Habitual snoring and obstructive sleep apnea syndrome in children: effects of early tonsil surgery.

Habitual snoring and obstructive sleep apnea syndrome (OSA) in children are important in determining disturbed sleep, daytime symptoms and haemodynamic modifications. Moreover, chronic snoring is often associated with enlarged tonsils and adenoids. We studied 60 children (mean age 42.2 months) with habitual snoring, defined as a positive answer to the question 'does the child snore every night', by nocturnal or diurnal polysomnography in order to evaluate breathing disorders and choose surgical correction of upper airway stenosis. In more than half the children habitual (every night) snoring begin before the first year of life and is associated with obstructive apneas. Both nocturnal and, with some limits, diurnal recordings may be a good tool for diagnosis of sleep-related upper airway obstruction. Early adenomonotonsillectomy, in mild to moderate form and in children before 4 years of age, and adenotonsillectomy in the others seems to show a clinical and polysomnographic resolution of snoring and OSA during a short-term follow up.

Obstructive sleep apnea in the Rubinstein-Taybi syndrome.

The Rubinstein-Taybi syndrome is characterized by a pattern of malformations including broad thumbs and big toes, microcephaly, facial dysmorphism, small stature, and mental retardation. Obstructive sleep apnea (OSA), has been described in several facial or skeletal malformations, but never in the Rubinstein-Taybi syndrome. We studied a 9-year-old boy, previously diagnosed as having the Rubinstein-Taybi syndrome and affected by severe OSA, as documented by polysomnography. He manifested the habitual and heavy snoring with breathing difficulties at night, and excessive daytime sleepiness. Short neck and obesity were important factors for the severity of the syndrome. Continuous positive airway pressure was not tolerated and weight loss was the only possible treatment, as upper airway surgery was not indicated by cephalometric, otolaryngologic or clinical results.

Azithromycin in upper respiratory tract infections: a clinical trial in children with otitis media.

Azithromycin is a newly developed azalide antibiotic which is very active against microbes causing respiratory tract infections; tissue concentrations remain elevated for a long time after discontinuation of treatment. A clinical study was conducted to compare azithromycin (10 mg/kg administered as a single daily dose for 3 days) with amoxycillin/clavulanic acid (50 mg/kg/day given b.i.d. for 10 days) in 30 children with otitis media. Sensitivity testing demonstrated good azithromycin activity against beta-haemolytic streptococci, Moraxella catarrhalis, Haemophilus influenzae and Staphylococcus aureus. By day 12, clinical cure was recorded in 14/15 children treated with azithromycin and this was maintained at day 30. In the day 12 and 13/15 children by day 30. It was concluded that a 3-day azithromycin regimen produces a satisfactory clinical response and the eradication of key pathogens, and was acceptable for children.

Transtympanic drains in the treatment of serous otitis in children; anatomical versus functional long term results.

The long term results are reported of transtympanic drains in 391 ears of 258 children affected by serous otitis; 150 ears have been evaluated at the end of a 3-7-year observation period. (1) A high percentage of ears with major anatomical lesions was found (46.6%), especially in the higher age group (greater than 7 years). (2) Functional hearing results are better than anatomical results; 84.6% of the subjects had a hearing level better than 20 dB (0-10 dB: 53.3%; 11-20 dB: 31.3%). (3) Anatomical and functional results are worse in case of recurrence (2 or more drains). (4) It is imperative to control periodically those children with major tympanic lesions and present good hearing.

Evaluation of tympanometry in diagnosis and treatment of otitis media of the newborn and of the infant.

The authors report tympanometric findings in normal newborns and infants (W-shaped, large smooth-notched curves), comparing them with those obtained in 34 ears of infants aged 5-120 days with middle ear pathology. In most cases a large smooth-notched curve was found, both in cases of serous otitis or purulent otitis. The W-shaped curve was present only in the case of normal middle ear condition. The large smooth-notched curve, however, may be representative of a normal or a pathological condition. For this reason tympanometry is not always a useful clinical tool to differentiate normal from pathological conditions of the middle ear up to the fourth month of life.