Efficacy and safety of sublingual immunotherapy of allergic rhinitis in children between 4 and 5 years age group and 11 and 12 years age group / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of the sublingual immunotherapy with Dermatophagoides fannie drops on children with allergic rhinitis of different age groups (4 - 5 years old group and 11 - 12 years old group).</p><p><b>METHODS</b>Sixty-two children aged 4 - 5 years, and 71 children aged 11 - 12 years, who suffered from dust mite induced allergic rhinitis, was randomly divided into the sublingual immunotherapy (SLIT) + drug group and drug group. SLIT + drug group was treated with a standardized sublingual immunotherapy drops of Dermatophagoides fannie and combined with symptomatic therapy, drug group was treated with mometasone furoate nasal spray and desloratadine tablets as symptomatic treatment. These children were followed up for 2 years with one visit in every 3 months, then visited at the end of the study and 2-years after the treatment ended. Symptom scores and medication scores were recorded at each visit. Comprehensive evaluation of symptoms, medication, and patients' degree of satisfaction were used.</p><p><b>RESULTS</b>Two years after SLIT finished, symptom scores (SLIT + drug group: 1.13 ± 1.05; drug group: 4.68 ± 3.09), medication scores (SLIT + drug group: 0.07 ± 0.04; drug group: 0.36 ± 0.25) of SLIT + drug group were significantly lower than those in drug group (t value were -8.43, -8.87, respectively, all P < 0.01). Also, the subjective assessment of patients' symptoms, medication, and treatment satisfaction in SLIT + drug group was significantly lower than those in drug group. Subjective assessment symptoms, medication, and treatment satisfaction in age group 4 - 5 was the same as in age group 11 - 12. After SLIT ended for 2 years, subjective assessment and treatment satisfaction in age 11 - 12 group was better than those in age 4-5 group in medication score.</p><p><b>CONCLUSIONS</b>SLIT demonstrated clinical improvement in children of different ages during 2 years treatment. Two years after withdrawal, the symptom scores, medication score and subjective satisfaction in 11 years old group are better than those in 4-5 years old group.</p>

Experience in the removal of difficult and high risk tracheobronchial foreign body by bronchoscopy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the best methods and skill for the removal of difficult and high risk tracheobronchial foreign body under bronchoscope.</p><p><b>METHODS</b>A retrospective review was performed between August 1995 to August 2012. There were 4217 children with tracheobronchial foreign body, among them, 272 were diagnosed as high-risk, highly difficult tracheobronchial foreign bodies confirmed by clinical manifestations, foreign body type and bronchoscopy.</p><p><b>RESULTS</b>In 271 children, the tracheobronchial foreign body was removed under bronchoscope, the success rate was 99.6%; only one child with a pen cap blocking the left lower lobe bronchus was transferred to the department of thoracic surgery, and the foreign body was finally removed by thoracotomy. Eighty-five children (among them, 82 children were under 1 year of age) had II-II degree laryngeal obstruction, the emergency surgery was performed to remove the foreign body and to relieve the laryngeal obstruction. Twenty-six children had lung infection and 27 children had failed foreign body removal surgery before, in all these children, the foreign body was removed after infection control. There were 17 children with the pen cap as the tracheobronchial foreign body, direct removal was successful in 12 children with the history less than two weeks; in 4 children, the foreign body was removed after 0.1% epinephrine saline flush, and 1 case with the homemade bronchial foreign body hook remove. There were 26 children with the whistle as the foreign body, and 32 children had large and sharp foreign bodies. In these cases, the foreign bodies were removed together with the bronchoscope. Forty-two children had multiple or fragile foreign bodies, and 16 children had subsegmental bronchial foreign bodies. In these cases, the foreign bodies were removed with forceps under direct vision and intraoperative bronchial lavage.In This series, 129 children received intraoperative bronchial lavage, among them, 127 children showed normal X-ray changes one week after operation. Two children with a history of more than 1 month complicated with pulmonary consolidation. After bronchial lavage, pneumothorax and subcutaneous emphysema occurred, which recovered after treatment. No glottic edema, asphyxia, and other complications were found, the complication rate of surgery was 0.7%.</p><p><b>CONCLUSION</b>For the removal of highly difficult and high risk tracheobronchial foreign bodies, preoperative analysis and discussion should be sufficient, appropriate surgical skill and surgical instruments may improve the success rate of the surgery and prevent the operation complications.</p>

Risk factors for otitis media with effusion in children / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To identify the risk factors for otitis media with effusion (OME) in some kindergarten children in Wuhan City of China and analyze the results with reference to the review of the literature.</p><p><b>METHODS</b>The study subjects were 3 to 6 years old children drawn from a school screening program for OME in Wuhan. All subjects were assessed with routine otorhinolaryngologic examination, otoscopic examination and tympanometry. During the test, parents were interviewed to provide information with regard to the children's birth history, neonatal history, feeding history, family smoke history, otological history, rhinorrhea, sneeze, nasal obstruction, snoring, tonsillitis episodes history, et al. These data formed the basis in the estimation of potential risk factors for OME.</p><p><b>RESULTS</b>In the univariate analysis of 144 cases and 288 controls, significantly elevated odds ratios (OR) for OME were detected on the symptoms of nasal obstruction (OR = 2.60, P = 0.002), rhinorrhoea (OR = 1.442, P = 0.003), high hard palate (OR = 4.411, P < 0.0001), and previous history of acute otitis media (OR = 1.77, P = 0.025). However, four factors were found to be significant in the multivariate logistic regression model, including feeding history (OR = 0.746, P = 0.047), nasal obstruction (OR = 2.56, P = 0.003) and previous acute otitis media episodes (OR = 1.735, P = 0.032).</p><p><b>CONCLUSIONS</b>Previous acute otitis media episodes and nasal obstruction were risk factors, which was accordant with literature. In addition, breastfeeding was a protective factor for OME, but acute tonsillitis was not a factor for OME. A child who had previous acute otitis media episode and often had nasal obstruction is suggested to have otorhinolaryngologic regulatory examination.</p>