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Children with obstructive sleep apnea (OSA) show symptoms such as snoring, sleep apnea, and oral breathing. The diagnosis of the disease can be made through polysomnography and as the most common causes are tonsillar and adenoid hypertrophy, tonsillectomy and adenoidectomy (T et A) are considered as initial treatment. OSA is an increasingly recognized problem in children with Down syndrome, who are more prone to facial hypoplasia, hypoplasia of the mandible, and have a large tongue. In OSA Down syndrome patients, T et A can be performed if tonsillar hypertrophy is present. However, because these patients have underlying diseases (atlatoaxial unstability, airway problem, heart problem, endocrine problem), general anesthesia may be difficult and cervical extension may be limited during the operation. We describe a case of 10-year-old child with Down syndrome and OSA, who underwent T et A under general anesthesia through multidisciplinary care.
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Background and Objectives@#Voice therapy (VT) is considered to be the gold standard of treatment of vocal fold nodule in children. This study was designed to analyze the success rate of pediatric VT and investigate the predictive factors for good response of periatic VT for vocal fold nodule.Materials and Method This was a retrospective cohort study of 23 patients under 18 years old who were diagnosed with vocal fold nodule and received pediatric VT. We divided the patients into responding and non-responding groups. We analyzed clinical and voice parameters related to the voice results. @*Results@#Twelve patients showed improved findings after VT. By univariate analysis, female patients (85.7%) and adolescence children (100%) showed a good response to VT. In multivariate analysis, female sex (p<0.05) and adolescence children (p<0.05) were significantly related to a successful voice response. Proton pump inhibitor or antihistamine, mucolytics treatment and pre-VT voice parameters did not significantly influence voice outcomes. @*Conclusion@#Pediatric VT is more effective in female and adolescence children.
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Background and Objectives@#The canalith reposition procedure (CRP) is used for the treatment of benign paroxysmal positional vertigo (BPPV) where the accuracy of position may affect the therapeutic efficacy. We investigate the accuracy of head position in CRP and its influencing factors during the procedure by measuring the position using inertial sensors and three dimensional remodeling.Subjects and Method We included 28 patients who were diagnosed as BPPV. To evaluate the accuracy of the CRP, we used the inertial sensor on the patient’s goggle used for videonystagmography. We evaluated the accuracy of the treatment compared to the textual treatment used during CRP. We also evaluated patient factors that affected the accuracy of head position as well as analyzing the correlation between the error rate and the successful treatment rate. @*Results@#While the average error rate was 12.6±5.8% for the PSCC group, it was 10.2±5.2% for the lateral semicircular canal (LSCC) group. For the posterior semicircular canal (PSCC) the group with body mass index (BMI), less than 25 patients had the lower error rate than the group with BMI greater than 25. There was no significant differences regarding the error rate according to BMI or age in the PSCC group. There is no significant differences regarding the error rate between those treated within 1 week and those over 1 week. For the LSCC delayed treatment group, there was no significant differences of error rate between the 1st and 2nd maneuver at each position. @*Conclusion@#For the Epley maneuver, the error rate of patients with high BMI is higher than those with low BMI. When the repeated barbeque maneuver was conducted, patients could have a more accurate position due to the learning effect. Care should be taken to ensure accurate CRP by considering various factors.