Series de Pediatría Garrahan. El niño con problemas de la vía aérea superior / Garrahan Pediatrics Series. The child with upper airway problems

Las enfermedades de la vía aérea superior en la infancia constituyen la causa más frecuente de consulta al pediatra y abarcan una diversidad de trastornos cuyo abordaje preciso y oportuno es fundamental. En este nuevo volumen de las Series de Pediatría Garrahan: El niño con problemas de la vía aérea superior se han reunido pediatras con amplia experiencia en el área ambulatoria del Hospital y prestigiosos especialistas en otorrinolaringología pediátrica para resumir y actualizar las claves en el manejo integral de esta problemática. Entre sus características se destacan: El estudio detallado de las patologías clínicas más frecuentes, como otitis media aguda, rinosinusitis, estridor, tos crónica, hipoacusia y faringoamigdalitis, y de las indicaciones de amigdalectomía o adenoidectomía. El abordaje, a través de casos clínicos y de manera dinámica, con la secuencia de presentación clínica, los estudios de diagnósticos, el tratamiento y la evolución de los niños con estas patologías y sus complicaciones. El cierre de cada capítulo con un recordatorio de puntos clave y lecturas recomendadas y, además, material complementario como videos o descripción de procedimientos disponibles en el sitio web. Comparte y transmite una modalidad de trabajo propia del hospital, con base en el rol central del pediatra como coordinador de la atención interdisciplinaria en el marco de su tarea cotidiana junto a los niños y sus familias. Una obra actualizada y práctica que aporta información científica y experiencia de los profesionales de una institución de prestigio. Este tomo y las Series de Pediatría, en su conjunto, serán de gran utilidad para todos aquellos miembros del equipo de salud que atienden y cuidan niños, dondequiera que trabajen al servicio de la salud infantil.

Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test.

UNLABELLED: Balance disorders are common in adult patients but less usual in the pediatric population. When this symptomatology appears in children it is a cause for concern, both for parents and health-care professionals. OBJECTIVES: To explain the balance disorders in children describing a case series and to discuss the main etiologies found according to age. STUDY DESIGN: A retrospective, observational, descriptive, and cross-sectional study was conducted. POPULATION: Patients aged 1-18 years who consulted because of balance disorders at the otolaryngology department of a pediatric tertiary-care hospital between March 2012 and July 2015. RESULTS: Two hundred and six patients were included in the study. Median age was 10 years. The most common diagnoses were vestibular migraine in 21.8% of the children, ataxia in 9.22%, benign paroxysmal vertigo of childhood in 7.77%, and post-traumatic vertigo in 6.31%.Overall, 61 videonystagmographies- of which 46 were normal - and 55 video head impulse tests - which were normal in 45 and showed abnormalities in the vestibulo-ocular reflex gain in 10 - were performed. CONCLUSIONS: In a child with balance disorders, the medical history and neurotological examination are essential. Vestibular migraine is the most commonly found disorder in every age group, and most of the patients have a family history of migraine. Ancillary studies, especially the video head-impulse test, provide important data to confirm the diagnosis.

Acute otitis media in infants younger than three months not vaccinated against Streptococcus pneumoniae.

UNLABELLED: The true incidence of acute otitis media (AOM) in neonates and infants younger than three months is unknown. In this population organisms causing AOM may disseminate leading to bacteremia, sepsis, and meningitis [1]. OBJECTIVES: To describe the clinical presentation, associated severe infections, bacteriologic etiology, and antibiotic resistance patterns of organisms isolated from the middle ear of infants younger than three months that were not vaccinated against Streptococcus pneumoniae. METHODS: Otomicroscopy was performed in all children to confirm the suspected diagnosis of AOM. When purulent effusion retained in the middle ear was diagnosed, tympanocentesis and culture of middle-ear fluid was performed by conventional methods. Serotyping was done using the Quellung technique. RESULTS: From May 2, 2009 to February 28, 2010, 52 infants met the inclusion criteria. Thirty-six were male (69.2%) and 16 were female (30.8%). From these 52 patients, 76 samples were obtained for culture. Bilateral acute suppurative otitis media was diagnosed in 24 (46.2%) infants. Of all infants, 18 (34.6%) had been treated with antibiotics before tympanocentesis. Eight patients (44.4%) had negative middle-ear fluid cultures. Sixty bacterial pathogens were isolated from the middle-ear fluid of 43 patients. Mixed infections were recorded in 14/52 patients (26.9%). Nine cultures were negative (17.3%), of which eight were from patients that had previously been treated with antibiotics. S. pneumoniae was isolated from middle-ear aspirates of 26/52 (50%) patients with acute suppurative otitis media. Twenty-two out of the 26 isolates were susceptible (84.7%) and four were intermediately susceptible to penicillin (15.3%). Streptococcus pyogenes was isolated in 3/52 (5.8%) and Haemophilus influenzae in 18/52 patients (34.6%). Five (27.8%) of these were beta-lactamase producers. Blood cultures, cerebrospinal fluid, and urine cultures were negative. Parenteral antimicrobial treatment was indicated in 29/52 (56%). CONCLUSIONS: S. pneumoniae is the most frequent pathogen to cause AOM in this age group. Empirical treatment with amoxicillin or ceftriaxone should be considered depending on clinical suspicion of severe invasive infection.

Diecisiete casos de complicaciones intratemporales de otitis media aguda en niños en dos años / Intratemporal complications from acute otitis media in children: 17 cases in two years

Introducción: Para describir las características clínicas de los niños con complicaciones intratemporales de otitis media aguda (OMA), se realizó un trabajo retrospectivo y descriptivo durante dos años. Métodos: Se consideró mastoiditis al eritema y edema retroauricular, protrusión del pabellón auricular y caída de la pared posterior del conducto auditivo externo; laberintitis, al vértigo con o sin náuseas, vómitos y nistagmus, y parálisis facial periférica, a la ausencia o disminución de la movilidad en hemicara. Previa otomicroscopía para diagnóstico de enfermedad otológica aguda coexistente, se tomó material para estudio bacteriológico de oído medio, de absceso subperióstico o de cavidad mastoidea. Resultados: Edad media: 54,23 meses; 30% menores de 12 meses; 12/17 masculinos y 5/17 femeninos; 8/17 recibían antibioticoterapia; 7/17 presentaban fiebre; 9/17 (52,9%) con mastoiditis aguda; 7/17 (41,2%) con laberintitis y 1/17 (5,9%) con parálisis facial periférica. El 17,6% presentó complicaciones endocraneales. Todos requirieron antibioticoterapia parenteral. Se realizó miringotomía en 16/17 (94,1%); drenaje de absceso subperióstico en 3/17 (17,6%) y antromastoidectomía en 2/17 (11,8%). La bacteriología fue positiva en 9/17, aislándose Streptococcus pyogenes (S. pyogenes) en el 44% de los casos. Secuelas: una hipoacusia neurosensorial. Entre enero de 2008 y diciembre de 2009 fueron asistidos 17 pacientes con complicaciones intratemporales de OMA. Conclusión: La mastoiditis aguda es la complicación intratemporal más frecuente. S. pyogenes es prevalente en estas infecciones invasivas en nuestro medio. La resolución de la OMA complicada requiere procedimientos quirúrgicos en todos los casos (miringotomía, drenaje de absceso subperióstico o antromastoidectomía) y tratamiento antimicrobiano parenteral(AU)

Background: To describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for two years. Methods: We considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface. All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess or from granulation tissue during tympanomastoidectomy. Results: From January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than twelve months and most were boys (70.6%).8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17 and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. Conclusions: Acute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess or tympanomastoidectomy) (AU)

Intratemporal complications from acute otitis media in children: 17 cases in two years.

BACKGROUND: To describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for two years. METHODS: We considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface. All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess or from granulation tissue during tympanomastoidectomy. RESULTS: From January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than twelve months and most were boys (70.6%). 8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17 and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. CONCLUSIONS: Acute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess or tympanomastoidectomy).