Cricopharyngeal achalasia in children: surgical and medical treatment.

BACKGROUND: Cricopharyngeal achalasia (CA) is a rare cause of dysphagia in children presenting with non-specific symptoms such as choking, food regurgitation, nasal reflux, coughing, recurrent pneumonia, cyanosis, and failure to thrive. It results from failure of relaxation of the upper esophageal sphincter (UES) and may appea reither as an isolated lesion or in conjunction with other pathologies. Recognition and early diagnosis of this condition may minimize morbidity in children. OBJECTIVES: To evaluate the clinical course of four children with cricopharyngeal achalasia presenting to our clinic. METHODS: We conducted a 5 year retrospective chart review in a tertiary referral center. RESULTS: Four children were diagnosed with primary cricopharyngeal achalasia between 2006 and 2010. Diagnosis was established by videofluoroscopy and all underwent uneventful cricopharyngeal myotomy. Three children recovered completely and one child showed partial improvement. For residual UES spasm in a partially improved patient, botulinum toxin was injected into the UES which led to further improvement. Dysphagia recurred in one child who was successfully treated with botulinum toxin injection. CONCLUSIONS: Cricopharyngeal myotomy is a safe procedure in infants and young children. Botulinum toxin injection of the UES was found to be effective in refractory cases.

Hearing loss in bullous myringitis.

OBJECTIVE: To evaluate the incidence of sensorineural and mixed hearing loss in patients with bullous myringitis. METHODS: Prospective observational study was conducted in a tertiary care medical center.Patients diagnosed as having bullous myringitis in our medical center between 2007 and 2009, underwent pure-tone audiometry upon presentation and were treated according to physicians' preferences RESULTS: Bullous myringitis was diagnosed in 43 patients (16 males, 27 females) with a mean age of 30.9 years (range 15-92). Thirty-six (83.7%) had unilateral infection (24 right, 12 left), and 7 (16.3%) had bilateral involvement. The most common type of hearing loss was mixed, detected in 24 patients (55.8%) and involving 27 of the 50 affected ears (54%). Seven patients (16.3%) had a conductive hearing loss, involving 9 ears (18%). Three patients (6.9%) presented with sensorineural hearing loss involving 5 ears (10%). The mean air-bone gap was 20.6±8.8dB. Down-slope audiometry was noted in 68.7% of the affected ears, followed by a U-shaped curve (25%). The sensorineural component mainly involved the high frequencies and the hearing loss ranged from slight to severe. CONCLUSION: The results of the present study demonstrate a high incidence of mixed or sensorineural hearing loss in bullous myringitis patients, and emphasize the need for routine early audiometric evaluation and appropriate follow up for individuals diagnosed as having bullous myringitis.