Versatility and Benefits of 4.0mm Flexible Nasal Endoscopy in 118 Children up to 10 Years of Age.

Purpose This retrospective study looked at the feasibility of using adult 4.0 mm flexible nasendoscopes (FNE) examination under local anesthetic (LA) in children three to 10 years old to diagnose adenoid hypertrophy (AH) and other conditions. We also looked for a correlation between the adenoid size on FNE and a) tonsil size, b) the typical symptoms of snoring, mouth breathing, impaired hearing, and apnoeic episodes c) the management options of otitis media with effusion (OME) and d) the adenoid size intraoperatively. Methods A retrospective, observational study of 118 children in an NHS pediatric otolaryngology clinic led by a single consultant. One hundred ten consecutive patients with suspected AH were divided into two groups of three to five years and six to 10 years. We compared the acceptance rate to FNE in two subgroups (three to five years and six to 10 years old) and examined the correlation between various parameters as outlined above, using the Chi-square test. Eight children underwent FNE for other reasons of change of voice and epistaxis. Results FNE was successfully performed in 86% of the patients without restraint. Thirty-three percent of patients had non-obstructive adenoids (OA) and did not require surgical intervention. The intraoperative adenoid size, symptoms of snoring, mouth-breathing, and apnoeic episodes positively correlated with OA; however, no correlation was seen with the tonsil size (p=0.1143). All patients with OA and type B tympanogram needed adenoidectomy and grommet insertion (p=0.0119), and those with type C curves recovered with adenoidectomy alone. Conclusions 4.0 mm adult scope helped reach a definitive diagnosis for AH in most children above three years of age, thus proving cost-effective. The symptoms of snoring, mouth-breathing, and apnoeic episodes had a positive correlation to the presence of OA; however, the tonsil size was seen to be independent of adenoid size. Primary surgical management can be considered the treatment of choice for all patients with OA and type B tympanogram without a trial of conservative therapy.

Stylohyoid Complex Syndrome Associated With Unilateral Vocal Cord Palsy: A Case Report.

Eagle's syndrome is a rare cause of cervicofacial pain and is due to abnormalities in the stylohyoid process, stylohyoid ligament or lesser cornu of the hyoid bone. Generally, patients affected by Eagle's syndrome present with pain in the lateral or upper neck, angle of the mandible, submandibular space and throat (exacerbated by head movements and/or mastication); foreign body sensation; headache and referred otalgia. A 66-year old gentleman presented with a 36-month history of recurrent pain localising mainly to the right angle of the mandible and radiating to the submandibular triangle. No pathological changes were noted on multiple ultrasound scans. Flexible nasendoscopy revealed a right vocal cord palsy. Initially, the CT scan revealed an abnormality in the stylohyoid complex, and the patient was managed conservatively. Subsequent three-dimensional CT scan noted significant worsening of the abnormality in the stylohyoid complex. Due to progressive nature of the patient's symptoms and progression of stylohyoid complex calcification noted on imaging, the patient was listed for surgery. He underwent partial styloidectomy and vocal cord injection for cord paralysis secondary to impingement on the vagal nerve by the stylohyoid complex. The patient recovered well and denies any ongoing stylalgia. Various cases of Eagle's syndrome have been managed successfully in a conservative manner. However, the authors of this case report suggest that patients with Eagle's syndrome should be monitored closely. A delay in surgical intervention can lead to complications such as complete ossification of the stylohyoid complex and impingement on surrounding structures. This, in turn, increases intra-operative complexity.

Paediatric Longitudinal Tracheal Laceration From Blunt Force Trauma: A Case Report.

Tracheal lacerations in the paediatric population are not common; however, they can be life-threatening. Prompt diagnosis and management are essential for a good prognosis. Here, we present the case of a nine-year-old boy who presented to the hospital following a bicycle handlebar injury with neck pain and subcutaneous emphysema of the anterior thorax and neck. Chest X-ray revealed pneumomediastinum and a small pneumothorax. A computed tomography scan revealed a posterior longitudinal laceration of the trachea, measuring 1.5 cm, located superior to the carina at T1/2. As the patient was clinically stable, did not require any supplemental oxygen, and the tear was smaller than 2 cm, conservative management with steroids and broad-spectrum antibiotics was implemented. The patient was transferred to a tertiary ENT centre in Glasgow for observation in the paediatric intensive care unit where he recovered uneventfully. A repeat cross-sectional imaging six days after the injury revealed successful healing of the laceration. Non-surgical management of a tracheobronchial injury can be an effective approach. This can be considered in the case of tears measuring <2 cm and in clinically stable patients. Imaging-based diagnosis in the case of patients with minor injuries who are improving with conservative treatment may be sufficient, and confirmation with bronchoscopy would be of questionable clinical value in such patients.

An Incidental Finding of a Double-Lumen Trachea.

The aim of this case report is to present an incidental finding of a firm tracheal septum in a 61-year-old woman. The patient was admitted to the hospital with mild dyspnea and a preliminary diagnosis of a tracheal subglottic stenosis. During microlaryngoscopy, just below the subglottic stenosis, a firm, vertical symphysis (septum), forming a double-lumen trachea was found. There was no record of any previous difficulties with intubation. A computed tomography scan performed after the microlaryngoscopy revealed an airway branch arising from the trachea at the level of thyroid gland and joining its lumen below. The radiological and endoscopic findings in the presented case hardly resemble the conditions described in the literature, as the discovered septum does not have a pseudomembranous nature, nor does it form a tracheal bronchus. Therefore, the finding is thought to be an unusual complication of multiple intubations in the past. This is an extremely rare finding and it is important to share our experience in managing a patient with the aforementioned post-intubation complications.

O objetivo deste relato de caso é apresentar um achado incidental de um septo traqueal numa mulher de 61 anos. A paciente foi internada no hospital com dispneia leve e diagnóstico preliminar de estenose subglótica traqueal. A microlaringoscopia realizada mostrou uma sínfise vertical firme (septo) logo abaixo da estenose subglótica, formando uma traqueia de duplo lúmen. Não houve registo de qualquer dificuldade prévia com a intubação. A tomografia computadorizada realizada após a microlaringoscopia revelou um ramo da via aérea originando-se a partir da traquéia ao nível da glândula tiróide e unindo-se ao seu lúmen em baixo. Os achados radiológicos e endoscópicos do caso apresentado dificilmente se assemelham aos descritos na literatura, pois o septo descoberto não é pseudomembranoso, nem forma um brônquio traqueal. Assim, julga-se que o achado seja uma complicação pouco comum no contexto de múltiplas intubações no passado. Este é um achado extremamente raro pelo que é importante partilhar a nossa experiência no tratamento de um doente com as complicações pós-intubação supra-citadas.

Correlates of inconsistent condom use and drug use among men having sex with men in Poland: a cross-sectional study.

The number of new human immunodeficiency virus (HIV) diagnoses is rising in many parts of Europe. We sought to evaluate the rising prevalence of new HIV diagnoses in Poland, where the majority of newly-diagnosed HIV cases are men having sex with men (MSM). This study aims to measure the prevalence of condom use and drug use and to identify risk factors for contracting sexually transmitted infections (STIs) among MSM in Poland by distributing an anonymous online survey aimed toward MSM. Among the 1438 participants who completed valid surveys, those with low education level and greater than 100 prior sexual partners showed the highest odds for inconsistent condom use (adjusted odds ratio [aOR] 3.027, 2.044, respectively). Participants who identified themselves as heterosexuals, with multiple sexual partners and living in big cities showed the highest odds for drug use (aOR 4.869, 3.305, 1.720, respectively). This study identifies groups at the highest risk of HIV/STIs and provides valuable information for public health experts to develop targeted STI prevention campaigns.