Adaptation of the Pediatric Smell WheelTM to evaluate olfactory function in Brazilian children

Abstract Objective: Olfaction influences nutrition, safety, and the cognitive development of children. Presently there are few olfactory tests for children, and normative reference values are generally lacking. In this study, we validate the Pediatric Smell WheelTM (PSW) to evaluate olfactory function in Brazilian children. Methods: We modified and validated the PSW, a test developed in the United States, for administration in Brazil, and established normative data for Brazilian children. The validation process consisted of five phases. First, we identified odorants familiar to Brazilian children. Second, we established the test-retest reliability of the Brazilian PSW test that employed these odorants. Third, we compared the test scores of healthy children to those microsmic from adenoid hypertrophy. Fourth, we examined the test's ability to detect improvement in olfactory function before and after adenoidectomy. Finally, we determined a normative 10th percentile cut point for defining microsmia in a sample of 169 healthy Brazilian children between 5 and 12 years of age. Results: Eleven odors were identified for inclusion in the test. The test-retest reliability was modest (r = 0.54, p < 0.001), although likely attenuated based on the inclusion of only data from children with normal function. The test clearly differentiated the olfactory function of children with adenoid hypertrophy from that of healthy children and demonstrated the return of function after adenoidectomy. An overall score <7 was found useful in defining hyposmia, although additional age-related cut-points were also defined. Conclusion: A Brazilian version of the PSW was developed and validated and found to be efficacious in detecting smell dysfunction in children ranging in age from 5 to 12 years. Level of evidence: 1b (Diagnosis).

Pólipo piloso nasofaríngeo en un recién nacido con obstrucción intermitente de la vía aérea. Presentación de un caso / Nasopharyngeal hairy polyp in a newborn with intermittent airway obstruction. Case report

Los pólipos pilosos nasofaríngeos son tumores benignos poco frecuentes. Se presenta el caso de esta patología en una paciente recién nacida, quien presentó cianosis y dificultad respiratoria por obstrucción de la vía aérea superior, durante las primeras 24 horas de vida. La paciente requirió maniobras de reanimación e intubación endotraqueal. Estudios diagnósticos confirmaron la presencia de una masa en la pared lateral de la faringe. Se realizó la extirpación quirúrgica exitosa con evolución satisfactoria de la paciente

Nasopharyngeal hairy polyps are rare benign tumors. We present a newborn case with a hairy polyp mass causing cyanosis and respiratory distress due to obstruction of the upper airway during the first 24 hours of life. The patient required resuscitation and endotracheal intubation. Diagnostic studies confirmed the presence of a mass in the lateral pharyngeal wall. Surgical treatment and removal of the mass was performed with satisfactory evolution of the patient

Analysis on correlation of children adenoid size and nasopharyngeal volume with CT volume model / 中国医学影像技术

Objective: To explore the relationship of children adenoid and nasopharyngeal volume using upper airway model established with CT volume scanning and three-dimensional reconstruction technology, and to analyze the impact of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Nasopharyngeal CT images of 109 children were collected. After reconstruction of all images, the size of adenoid (A/N value) and nasopharyngeal cavity volume were measured and calculated. The children were divided into normal group and hypertrophic group according to A/N value, also OSAHS group and non-OSAHS group according to whether had OSAHS or not. The indexes were compared between normal group and hypertrophic group. The correlation of A/N value and nasopharyngeal cavity volume in different genders and ages were analyzed, and the impact of OSAHS on the relationship of A/N value and nasopharyngeal cavity volume was observed. Results: Nasopharyngeal volume of hypertrophic group ([3 111.67±1304.73]mm3) was smaller than that of normal group ([4 960.55±2 036.14]mm3,P<0.01). A/N value of hypertrophic group (0.69±0.11) was greater than that of normal group (0.45±0.97, P<0.01). The nasopharyngeal volume was negatively correlated with A/N value in both genders (rmale=-0.43, rfemale=-0.42, both P<0.01). The correlation coefficient of A/N value and nasopharyngeal volume in children <5 years old (r=-0.43) was less than that in children aged 6-10 years old (r=-0.49), and of OSAHS group (r=-0.60) was higher than of non-OSAHS group (r=-0.33). Conclusion: Negative correlation of adenoid size and nasopharyngeal cavity volume exists, which is of age difference. Compared with non-OSAHS children, adenoid size is obviously correlated with nasopharyngeal cavity volume in children with OSAHS.

Combination of adenoid and upper airway morphology in predicting obstructive sleep apnea hypopnea syndrome in children / 中国医学影像技术

Objective: To analyze the relationship of adenoid and upper airway morphology with obstructive sleep apnea hypopnea syndrome (OSAHS) in children, and to observe the efficacy of predicting OSAHS. Methods: Totally 109 children aged 1-10 years who received nasopharyngeal CT volume scanning were enrolled and divided into OSAHS group (n=20) and non-OSAHS group (n=89). After 3D reconstruction of all CT images, the shape and size of adenoid and the morphology of upper airway (including nasopharyngeal volume, nasal space, airway narrowest area, upper and lower diameter as well as left and right diameter) were evaluated. The shape and size of adenoid and the morphology of upper airway were compared between 2 groups, the relationships with OSAHS were analyzed, and the efficacy of combination of which for predicting OSAHS were evaluated. Results: Statistical differences of nasopharyngeal volume, nasal space, upper airway narrowest area, upper and lower diameters and left and right diameters (t=2.07, 4.55, 3.96, 3.62, 3.48, all P<0.05), also of adenoid hypertrophy and adenoid morphology (χ2=24.43, 12.94, both P<0.05) were found between 2 groups. Adenoid hypertrophy and OSAHS were more likely to occur in children with smaller nasal space, airway narrowest area and left and right diameter. Adenoid hypertrophy was a risk factor for OSAHS. The AUC, sensitivity, specificity and accuracy of combination of adenoid and upper airway morphology in prediction of OSAHS was 0.91, 90.00%, 79.78% and 81.65%, respectively. Conclusion: Adenoid hypertrophy is a risk factor of OSAHS. Combination of adenoid and upper airway morphology has good efficacy for predicting OSAHS in children.

The Role of Modified Expansion Sphincter Pharyngoplasty in Multilevel Obstructive Sleep Apnea Syndrome Surgery

Abstract Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by an excessive narrowing of the pharyngeal airway that also collapses during inspiration, with an important role played by the lateral pharyngeal wall in the development of the obstruction. Objective To describe our surgical experience with modified expansion sphincter pharyngoplasty (MESP) in the management of lateral collapse in upper airway multilevel surgery. Methods A total of 20 patients with moderate to severe OSAS were recruited in the Ear, Nose and Throat (ENT) Department of the University of Palermo, Italy. All of the enrolled patients refused the ventilatory therapy. The subjects were evaluated for snoring, and daytime sleepiness had a clinical evaluation including collection of anthropometric data and ENT examination and rhinofibroscopy with Müller maneuver. The patients undergoing upper airway multilevel surgery and we selected for MESP the patients with an oropharyngeal transverse pattern of collapse at Müller maneuver. Results In the postoperative assessment, all of the patients reported a reduction in snoring scores and daytime sleepiness. We observed a reduction in the mean apnea-hypopnea index (AHI) of 57.5% of the sample, which decreased from a mean value of 41.7 ( ± 21.5) to 17.4 ( ± 8.9) (p< 0.05), with a success rate, according to the Sher criteria, of 65%. We observed very few postoperative complications. Conclusion Modified expansion sphincter pharyngoplasty in multilevel surgical therapy preceded by a careful selection of patients has proven to be effective in treating patients with moderate to severe syndromes.

Prevalencia de colonización nasofaríngea por neumococo en niños de 1 a 5 años de edad institucionalizados en Cienfuegos. 2014-2015 / Prevalence of naso-pharyngeal Pneumococcal colonization in children between 1 to 5 years old in pre-school educative centers. 2014-2015

Fundamento: El Streptococcus pneumoniae forma parte de la flora bacteriana normal de la mucosa nasal y faríngea. La colonización nasofaríngea antecede a la enfermedad neumocócica y los individuos afectados constituyen el reservorio a nivel comunitario.Objetivo: determinar la prevalencia de colonización nasofaríngea global y por serotipos de Streptococcus pneumoniae en niños de 1 a 5 años institucionalizados, previo a la vacunación antineumocócica.Métodos: se realizó un estudio descriptivo de corte transversal en el municipio de Cienfuegos, en el período comprendido de junio del 2014 hasta abril del 2015, en niños de edades entre 1 y 5 años, que asisten a círculos infantiles (N=1 129). Las muestras de exudado nasofaríngeo se tomaron siguiendo los protocolos establecidos. Se estimó la prevalencia de colonización y se identificaron los serotipos más frecuentes.Resultados: la prevalencia global de colonización nasofaríngea por neumococos fue de 32,32 %. Los serotipos vacunales más frecuentes fueron el 19F (6,02 %) y el 6B (3,99 %); de los relacionados con la vacuna, predominó el 6A (5,49 %) y de los no vacunales, el más observado fue el 14B.Conclusión: la colonización nasofaríngea en niños preescolares no vacunados contra el neumococo presentó una prevalencia elevada, a expensas de los serotipos incluidos en las vacunas conjugadas antineumocócicas.

Foundation: Streptococcus pneumoniae is part of the normal bacterial flora of the nasal and pharingeal mucosa. Naso-pharyngeal colonization precedes the pneumococcal disease and affected individuals are a reservoir at the community level.Objective: to determine the prevalence of global naso-pharyngeal colonization and by serotypes of Streptococcus pneumoniae in children of pre-school age before anti pneumoccocal vaccination.Methods: a cross descriptive study in the Cienfuegos Municipality, within the period of June 2014 and April 2015. in children aged between 1 and 5 years attending preschool educative centers (N=1 129). Samples of naso-pharyngeal exudates were taken following the set guidelines. The prevalence of colonization was estimated and the most frequent serotypes were identified.Results: the global prevalence of naso-pharyngeal colonization was 32,32 %. The most frequent vaccine serotypes were 19F (6,02 %) and 6B (3,99 %); of those related with the vaccine, 6A predominated (5,49 %) and of the not related to the vaccine the most frequently observed was 14B.Conclusion: naso-pharyngeal colonization in preschool children not vaccinated against pneumoccocus presented a high prevalence at the expense of the serotypes included in the conjugated anti-peumococcal vaccines.

The differential diagnosis of abnormal image in the nasopharyngeal cavity and wall / 中华放射学杂志

Objective To improve the differential diagnostic accuracy of abnormal image in the nasopharyngeal cavity and wall.Methods Sixty-five cases with abnormal image in the nasopharyngeal cavity and wall were collected.Twenty cases were proven by operation and pathology.Forty-five cases were proven by biopsy and pathology. All the patients were examined by using CT and (or) MRI. Their imaging features were analyzed in details.Results In 19 cases, polyp and inverted papilloma in the nasal cavity and choanal projected into the nasopharyngeal cavity. Small air bubbles or contact between the lesion and the nasopharyngeal wall were detected in 18 of them. The edge of the polyp was regular, while the margin of the inverted papilloma was irregular. In 11 cases, nasopharyngitis or adenoidal hypertrophy located in the posterosuperior wall. The anterior borders were almost straight or curve toward inside, and the contrast enhanced CT and MRI scans showed that the mucous membrane lines were continuous. Oropharyngitis in the right side spread to the right wall of the nasopharynx without clear borderline and the space occupying effect was little in 1 case. There were 33 cases of nasopharyngeal carcinoma (NPC) and 1 case of non-Hodgkin′s lymphoma (NHL), and the anterior borders of the masses were evaginated like a curve, and most of them were accompanied with shallowing or disappearing of pharyngeal recess and tumefaction of the levator muscle of palatine velum.Conclusion According to the imaging features, most of the abnormalities in the nasopharyngeal cavity and wall can be diagnosed correctly.