Effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring / 南方医科大学学报

OBJECTIVE@#To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring.@*METHODS@#Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded.@*RESULTS@#No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)(@*CONCLUSIONS@#In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.

The effect of low-temperature coblation under endoscopy on infantile subglottic hemangioma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the effect of low-temperature coblation on subglottic hemangioma under endoscopy.@*METHOD@#Clinical data of 5 patients whom were diagnosed as subglottic hemangioma treated with low-temperature coblation under endoscopy were retrospectively studied. Two cases of the patients were treated after tracheotomy.@*RESULT@#Hemangioma vanished completely in the 5 patients. All patients were followed-up from 3-6 months,no recurrence was found, and the 2 cases were extubated successfully.@*CONCLUSION@#Endoscopic surgery u sing low-temperature coblation for subglottic hemangioma after tracheotomy can relief the airway obstruction quickly, shorten the nature course of hemangioma and the period of wearing trachea,also no complication such as subglottic stenosis which is thought to be a safe and effective therapy for large size hemangioma. While for small size hemangioma, endoscopic surgery using low-temperature coblation under good total anesthesia without tracheotomy combined is effective, less injure, and suitable. Endoscopic surgery using low-temperature coblation for subglottic hemangioma has following advantages such as simplicity, minimal invasion and so on. It is a viable surgical method for the treatment of subglottic hemangioma.

Clinical features of sudden hearing loss in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical features and prognosis of sudden hearing loss in children, so that to guide clinical diagnosis and treatment.@*METHOD@#A retrospective review of medical records of 12 hospitalized children (21 ears) suffering from sudden hearing loss was conducted.@*RESULT@#The study comprised 8 males and 4 females with a mean age of 6.28 years old, among which 25% had a unilateral hearing loss and 75% exhibited bilateral hearing loss. The mean onset time was 5.42 days. Four children had tinnitus and 3 patients showed dizziness. For the possible etiology. 2 cases had mumps. 6 cases had definite upper respiratory infections history, one experienced trauma, and another one took ototoxic drugs. Five patients were proved to come down with the large vestibular aqua duct syndrome by the CT scan. Among the 21 ears. 7 ears were diagnosed severe hearing loss and 14 ears were diagnosed profound hearing loss. After the treatment of 7 days, 6 ears were cured, one car showed effective change. and 14 cars came out to be ineffective, with the total effective rate of 33.3%. After the 14 days' treatment, there was no improvement for 5 patients.@*CONCLUSION@#CT scan should he performed on all of the children with hearing loss to exclude the inner ear malformation. Most of the children with sudden hearing loss underwent some clear etiology, showing more severe hearing loss and had a poorer prognosis.

Pathogenic bacteria distribution and drug susceptibility in children with acute otitis media in Pearl River Delta / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the pathogenic bacteria distribution and drug susceptibility in children with acute otitis media (AOM) in different age and different season in the Pearl River Delta region.@*METHOD@#Four hundred and forty-two children diagnosed as AOM were divided into three groups by age factor and four groups by season factor. Midge ear pus collecting and culturing were used for bacteria and antimicrobial susceptibility test.@*RESULT@#(1) Strains of bacteria were isolated from 356 children with the positive rate of 80.5%. Streptococcus pneumoniae (39.2%), staphylococcus aureus (25.9%) and haemophilus influenzae (7.4%) were the most frequently isolated pathogens. (2) Streptococcus pneumoniae was the main pathogenic bacteria in 0-1 year group and > 1-3 years group (P 3 years group (P 0.05). Staphylococcus aureus was the main pathogen in January-March group (P < 0.05); (4) Drug sensitivity shown that linezolid and ofloxacin were most sensitive to streptococcus pneumoniae and staphylococcus aureus, and macrolides had a good therapy effect to haemophilus influenzae.@*CONCLUSION@#The pathogens distribution and drug susceptibility in children with AOM were varies in different age and different season. As a result, a treatment should be done based on the climate, environment, and pathogens distribution of a region.

Comparison of the residual hearing on the profound hearing-impaired children with the hearing aids and cochlear implants / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To compare the hearing test data of the profound hearing-impaired children with the hearing aids and with cochlear implants; to find out the useful method to measure the residual hearing.@*METHOD@#Twenty-two profound hearing-impaired children participated in the study with complete set of hearing test and verbal rehabilitation file. Ten children fitted hearing aids and underwent verbal rehabilitation more than 3 months. Among the other 12 children with cochlear implants, 10 children fell in the same year range with the hearing aid patients. The children with hearing aids were divided into two groups according to the achievement of the verbal rehabilitation. ASSR threshold and pure- tone threshold were compared between the groups.@*RESULT@#(1) ASSR test: 7 children (14 ears) with hearing aids achieved good verbal representation, in which ASSR threshold can be recorded on 2.71 frequency on average [(110.92 +/- 7.43) dB HL]. Among 3 children with hearing aids representing poor verbal achievement and 5 children with additional cochlear implant because of the poor verbal achievement with hearing aids, only 1.06 frequency had response of ASSR test [(110.88 +/- 48.52 ) dB HL]. (2) Pure tone audiometry: the average threshold of the 7 children with good representation was (96.11 +/- 7.81) dB HL, and the threshold on 3 frequency were less than 100 dB HL on average. The average threshold of the other 3 children with poor verbal achievement was (112.19 +/- 5.15) dB HL, and none of the frequency threshold was 100 dB HL.@*CONCLUSION@#The number of the frequency with the response of ASSR and the threshold < or =100 dB HL of pure tone audiometry is an effective indication of the useful residual hearing.

Analysis of clinical manifestations and misdiagnosis of congenital vallecular cyst / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the clinical manifestations and the cause of misdiagnosis of congenital vallecular cyst.@*METHOD@#Nineteen cases of congenital vallecular cysts were collected and reviewed retrospectively. Their clinical manifestations and diagnosis were analyzed.@*RESULT@#Their clinical manifestations included inspiratory stridor, respiratory distress, inspiratory dyspnea, feeding difficulty etc. Among 19 cases, 15 cases were misdiagnosed as neonate pneumonia (9 cases), bronchial pneumonia (5 cases), and laryngitis (1 case), respectively. All cases were diagnosed as congenital vallecular cysts by fibrolaryngoscope. The diagnosis was confirmed by pathological examination.@*CONCLUSION@#Congenital vallecular cyst is fairly uncommon. To cure these patients on time, early examination of upper airway is recommended for patients with inspiratory stridor and inspiratory dyspnea. Fibrolaryngoscope would be useful for diagnosis and timely treatment.

Analysis of characteristics of heart rate and heart rhythm in children with obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the characteristics of heart rate (HR) and heart rhythm in children with obstructive sleep apnea-hypopnea syndrome (OSAHS).@*METHOD@#Ninety-five patients underwent overnight PSG for clinically suspected OSAHS. According to the apnea index (AI), the patients were assigned to control group (AI 92%, n = 27) or OSAHS group (AI > 1/h, SaO2 < 92%, n = 68). The HR and heart rhythm were monitored and compared between the two groups.@*RESULT@#The maximum HR during sleep was significantly higher in OSAHS group while the minimum HR was significantly lower during sleep. Bradycardia and tachycardia is a common feature of pediatric OSAHS. There was a significantly higher incidence of tachycardia in OSAHS groups than in the control group.@*CONCLUSION@#These findings suggest that pediatric OSAHS might influence HR and heart rhythm.

Roentgenographic cephalometry in children with obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To elucidate the relationship between different cephalometric measurements and the severity of childhood OSAHS, then analyze the value of cephalometric measurements in predicting the severity of OSAHS in children.@*METHOD@#Sixty-one patients received PSG examination and standard lateral neck roentgenography including cervical trachea. Cephalometric measurements include adenoid size, adenoidal-nasopharyngeal ratio, narrowest posterior airway space of nasopharynx, ratio of the narrowest posterior airway space of nasopharynx and trachea diameter. Statistical analysis was made to study the relationship between the data of Cephalometric measurements and PSG.@*RESULT@#Cephalometric measurements were all associated with AHI and AI (P 0.01).@*CONCLUSION@#PAS/TD is useful and simple in predicting the severity of OSAHS in children, but no use in predicting the severity of arterial oxygen saturation.