Tracheocutaneous Fistula After Tracheostomy: Spotlight on a Closure Technique With a High Success Rate.

Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation. While it effectively provides a secure airway, tracheostomy can lead to complications, such as tracheal stenosis, tracheomalacia granulation tissue, pneumonia, aspiration tracheovascular fistula, tracheoesophageal fistula, and tracheocutaneous fistula.  In this systematic review, we aim to identify the most suitable closure method and compare recurrence outcomes between methods for persistent tracheocutaneous fistula (TCF) in all age groups. We conducted a bibliographic search between January 1st, 2011 and March 10th, 2021 in the PubMed, B-on, Scopus, and Web of Science databases, and also performed a manual search to identify relevant articles. Our inclusion criteria were case series or comparative studies of surgery for persistent TCF and the success rate of TCF closure in patients both below and above 18 years of age. After applying the inclusion criteria to the research results, we included nine studies in our analysis. We found that closure by secondary intention is the most effective method for TCF closure, followed by primary and secondary intention combined. The success rate with most of the techniques was high, regardless of the size of the fistula or associated comorbidities, and its simplicity makes it an appealing treatment option in the care of patients with TCF. In conclusion, this systematic review highlights the importance of selecting an appropriate closure method for persistent TCF and provides valuable insights into the success rate of various techniques.

Lemierre Syndrome Complicating Deep Neck Infection and Descending Mediastinitis Secondary to Methicillin resistant Staphylococcus aureus (MRSA) Infection.

Lemierre syndrome (LS) is an oropharyngeal infection, followed by bacteremia, thrombosis of the internal jugular vein and subsequent hematogenic metastasis via septic emboli. We report a case of Lemierre syndrome complicated by descending necrotizing mediastinitis due to a Methicillin-resistant Staphylococcus aureus (MRSA) infection in a 5-month-old Saudi boy.

Is type 1 diabetes mellitus a cause for subtle hearing loss in pediatric patients?

The objective of this study is to investigate the effects of IDDM on the function of the auditory pathway from the cochlea to the auditory cortex in child patients. Totally, 140 ears of 70 children with IDDM and 60 ears of 30 age and gender-matched healthy controls were included in the study. The ages of patients and controls ranged from 4 to 14 years. Audiological assessment including pure-tone audiometry, otoacoustic emission testing (OAE) and auditory brainstem response testing (ABR) has been performed to all participants. There was no significant difference between the patients and controls regarding pure-tone thresholds on audiometry (p > 0.05). The latencies of waves I, III and V on ABR were not significantly different between the patients and controls (p > 0.05). The amplitudes on DPOAE testing obtained from both groups were not significantly different at the frequencies of 2,000 and 4,000 Hz (p > 0.05). However, the DPOAE amplitudes of the patients at 1,000 Hz were significantly lower than those of controls at the same frequency (p = 0.03). There was no difference between the patients who had chronic disease (>5 years) and healthy controls regarding pure-tone audiometry, ABR and DPOAE testing results (p > 0.05). In the light of the findings obtained with pure-tone audiometry, and OAE and ABR testing, it seems that auditory system is spared in children with IDDM at clinical level. Diabetes control and chronicity of the disease do not impact on the auditory system except for a subclinical involvement in the apical portion of the cochlea.

Ultrasonography assessment of vocal cords mobility in children after cardiac surgery.

OBJECTIVES: Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the cardiac surgical population, an important etiology is vocal cord paresis or paralysis following extubation. In this study, we aimed to evaluate the feasibility and accuracy of ultrasonography (US) assessment of the vocal cords mobility and compare it to fiber-optic laryngoscope (FL). MATERIAL AND METHODS: A prospective pilot study has been conducted in Pediatric Cardiac ICU (PCICU) at King Abdulaziz Cardiac Center (KACC) from the 1st of June 2009 till the end of July 2010. Patients who had cardiac surgery manifested with significant signs of upper airway obstruction were included. Each procedure was performed by different operators who were blinded to each other report. Results of invasive (FL) and non-invasive ultrasonography (US) investigations were compared. RESULTS: Ten patients developed persistent significant upper airway obstruction after cardiac surgery were included in the study. Their mean ± SEM of weight and age were 4.6 ± 0.4 kg and 126.4 ± 51.4 days, respectively. All patients were referred to bedside US screening for vocal cord mobility. The results of US were compared subsequently with FL findings. Results were identical in nine (90%) patients and partially different in one (10%). Six patients showed abnormal glottal movement while the other four patients demonstrated normal vocal cords mobility by FL. Sensitivity of US was 100% and specificity of 80%. CONCLUSION: US assessment of vocal cord is simple, non-invasive and reliable tool to assess vocal cords mobility in the critical care settings. This screening tool requires skills that can be easily obtained.