RESUMO
The tests currently used for the direct identification of SARS-CoV-2 include specimens taken from upper and lower respiratory tract; recommendations from Word Health Organization prioritise nasopharyngeal swab (NS). In literature there are not available paediatric studies about the identification of SARS-CoV-2 through nasopharyngeal aspirate (NPA), but the use of NPA is deemed to be better than NS to identify respiratory viruses in children. The aim of our study is to evaluate diagnostic performances of NS compared to NPA for the detection of SARS-CoV-2 in children. We collected 300 paired samples (NS and NPA) from children hospitalized and followed up in our paediatric unit. We calculated the sensitivity and specificity of NS referred to NPA of the whole sample and then, considering both the age ([≥] and < 6 years old) and the period of collection (March vs follow up) as covariates in different analysis. The NS has a low sensitivity in detecting SARS-CoV-2 in children when referred to NPA; whereas its specificity results high. In children under 6 years of age, our results suggest to prefer the collection of NS, whenever possible. Though statistically not significant, the sensitivity of NS becomes higher if it is performed before NPA.
RESUMO
OBJECTIVES: Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. METHODS: This prospective, double-blind and controlled study involved 120 consecutive patients aged 4-12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. RESULTS: There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). CONCLUSION: Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.
