Pediatric laryngeal clefts: an experience in the diagnosis and management of 13 cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the diagnosis and management of laryngeal cleft.@*Method@#The clinical data of 13 cases of laryngeal cleft treated between 2007 and 2015 was analyzed retrospectively.@*Results@#The children with laryngeal cleft were classified according to the classification of Benjamin-Inglis, as type Ⅰ(11 cases), typeⅡ(1 case) and type Ⅲ(1 case). All patients were confirmed by microlaryngobronchoscopy under general anaesthetic. Eleven typeⅠ and 1 type Ⅱ clefts were managed conservatively, with which all type Ⅰ patients were successfully managed, while the type Ⅱ patient was resolved by surgical endoscopy. The type Ⅲ patient was treated by open repair but the results was poor.@*Conclusions@#Patients who suffered with choking on feeding or recurrent aspiration pneumonia, especially coexisted with other congenital malformation, needed detailed evaluation for laryngeal cleft, although which was a rare congenital abnormality. Electronic laryngoscope could be the first step to screen the cleft, while microlaryngobronchoscopy is the gold standard for diagnosis of laryngeal cleft. The majority of children with lower type clefts can be managed conservatively. Surgical endoscopy has high success rate when strictly following the indication. Type Ⅲ and Ⅳ clefts have high mortality for usually combining with severe complications and abnormalities.

Causes and management of pediatric spontaneous tonsillar haemorrhage / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the causes and management plan of pediatric spontaneous tonsillar haemorrhage(STH).@*Methods@#According to the criteria of STH difined by Griffies, patients with STH from December 2013 to January 2016 were included in this retrospective study.@*Results@#A total of 11 patients were reviewed. The etiological diagnosis included 3 pediatric Epstein-Barr virus associated infectious mononucleosis(EBV-IM), 3 suspected pediatric EBV-IM to 3 acute suppurative tonsillitis, 1 acute viral tonsillitis and 1 hemophilia A. The management strategies included antiviral, antibacteria, transfusion, surgical examination followed with bipolar coagulation hemostasis under general anesthesia. No patient treated with tosillectomy.@*Conclusions@#STH is now a rare condition, the causes of which in child are more or less different from adult.This emergency can be treated in time if a detailed management plan for pediatric STH is formulated.

Management of nasal orbital cellulitis in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics, diagnostic and treatment principle of orbital cellulitis in children, and to improve the experience of antibiotic treatment in orbital cellulites.</p><p><b>METHODS</b>Twenty children were admitted to Shenzhen Children's Hospital with the diagnosis of nasal orbital cellulitis between January 2009 and December 2013. The children were severe enough to warrant hospital admission. There were 13(65%) males and 7 (35%) females. The median age was 3.5 years (2 months to 7.2 years). The relationship between the serum C-reactive protein (CRP), white blood cell count and the hospitalization days were analyzed. The children were divided into 2 groups: Cefoperazone Sodium and Sulbactam Sodium for injection group and other antibiotic treatment group, the difference was compared. Statistical calculation was performed using SPSS 13.0 software.</p><p><b>RESULTS</b>The serum CRP [(29.8 ± 22.0) mg/L] at the time of admission had a positive correlation with the time of hospitalization[ (6.3 ± 4.1) d, r = 0.46, P < 0.05]. The time of CRP decreased to normal range after admission [(3.4 ± 1.8) d] were apparently related to the hospitalization time (r = 0.81, P < 0.01). The hospital days whose CRP could be decreased to normal within 3 days [n = 12, (4.3 ± 1.7) d] were significantly shorter than that in the others [n = 8, (9.1 ± 5.0) d, t = 2.61, P < 0.05]. The hospitalization of 12 cases with Cefoperazone Sodium and Sulbactam Sodium for injection [(4.3 ± 1.9) d] was shorter than that in other 8 cases with other drugs [(9.3 ± 4.7) d, t = 2.83, P < 0.05]. Bacterial pathogens were only identified in 4 children, including 3 cases of methicillin-resistant staphylococcus aureus (MRSA), 1 case of streptococcus anginosus. Only 1 case in 20 cases with positive blood culture for Staphylococcus aureus, consistented with the pus culture.</p><p><b>CONCLUSIONS</b>If early treatment at the first three days is valid, the course of nasal orbital cellulitis will be shorter and the orbital abscess can be prevented. Cefoperazone sulbactam and Sulbactam Sodium for injection is effective in treating pediatric orbital cellulitis.</p>

Clinical manifestations in pediatric laryngopharyngeal reflux / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical manifestations in pediatric laryngopharyngeal reflux and to provide more information on diagnosis and treatment.@*METHOD@#Sixty-two cases with recurrent respiratory infections, hoarseness and chronic cough were examined with reflux symptom index (RSI), reflux finding score (RFS), and 24-hour pH monitoring. Those who had at least two positive test for reflux were given PPI for diagnostic therapy.@*RESULT@#All patients completed reflux symptom index (RSI) questionnaire and underwent fiberoptic laryngoscopy, and reflux finding score (RFS) was evaluated. The positive rate of RSI and RFS was 91.94% and 79.03% differently. 24-hours pH monitoring and diagnostic therapy was about 30.76% and 85.48% differently. The symptoms show hoarseness 90.32%, postnasal drip 77.42%, difficulty swallowing 74.19%, abdominal pain and chest pain 72.58%, throat clearing 64.52%, chronic cough 56.45%, dysphagia 51.61%, throat abnormal feeling 48.39%. Laryngoscope examination shows inter-arytenoid erythema 100%, vocal mucosal oedema 75.81%, diffuse laryngeal edema 50.00%, posterior commissure hypertrophy 33.87%, subglottic edema 4.84%, no granuloma case. There was 16 cases showing positive in 24-hours pH monitoring test. The positive rate was 30.76%. All cases accepted diagnostic therapy. Fifty-three cases were effective. The positive rate was 85.48%.@*CONCLUSION@#There are no clinical presentations specific to pediatric laryngopharyngeal reflux. Patients often present with a wide range of atypical symptoms and signs. RSI questionnaire and RFS may provide diagnostic datas. Primary treatment includes lifestyle and medical therapy.