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

Stapes surgery: comparison between microdrill and footplate perforator

The study goal was to compare the effect of using footplate perforator and the microdrill on the postoperative hearing results and complications rate during stapes surgery. 70 ears with otosclerosis have been operated upon using microdrill to perforate the footplate in 34 ears and microperforator in 36 ears. All operations were operated upon at the Department of Otolaryngology, Mansoura University Hospitals from 2005 to 2007. The audiological results and complications rate of both groups were compared. There were statistically significant decrease of postoperative air and bone conduction in both groups. There was significant decrease in the mean post operative bone conduction in the microdrill group as compared to the perforator group. The mean postoperative air bone gap [500-4000Hz] was 7.8 dB and 9.3 dB for the microdrill group and the perforator group, respectively, which was statistically insignificant there was no significant SNHL in the microdrill group, while there was one ear [2.7%] had it in the perforator group. Stapedotomy using microdrill or footplate perforator provides good results, however, the use of microdrill may be useful as it is easy, safe and less traumatizing to the inner ear

Comparative study of the efficacy of local ciprofloxacin versus Aluminum acetate 3.5% in the management of active chronic suppurative otitis media [CSOM]

The management of active mucosal chronic otitis media can be both time consuming and difficult. Treatment options include aural toilette, local insufflations of anti-septic powders, an array of topical otic drops and sprays, systemic antibiotics and surgery. to determine the clinical and bacteriological efficacy of local Ciprofloxacin versus Aluminum acetate 3.5% in cases of active chronic supp.o.media. Design: Randomized double-blind study with clinical, bacteriological and audiological assessment pre and post management. Patients: A total of 30 patients with bilateral Ch.O.S.M aged 8-17 years, were enrolled, if they has persistent otorrhea. Intervention: All Rt. ears, received ototopical ciprofloxacin hydrochloride 0.3% drops and all left ears received Aluminum acetate 3.5% solution for 14 days in both ears. Patients were examined for clinical improvement on days7 and 14. Bone conduction audiometry was performed at baseline, on day 14 and one month after the end of the course therapy. Our results showed that Rt.ears had the same cure rate of the Left ears so, long as the duration of otorrhea was less than 2 months.Rt.ears otorrhea had more successful improvement rate 94%, than Left ears 82%, if the duration was more than 2 months. Pure tone average improvement was 10.6 dB in RI ears compared with 9.3 dB in Left ears. We concluded that both ciprofloxacin 0.3% and aluminum acetate 3.5% drops were effective in the treatment of active CSOM, with no adverse effects were noted especially on hearing. There was no statistically significant difference in the efficacy of both drops with a better clinical improvement with ciprofloxacin, if otorrhea is more than 2 months. Aluminum acetate solution 3.5% fulfills the criteria for a cheap, yet effective alternative to more expensive antibiotic preparation

Bony and submuccsal tissue reduction of inferior turbinate: subjective and objective evaluation

Chronic nasal obstruction is one of the most common symptom in the practice of Otolaryngology. Our study was to evaluate the value of the reduction of both the bone and the submucosal soft tissue of the inferior turbinates by using microdebrider and microdrill burrs in 70 patients with bilateral inferior turbinate hypertrophy. They were 36 males and 34 females. The age ranged between 17-65 years. All cases were performed at ORL department, Mansoura University Hospital in the period between 2002-2003. Subjective and objective evaluations were done preoperativeI3rnonths postoperatively. Subjective evaluation was done by questionnaires regarding nasal symptoms with score calculation. Objective evaluations were done by clinical examination, endoscopic evaluation, and CT scanning. Turbinates were graded into I, II, III. Turbinates in grade 1ff were included in the study. The preoperative mean of total symptom score was [7.99 +/- 7.9 7] and postoperative was [1.79 +/- 1.81]. Preoperatively most of turbinates were in grade III but after surgery most of them were in grade I. AU turbinates were decreased in size after the procedure Bleeding occurred in 3 cases and required tight packing. Mucosal tears without mucosal loss occurred in 20 cases. We did not observe crustation, synechiae, foul odor or nasolacrimal injury. So by this technique patients showed both subjective and objective improvement