Retropharyngeal abscess in children; changes in airway clinical presentation and management

Diagnosis of retropharyngeal abscess [RPA] in children is based on clinical suspicioun with supportive imaging studies RPA is frequently described as acute airway emergency. There is nowadays a change in the clinical presentation and management that has been explored in this study. The study included cases identified by a diagnosis of RPA including infectious and traumatic cases with confirmatory computed Tomography [CT] scan findings. Patients were treated with conservative antibiotics, CT-guided needle aspiration or open transoral drainage under general endotracheal anesthesia. Seventeen patients were identified. The mean age was 5.5 years. The symptoms were in the following order of frequency; posterolateral neck pain in 70.5%, odynophagia and drooling 47%, fever 29.4%, lateral neck mass 23.5%, and lastly respiratory distress in 1 patient [5.8%]. The commonest sign was limitation of neck movement 88.2%; of those, 10 patients [58.8%] had limitation of neck extension, 3 [17.6%] had torticollis, 2 [11.7%] had limitation on flexion. Following signs were, fever 53%, enlarged tender upper cervical lymph nodes 47%, tachypnea 35%, posterior pharyngeal bulge 11.7%, inspiratory stridor 5.8%, posterior pharyngeal wall congestion 5.8%. Conservative medical treatment with IV antibiotics alone was successful in 4 [23.5%], transoral incision drainage done for 5 patients [29.4%] patients, external neck drainage in 2 [11.7%] patients, transoral needle aspiration of pus plus IV antibiotics successful in 6 [35%]. Airway related side effects were self-limited and none of the patients needed tracheostomy. Children with RPA present with manifestations other than respiratory distress or stridor. CT scan is useful in confirming the diagnosis. IV antibiotics alone can be effective in clinically stable patients; transoral needle aspiration of pus covered by IV antibiotics be helpful while transpharyngeal incision drainage can be reserved for clinically unstable or difficult to aspirate patients

Outcome of endoscopic sinus surgery for nasal polyposis

Nasal polyposis is the most common mass lesions in the nose. It has been shown that it reduces quality of life. It has characteristically frequent recurrences. The objective of this study is to evaluate the outcome of nasal polyposis with medium term follow up [mean of 42 months]. This s M y included 216 adult patients with nasal polyps treated with endoscopic sinus surgery in the period from June 1997 to June 2003. All operations were done at Otori7inoiaryngoiogy Department, Mansoura University Hospital. Patients were grouped into polyposis, polyposis with asthmas, and polyposis with aspirin intolerance. Outcome measures include symptomatic improvement, residual and recurrent diseases, CT score, endoscopic score and complications. Patients symptom score and CT scores improved significantly after surgery. Recurrence rate was 19.9% [16%, 34%, and 38%] for the three groups, respectively]. Better control of asthma with less dependency on medication was not achieved in patients with asthma as well as patients with aspirin intolerance In conclusion; endoscopic sinus surgery is effective in treating patients with nasal polyposis. Patients with asthma and aspirin intolerance have worse outcome than patients with polyps with no asthma