Clinical practice: diagnosis and treatment of childhood snoring.

Obstructive sleep-disordered breathing in children is a relatively common problem, presenting in various ways, from primary snoring, without an apparent decrease in quality of life, to obstructive sleep apnea with cognitive, cardiac, and growth abnormalities. History, clinical examination, radiologic evaluations, sleep studies, and other diagnostic modalities are reviewed. Since application and interpretation of these methods are not consistent in studies of snoring, a consensus on optimal treatment options has not been established. Traditionally, adenotonsillectomy has long been the treatment of choice. Treatment failures or recurrences as well as the existence of causes and contributing factors other than adenotonsillar hypertrophy, like obesity, facial malformations, and Down syndrome, have changed the concept of adenotonsillectomy as the ultimate cure. Several other treatment options have been proposed on their own or in combination. Continuous positive airway pressure, anti-inflammatory medications, maxillofacial, and orthodontic treatments are reviewed suggesting the need of a multidisciplinary approach in some cases. Finally, at the end of the chapter, a diagnostic and treatment work up based on current evidence is proposed for otherwise normal children or children with specific conditions.

Comparison of LigaSure vessel sealing system, harmonic scalpel, and cold knife tonsillectomy.

OBJECTIVE: We sought to compare LigaSure Vessel Sealing System tonsillectomy (LT), Harmonic Scalpel tonsillectomy (HST), and cold knife tonsillectomy (CKT). STUDY DESIGN: We conducted a prospective study on 161 adult patients undergoing tonsillectomy. Subjects were randomized to LT, HST, or CKT groups, and intraoperative bleeding, operative time, postoperative pain, and complication rates were assessed. RESULTS: The LT, HST, and CKT groups consisted of 50, 43, and 37 individuals, respectively. Intraoperative bleeding was significantly lower in the LT group, whereas bleeding in the HST group was significantly lower than that in the CKT group. Operative time and postoperative pain were significantly lower in the LT and HST groups. One primary hemorrhage occurred in the HST group, and one occurred in he CKT group. Secondary hemorrhage occurred in one, two, and one patients in the LT, HST, and CKT groups, respectively. CONCLUSION: LT and HST have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with CKT, both were associated with less intraoperative blood loss and pain.

Comparative study of laser versus radiofrequency myringotomy in rabbits: The effectiveness of mitomycin C application.

OBJECTIVE: To compare laser-assisted tympanostomy (LAT) with radiofrequency myringotomy (RFM), as well as the effectiveness of mitomycin C (MC) on the above techniques, in rabbits. STUDY DESIGN: Experimental animal research protocol. SETTING: University of Crete, School of Medicine, Medical Experimental Education and Research Center. METHODS: Bilateral myringotomies were performed under general anesthesia on 40 rabbits. LAT was performed on 20 animals (40 ears) and RFM on the remaining 20 animals (40 ears). MC (0.3 mg/mL) pledgets were applied to the right ears and saline pledgets to the left ears. Animals were monitored weekly using otomicroscopy until myringotomy closure. Kaplan-Meier survival techniques were used to compare myringotomy patency times. INTERVENTIONS: Under general anesthesia, bilateral LAT was performed on 20 rabbits and bilateral RFM on 20 rabbits. MAIN OUTCOME MEASURES: Myringotomy patency time. RESULTS: The mean patency times of the saline-treated ears were: 1.85 weeks (95% confidence interval [CI], 1.556-2.144 wk) for the LAT group and 1.70 weeks (95% CI, 1.494-1.906 wk) for the RFM group. This difference was not significant (p > 0.5). MC application significantly prolonged mean patency time (p < 0.0001) in both LAT and RFM groups. The mean patency times in the MC-treated ears were 5.45 weeks (95% CI, 5.226-5.674 wk) for the LAT group and 5.55 weeks (95% CI, 5.285-5.815 wk) for the RFM group. This difference was not significant (p > 0.5). CONCLUSION: There is no significant difference in myringotomy patency times between LAT and RFM techniques in rabbits, whereas MC significantly prolongs the patency rate of either technique.

Radiofrequency myringotomy with the topical use of mitomycin C: an experimental study.

OBJECTIVE: To assess the use of radiofrequency myringotomy in combination with mitomycin C as an alternative myringotomy technique on rabbits. STUDY DESIGN: Experimental animal research protocol. SETTING: University of Crete, School of Medicine, Medical Experimental Education and Research Center. METHODS: Radiofrequency myringotomies were performed under general anesthesia on both ears of 20 rabbits. Mitomycin C (0.3 mg/ml) pledgets were applied in the right ears (study group) and saline pledgets in the left ears (control group). Animals were monitored using otomicroscopy weekly until myringotomy closure. Kaplan-Meier survival techniques were used to compare myringotomy patency time between the two sides. INTERVENTION: Radiofrequency myringotomy under general anesthesia on both ears of 20 rabbits. MAIN OUTCOME MEASURE: Myringotomy patency time. RESULTS: The mean patency time of the study group was 5.45 weeks (95% confidence interval, 5.185-5.715 weeks). The mean patency rate for the control side was 1.60 weeks (95% confidence interval, 1.38-1.82 weeks). The Breslow (generalized Wilcoxon) test showed the study group to have significantly longer patency of radiofrequency myringotomy than the control group (p<0.0001). CONCLUSION: The patency period of radiofrequency myringotomy was not long enough to be proposed as an alternative to the insertion of ventilation tubes, although mitomycin C had a significant adjunct effect in prolonging the patency rate of radiofrequency myringotomy on rabbits.