Can contaminated water be rendered safe for nasal saline irrigations?

OBJECTIVES/HYPOTHESIS: To compare sterile water to three methods of sterilization (carbon filtration, boiling, and ultraviolet [UV] light) for preparation of nasal saline irrigants free of bacterial and amebic contaminants. STUDY DESIGN: Bench-top translational research and cost comparison. METHODS: Sterile water was compared to common sterilization methods. Sterile water was contaminated with known concentrations of Staphylococcus aureus, Pseudomonas aeruginosa, Moraxella catarrhalis, Acinetobacter baumannii, Klebsiella pneumonia, Legionella pneumophila, and Naegleria fowleri. Test samples were subjected to boiling, carbon filtration, or ultraviolet light (UV) and then cultivated on appropriate media. Controls included samples of sterile water (negative control) and untreated test samples (positive control). RESULTS: Carbon filtration reduced but did not eliminate the number of organisms present in test samples. Boiling test samples for 5 minutes and UV light treatment resulted in sterilization of all organisms. Negative (sham contaminated) samples produced no growth, whereas positive (untreated) samples grew numerous organisms as expected. A cost comparison between bottled water and UV water sterilization (with SteriPEN Ultra) became equal in less than 2 years of consistent use. CONCLUSIONS: Carbon filtration reduces contamination but does not sterilize water and is thus unsafe for preparation of nasal saline irrigant. Boiling and UV treatment resulted in sterilization and are equivalent to purchased sterile water. Ultraviolet treatment was found to be safe, convenient, and a cost-effective alternative to purchased sterile water. LEVEL OF EVIDENCE: NA Laryngoscope, 127:1513-1519, 2017.

Case presentation and images of a lingual osseous choristoma in a pediatric patient.

Since its original description in 1913, fewer than 100 lingual osseous choristomas have been reported in the literature; thus, prevalence is unknown. We describe a case of an 11 year old male who was seen in consultation after an incidental left posterior tongue mass was discovered on exam. The patient's presentation of an asymptomatic, hard, pedunculate posterior tongue lesion is typical; however, if one is to believe the proposed congenital remnant theory in regards to the etiology of this benign tumor, it is curious that no mention was made of a lesion of the tongue on prior evaluations by his pediatrician or on the otolaryngologic examinations performed 3 and 6 years prior to the most recent presentation. Included with the case description are interesting radiographs, intra-operative photos, gross specimen photo and microscopic images.

Management of pediatric subglottic cysts using the Bugbee fulgurating electrode.

IMPORTANCE: Subglottic cysts are an important cause of pediatric airway obstruction. We describe the typical presentation and management of subglottic cysts, with historical recurrence rates between 12.5% and 71.0%, and treatment using the Bugbee fulgurating diathermy electrode as a technique to successfully manage subglottic cysts with a low recurrence rate. OBSERVATIONS: A retrospective review was performed on 16 consecutive patients treated for subglottic cysts at a single tertiary-care facility. The mean gestational age was 26.9 weeks, with a male to female ratio of 4.3:1. All patients had at least 1 prior intubation, with a mean of 1.8 prior intubations per patient. Biphasic stridor was the most common presenting symptom, occurring at a mean of 7.3 months after the last extubation. At the time of diagnosis, patients were found to have a mean of 1.6 cysts, and the left lateral subglottic wall was the most common location of unilateral cysts. Nine patients (56%) had an associated laryngeal pathologic condition. Symptomatic cyst recurrence occurred in only 6% of patients, and no major complications were reported. CONCLUSIONS AND RELEVANCE: This review presents a treatment method for subglottic cysts that is safe and effective and has a symptomatic recurrence rate lower than previously reported.