reduction is an easy, cost-effective, and tolerable method for treatment of OSA, which is nearly devoid of serious complications. RF is effective in treatment of moderate OSA patients. The severe OSA patients were partially improved, still their AI was reasonably reduced after RF treatment, and they were c and idates for further potential deposition of RF energy in their tongues or in lateral pharyngeal wall which needs further research for testing the safety and feasibility of this application. Reduction of the AI in patients with severe OSA using this minimally invasive RF technique makes them better c and idates for CPAP with lower occlusive airway pressure and better tolerance

Assessment of the pharynx by acoustic pharyngometry in normal subjects and obstructive sleep apnoea patients

This prospective controlled study included 40 middle aged subjects of both sexes divided into two groups: Group A included 20 normal subjects and group B included 20 patients suffering from snoring with or without obstructive sleep apnea. Both groups were investigated by acoustic pharyngometer, by which the cross sectional area of different segments of the pharynx was recorded and analyzed for the standardization of normal curve by standard operating procedure. Acoustic pharyngometry proved to be an easy method to assess the possible level[s] of obstruction

Radiofrequency palatal reduction versus LAUP as a treatment of snoring and mild obstructive sleep apnea

In this study, 30 patients complaining of snoring and mild obstructive sleep apnea were randomly distributed into two groups, 15 patients each. One group was subjected to laser assisted uvulopalatoplasty [LAUP] while the other to RF. The follow up of these patients revealed that LAUP is more effective than RF, whereas RF is more tolerable than LAUP. LAUP was proved to be an effective method in the treatment of snoring and mild obstructive sleep apnea, while RF proved to be very safe and well-tolerated but needs further study to exactly evaluate its efficacy

Re-evaluation of management policy of children with high Anti-streptolysin O titre

ASO [Anti-sireptolysin O] antibody is formed in response to infection with streptococcal pyogenes. Measurement of ASO antibody titre is an important investigation of post streptococcal diseases, particularly rheumatic fever. Management of children with elevated levels of ASOT is still controversial some prefer medical therapy while other prefer surgical tonsillectomy. Is to define the best method of management of high ASOT through trial of three different therapeutic therapies which are the classic long acting BPG or recent macrolide oral azithromycin or tonsillectomy. The study enrolled 109 patients with a mean age 5.3 years. Group I [50 patients] were treated, with long acting BPG, Group II [40 patients] treated by oral azithromycin and Group III [19 patients] with tonsillectomy. Patients with failed medical treatment had undergone surgical tonsillectomy with follow up of their ASOT for 3 months. Surgical tonsillectomy revealed the highest curative rate 86.3% followed by long acting BPG 66% then oral azithromycin 62.5%. Conservative medical therapies should be the first line of management of high ASOT. Its failure urges the attempt for surgical tonsillectomy with a follow up period of 3 months at least for their ASOT