Presentation, diagnosis and management of neck abscesses in children.

UNLABELLED: The aim of the study was to analyze the presenting signs and symptoms, diagnostic procedures, clinical course, pathogenic organisms and management of neck abscesses in children. MATERIALS AND METHODS: This retrospective medical records review comprised of 51 pediatric cases referred because of neck abscess from 2001 to 2014. Medical records of the patients were reviewed for demographic data, clinical presentation, treatment before referral, localization of the abscess, imaging evaluation, medical and surgical treatment, bacteriological data and complications. RESULTS: Average age of the patients was 4.9 years. 18 (35%) of the children were below one year of age. The submandibular was the most common area involved (41,2%). Contrast-enhanced computed tomography (CECT) was performed in 45% of patients mainly with deep neck abscesses. All CECT scans showed the fluid collections. In all but one of the patients treated surgically and diagnosed with ultrasound and/or CECT surgical intervention revealed presence of pus. The most common pathogen was Staphylococcus aureus- SA (78% of all isolates) of which 24% were methicillin resistant Staphylococcus aureus - MRSA. Clindamycin resistance was detected in 28% of all SA isolates and in 67% (4/6) of all MRSA isolates. All MRSA isolates were sensitive to vancomycin. CONCLUSIONS: CECT is reliable imaging technique for diagnosing deep neck abscesses in children. Infants with neck abscesses are at higher risk of having MRSA as offending pathogen which should be taken into consideration when considering empiric treatment. Vancomycin is recommended as empiric antibiotic therapy in newborns with neck abscess.

[Keratinocyte growth factor and its receptor in middle-ear cholesteatoma]. / Czynnik wzrostu komórek rogowaciejacych i jego receptor w perlaku ucha srodkowego.

AIM: Etiology of middle ear cholesteatoma is far from beeing elicidated. Current concepts postulate that cholesteatoma is the result of disturbed wound healing process. Keratinocyte growth factor (KGF) plays important role in wound healing, so it seemed interesting to assess the expression of KGF and its receptor in the cholesteatoma. MATERIAL AND METHODS: 25 cholesteatoma and 7 retraction pockets specimens were obtained from the patients during middle ear surgery. The expression of KGF and FGFR2 was evaluated by immunohistochemical staining using polyclonal antibodies. The results were analyzed depending on clinical features such as: localization, number of anatomic sites involved and presence of purulent discharge. RESULTS: KGF expression was detected in the cells of subepithelial tissue. It was observed in 4/7 (57%) of the specimens of retraction pockets and 11/25 (44%) of cholesteatoma specimens. FGFR2 expression was observed mainly in the cells of spinous layer of epithelium in 4/7 (57%) specimens of retraction pockets and 19/25 (76%) of specimens of cholesteatoma. Statistically significant (p=0.011) relationship between the presence of KGF expression in the subepithelial tissue and the presence of FGFR2 expression in the epithelium was found. There were no differences in the expression of KGF and FGFR2 between retraction pocket and cholesteatoma specimens. Also, no differences in the expression, depending on localization, extend of the cholesteatoma and presence of purulent discharge were observed. CONCLUSION: KGF and its receptor seem to play an important role in paracrine regulation of cholesteatoma growth.

The status of the contralateral ear in children with acquired cholesteatoma.

CONCLUSION: The high prevalence of pathological changes in the contralateral ear (CLE) among children treated because of middle ear cholesteatoma (MEC) was observed. Evolution of many retraction pockets into cholesteatoma points to the need for early intervention in those patients, especially those with concomitant attic retraction pockets and secretory otitis media (SOM). OBJECTIVES: The aim of the study was to assess the frequency of pathological changes in the CLE of children operated because of MEC, and to determine their clinical evolution. METHODS: Retrospective analysis was performed on the basis of medical records of 202 patients treated surgically for MEC in the years 1998-2011. The mean age of included patients was 11 years and the mean observation period was 54 months. Otoscopic findings before surgery were compared with the latest examination. RESULTS: At the time of surgery for MEC, 54.5% of CLEs presented with abnormalities. The most frequent findings were retraction of the tympanic membrane (30%) and SOM, 22.4%. Also, 7% of patients presented with bilateral MEC. Thirty-four percent (20 cases) of retraction pockets diagnosed at the beginning of the observation period required surgical intervention. During the intervention in 20% of cases (12/59 cases) diagnosis of cholesteatoma was confirmed. At the end of the observation period bilateral cholesteatoma was diagnosed in 12.9% of children.

[The status of contralateral ear in children with cholesteatoma]. / Stan ucha konralateralnego u dzieci z przewleklym zapaleniem ucha z perlakiem.

INTRODUCTION: Recently published data indicate that over 60% of patients with middle ear cholesteatoma (MEC) have concomitant changes in the contralateral ear (CE). Studies concerning the condition of the CE are few and rarely present the situation in the pediatric population. THE AIM OF THIS STUDY: was to assess the frequency of pathological changes occurring in the CE in children operated on MEC, as well as to determine their clinical evolution. MATERIAL AND METHOD: Retrospective analysis was performed on basis of medical records of 193 patients treated surgically for MEC in 1998-2008 at the Department of Pediatric Otolaryngology in Bialystok. The comparison of otoscopic evaluation before first operation with the latest examination was undertaken. The evolution of abnormalities was analyzed and the effect of age and type of cholesteatoma was assessed. RESULTS: The opposite ears were abnormal in 46.1% of patients. Most frequently observed changes in the CE were retraction pockets (23%). Cholesteatoma was found in 8 of 45 identified cases of retraction pocket. The incidence of abnormalities in the CE was not correlated with patients age or type of cholesteatoma. Cholesteatoma occurred on both sides in 9,3% of children. In these cases, the attic cholesteatoma was presented in 66.67%, tensa cholesteatoma in 16.67%. CONCLUSIONS: In patients with MEC contralateral ear should be systematically examined to detect early any abnormality, or to assess their evolution and take appropriate treatment.

[Propranolol for treatment of subglottic hemangioma]. / Zastosowanie propranololu w leczeniu naczyniaka podglosniowego.

Subglottic hemangiomas are extremely dangerous due to its location and rapid growth during the proliferative phase. Many different treatments are described but these methods are still not satisfactory. Recently propranolol has been used as a new option in hemangioma therapy. We describe a case of 6-week infant with subglottic hemangioma discovered direct laryngoscopy, presented with dyspnoea and inspiratory stridor. After oral propranolol administration all baseline airway symptoms had resolved and endoscopic examination demonstrated significant regression of the hemangioma. We suggest that the propranolol should be used as a first-line treatment in subglottic hemangiomas in children.

[Hemangiomas and vascular malformations of the head and neck]. / Guzy i malformacje naczyniowe glowy i szyi.

This paper presents the review of current knowledge regarding vascular lesions of the head and neck. For many years the term hemangioma was used to describe all vascular lesions. Mulliken and Glowacki classified congenital vascular lesions and recognized two distinct entities, hemangiomas-vascular tumors and vascular malformations. Hemangiomas are usually not present at birth, proliferate during first year of life and then involute. They are composed of proliferating endothelial cells. Vascular malformations are always present at birth although not always apparent, increase slowly in size throughout whole life and never involute. They enlarge by hypertrophy of malformed vessels. Vascular malformations can be further subdivided according to the type of involved vessels as arterial, arteriovenous, venous, capillary or lymphatic. Accurate diagnosis of hemangiomas and vascular malformations remains a challenge for physicians. Although majority of hemangiomas are self limiting lesions some of them may develop complications such as; ulceration, airway obstruction, ophthalmic complications, psychosocial consequences. Segmental hemangiomas are associated with the risk of structural anomalies such as those that occur in PHACE syndrome. Clinical presentation and forms of treatment of various forms of vascular malformations are presented. Vascular malformations have to be treated according to their histopathology and location, as well as their hemodynamic features shown by radiological examinations.

[Effect of the middle ear status on the recording of vestibular evoked myogenic potential--VEMP]. / Wplyw stanu ucha srodkowego na rejestracje miogennego przedsionkowego potencjalu wywolanego--VEMP.

The aim of this study was to assess the effect of the middle ear status on the recording of air- and bone-conducted vestibular evoked myogenic potential. Forty eight children were included in the study, ranging in age from 4 to 10 years. All of the children underwent otoscopy, pure tone audiometry, tympanometry and air- and bone-conducted VEMP in response to click. There were 3 groups according to the condition of the middle ear: group I--52 ears (type A and C1 tympanogram, pure tone average < or = 20 dB), group II--23 ears (type C2 and B tympanogram, pure tone average < or = 20 dB), group III--21 (type B tympanogram, pure tone average > 20 dB). The threshold, presence of correct waveform morphology of the response and latency was evaluated. The condition of the middle ear has no significant effect on the recording of VEMP and mean level of the response threshold with bone stimulation, based on the performed studies. However, with air stimulation it has effect on the recording of VEMP, increase of the mean threshold response and shortening of latency p13 and n23.

[Effect of the middle ear status on the recording of vestibular evoked myogenic potential--VEMP]. / Wplyw wieku na rejestracje miogennego przedsionkowego potencjalu wywolanego--VEMP.

The aim of this study was to assess the effect of age on the recording of air- and bone-conducted vestibular evoked myogenic potential. Forty six young subjects were included in the study, ranging in age from 4 to 18 years. All of them underwent otoscopy, pure tone audiometry, tympanometry and air- and bone-conducted VEMP in response to click. Eighty six ears with normal hearing (pure tone average 20 dB) and type A and C1 tympanogram were studied. There were 2 groups according to age: group I--children aged 4-10 years--52 ears, group II--young subjects aged 11-18 years--34 ears. The threshold, the presence of correct waveform morphology of the response and the latency were evaluated. Above parameters were examined at 95 dB and 100 dB (nHL) air conducted click intensity and 60 dB (nHL) bone conducted click intensity. The age has no significant effect on the percentage of the recording of VEMP and the level of the response threshold with air stimulation, based on the performed studies. However, the age has effect on the prolongation of latency p13 and n23 both with air and bone stimulation. We paid attention to the lower percentage of the recording of bone-conducted VEMP in young subjects aged 11-18 years.

[Venous malformations of the parotid gland]. / Malformacje zylne w obrebie slinianki przyusznej.

We describe two cases of venous malformations in the parotid gland that were operated on due to cosmetic reasons. We present the main differences between hemangiomas and vascular malformations and we also emphasize the importance of correct diagnosis in vascular lesions what is crucial for selection of appropriate treatment.