Rigid bronchoscopy for the suspicion of foreign body in the airway.

OBJECTIVE: Airway foreign bodies present a diagnostic dilemma and has been recognized for many years. Since aspiration of foreign bodies can be a serious and sometimes fatal problem, early intervention and proper management is vital. METHOD: In this retrospective study, the results of 1887 bronchoscopies, which were performed between the years 1973 and 2004 for the suspicion of foreign body aspiration in children, were presented. Various instruments and techniques were used over 31-year period and rigid bronchoscopy was the preferred method of foreign body extraction. RESULTS: There were 1106 boys and 781 girls with the median age of 2.3 years. Seventy-four percent of patients were less than 3 years old. The most common type of foreign body (89.9%) was organic; watermelon seeds (39.7%) were the most frequent organic foreign bodies. Eight hundred and twenty-three patients (43.6%) were referred to our clinic within the first 24h of the event while 4.5% of the patients were admitted to the hospital with the suspicion of foreign body in the airway later than one month. At bronchoscopy, a foreign body was identified in 79.1% of patients and no foreign body was seen in 20.9% of patients. Foreign bodies were encountered in 96.3% of the patients with positive history whereas 28.1% of the patients with negative history had foreign body. Of the patients with foreign bodies, 93.2% had positive history. Overall, the positive history was obtained from 85.2% of patients. The incidence of postbronchoscopic tracheotomy, thoracotomy, and overall mortality rate were 0.47, 0.15, and 0.21%, respectively. CONCLUSION: Otolaryngologists should consider foreign body aspiration in the airway in the differential diagnosis of any patient with the complaints of stridor, dyspnea, sudden onset of cough and intractable and recurrent lower respiratory tract infections. A careful history and physical examination were strong indicators of the diagnosis and raised the index of suspicion of an aspirated foreign body. Timely intervention with the experienced surgical team would decrease the complication rate and mortality rate. However, prevention of aspiration with the education of parents and caregivers is very important.

The role of factor V Leiden and prothrombin G20210A mutations in sudden sensorineural hearing loss.

OBJECTIVES: To investigate the incidence of factor V Leiden and prothrombin G20210A in sudden sensorineural hearing loss patients. STUDY DESIGN: The patient group for this study was selected prospectively in the case of 28 patients and retrospectively in the case of another 28. SETTING: Tertiary referral center. PATIENTS: Fifty-six patients (29 female, 27 male) with sudden sensorineural hearing loss (SSHL) and 95 control subjects (48 female, 47 male) were enrolled in this study. The age of the control subjects were between 26 and 76 (38 +/- 16.7), and that of the patients were between 10 and 87 (42.6 +/- 18.2). INTERVENTION: The factor V Leiden and prothrombin G20210A mutations were detected by rapid polymerase chain reaction amplification of genomic DNA extracted from the SSHL patients' peripheral blood cells. MAIN OUTCOME MEASURE: Thrombotic microangiopathic disorders are characterized by widespread microvascular thrombosis leading to end-organ injury. The mutations of factor V Leiden and prothrombin gene are known as genetic risk factors for thrombotic microangiopathy in normal patients. SSHL may occur with occlusion of the cochlear blood supply by microthromboangiopathy. RESULTS: Factor V Leiden mutation was found to be higher in SSHL patients when compared with control subjects (16.1% vs 5.3%). The difference between the two groups was found to be statistically significant (p = 0.02). However, statistical significance was not found between the groups in regard to prothrombin G20210A mutation. Factor V Leiden and prothrombin gene mutations were heterozygous in all of the subjects. CONCLUSION: A significant association between factor V Leiden mutation and idiopathic SSHL could be shown in this study. There was no correlation, however, between the occurrence of idiopathic SSHL and prothrombin mutation.