Olfactory assessment in the Chinese pediatric population.

Young children with olfactory disturbance are sometimes encountered in ENT clinics. We investigated the clinical applicability of olfactory testing to the pediatric population in China.One hundred and ninety-three healthy children aged 6 to 17 years were enrolled. All participants were asked for demographic information (age, sex, body mass index [BMI], and rating of olfactory function) in a structured questionnaire and underwent olfactory testing including T&T Olfactometer (T&T), odor discrimination (OD), and odor identification (OI) tests of Sniffin' Sticks.Age had a significant influence on the outcome of olfactory testing, sex, BMI, or self-rating had no influence. Children had better performance on T&T than OI and OD tests of Sniffin' Sticks.T&T and Sniffin' Sticks can be completed by Chinese children. Performance on olfactory tests increased with increasing age. T&T may be more suitable to assess olfactory function in the Chinese pediatric population.

[Management of nasal orbital cellulitis in children].

OBJECTIVE: To analyze the clinical characteristics, diagnostic and treatment principle of orbital cellulitis in children, and to improve the experience of antibiotic treatment in orbital cellulites. METHODS: Twenty children were admitted to Shenzhen Children's Hospital with the diagnosis of nasal orbital cellulitis between January 2009 and December 2013. The children were severe enough to warrant hospital admission. There were 13(65%) males and 7 (35%) females. The median age was 3.5 years (2 months to 7.2 years). The relationship between the serum C-reactive protein (CRP), white blood cell count and the hospitalization days were analyzed. The children were divided into 2 groups: Cefoperazone Sodium and Sulbactam Sodium for injection group and other antibiotic treatment group, the difference was compared. Statistical calculation was performed using SPSS 13.0 software. RESULTS: The serum CRP [(29.8 ± 22.0) mg/L] at the time of admission had a positive correlation with the time of hospitalization[ (6.3 ± 4.1) d, r = 0.46, P < 0.05]. The time of CRP decreased to normal range after admission [(3.4 ± 1.8) d] were apparently related to the hospitalization time (r = 0.81, P < 0.01). The hospital days whose CRP could be decreased to normal within 3 days [n = 12, (4.3 ± 1.7) d] were significantly shorter than that in the others [n = 8, (9.1 ± 5.0) d, t = 2.61, P < 0.05]. The hospitalization of 12 cases with Cefoperazone Sodium and Sulbactam Sodium for injection [(4.3 ± 1.9) d] was shorter than that in other 8 cases with other drugs [(9.3 ± 4.7) d, t = 2.83, P < 0.05]. Bacterial pathogens were only identified in 4 children, including 3 cases of methicillin-resistant staphylococcus aureus (MRSA), 1 case of streptococcus anginosus. Only 1 case in 20 cases with positive blood culture for Staphylococcus aureus, consistented with the pus culture. CONCLUSIONS: If early treatment at the first three days is valid, the course of nasal orbital cellulitis will be shorter and the orbital abscess can be prevented. Cefoperazone sulbactam and Sulbactam Sodium for injection is effective in treating pediatric orbital cellulitis.

[Clinical manifestations in pediatric laryngopharyngeal reflux].

OBJECTIVE: To explore the clinical manifestations in pediatric laryngopharyngeal reflux and to provide more information on diagnosis and treatment. METHOD: Sixty-two cases with recurrent respiratory infections, hoarseness and chronic cough were examined with reflux symptom index (RSI), reflux finding score (RFS), and 24-hour pH monitoring. Those who had at least two positive test for reflux were given PPI for diagnostic therapy. RESULT: All patients completed reflux symptom index (RSI) questionnaire and underwent fiberoptic laryngoscopy, and reflux finding score (RFS) was evaluated. The positive rate of RSI and RFS was 91.94% and 79.03% differently. 24-hours pH monitoring and diagnostic therapy was about 30.76% and 85.48% differently. The symptoms show hoarseness 90.32%, postnasal drip 77.42%, difficulty swallowing 74.19%, abdominal pain and chest pain 72.58%, throat clearing 64.52%, chronic cough 56.45%, dysphagia 51.61%, throat abnormal feeling 48.39%. Laryngoscope examination shows inter-arytenoid erythema 100%, vocal mucosal oedema 75.81%, diffuse laryngeal edema 50.00%, posterior commissure hypertrophy 33.87%, subglottic edema 4.84%, no granuloma case. There was 16 cases showing positive in 24-hours pH monitoring test. The positive rate was 30.76%. All cases accepted diagnostic therapy. Fifty-three cases were effective. The positive rate was 85.48%. CONCLUSION: There are no clinical presentations specific to pediatric laryngopharyngeal reflux. Patients often present with a wide range of atypical symptoms and signs. RSI questionnaire and RFS may provide diagnostic datas. Primary treatment includes lifestyle and medical therapy.

[CO2 laser supraglottoplasty for infantile laryngomalacia].

OBJECTIVE: To evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants. METHODS: From January 2009 to December 2011, 32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital. According to the choice made by the parents, 16 children accepted CO2 laser supraglottoplasty (group 1), the others were treated conservatively (group 2). The beginning observation point T0 was defined as the age on the first medicine taking day or the age of surgery. T1, T3, T6 were defined as 1, 3, 6 months following T0. Clinical symptoms included stridor, dyspnea, aspiration, and respiratory infections. The body weight, PSG reports, laryngoscope findings, cure rates of the two groups were compared. RESULTS: The anatomical abnormalities were corrected surgically, and the symptoms ,such as stridor, dyspnea, and aspiration improved rapidly after the operation. The cure rates was higher in group 1 than in group 2 on T1, T3, T6 stage. There were statistically significant differences(χ(2) were 13.9, 28.1, 24.6 respectively; all P < 0.01). Children in group 1 gained weight better than in group 2. There was a statistically significant difference in Z scores median on T1, T3, T6 stage (z score were -0.848, -2.940, -4.110; P < 0.05, or P < 0.01 respectively). The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ± 0.106 to 0.901 ± 0.041). There was a statistically significant difference (t = -7.876, P = 0.001). Complications included adhesion (1 case) and temporary new-onset aspiration (1 case). CONCLUSIONS: The CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor, dyspnea and aspiration. It can reduce the frequency of respiratory infections, and contribute to weight gaining. The CO2 laser supraglottoplasty is effective, of high security and with rare complications.

[Analysis of the causes of immediate bleeding after pediatric adenoidectomy].

OBJECTIVE: To evaluate the incidence of postoperative hemorrhage in children undergoing adenoidectomy, and to discuss its possible causes. METHODS: Included in this study were children who underwent adenoid and/or tonsil surgery at Shenzhen Children's Hospital between January 2004 and November 2009. The change of hemoglobin (Hb) and hematocrit (Hct) were retrospectively analysed. The blood loss was estimated by the change of Hct. RESULTS: There were 2078 cases that accomplished the inclusion criteria in the period of study. Ten children bled 0.5 - 4.0 hours after surgery, without superfluous hemorrhage during the operation and post-tonsillectomy. This represented an incidence of 0.48%of immediate postoperative haemorrhage among the 2078 procedures analyzed. Statistical differences were found between boys (0.21%) and girls (1.10%, χ² = 5.597, P < 0.05). The change of Hb and Hct was positively correlated (r = 0.95, P < 0.01), the blood loss was positively correlated with the bleeding time (r = 0.66, P < 0.05). The causes of postoperative hemorrhage were coagulation system deficits, chronic nasopharyngitis, deficient hemostasis and immoderate ravage. To control the postoperative hemorrhage, 2 postnasal packing under topical anaesthesia and 8 electrocautery under general anaesthesia were applied. CONCLUSIONS: Poor operative technique and deficient hemostasis are the major causes of primary hemorrhage. Prompt operation to control the postoperative bleeding should be done 2 hours after bleeding under general anesthesia in order to avoid severe complications.

[Diagnosis and treatment of neonatal inspiratory dyspnea].

OBJECTIVE: To analyze the causes and the clinical characteristics of the neonatal inspiratory dyspnea; so to raise the diagnosis and cure rate of the disease. METHODS: Eleven new born infants with severe inspiratory dyspnea were investigated from March, 2001 to June, 2004 in Shenzhen children's hospital. Six infants were male and 5 were female. The average age was 7.2 days ( range from 8 hours to 28 days). Four cases were hospitalized with trachea intubation. Three of them can not cry, and 2 cases were diagnosed as bilateral vocal cord paralysis, 1 case as multiple cranial nerve palsy with direct laryngoscopy. Two cases couldn't drink milk continuously and accompanied with deteriorated inspiratory dyspnea, and were diagnosed as congenital adenoid hypertrophy and neonatal rhinitis respectively with compute tomography and magnetic resonance imaging. Among the 6 cases with persistent inspiratory dyspnea, four of them were diagnosed as congenital laryngocele by direct laryngoscope, one case was diagnosed as subglottic stenosis by tracheoscopy and one case was confirmed to be thoracic tracheostenosis when tracheotomy performed. RESULTS: Four congenital laryngoceles and one case congenital adenoid hypertrophy were cured with surgery. Two bilateral vocal cord paralysies and one case of subglottic stenosis received tracheotomy. One neonatal rhinitis case applied 0.25% ephedrine. One case of thoracal tracheostenosis died. The parents of the infant with multiple cranial nerve palsy refused to accept any treatment. CONCLUSIONS: The laryngoscope examination is recommended for patients with neonatal inspiratory dyspnea. It is necessary for patients with persistent dyspnea to be examined by tracheoscopy as early as possible.