Diagnòstic i maneig de la paràlisi facial de Bell / Diagnosis and management of facial Bell's palsy

Fonament. La paràlisi facial perifèrica idiopàtica, o paràliside Bell, és la paràlisi facial més freqüent en la poblaciópediàtrica. La clínica pot incloure manifestacions motores,sensitives, autonòmiques i emocionals. Representa undiagnòstic d’exclusió, i és necessari descartar la presènciade signes o símptomes d’alarma que suggereixin una etiologia diferent. El tractament es basa en mesures de protecció i hidratació ocular, i l’ús de corticoesteroides en l’edatpediàtrica és controvertit.Objectiu. Descriure la clínica, el diagnòstic diferencial i eltractament de la paràlisi de Bell, analitzant l’evidència disponible actualment sobre l’ús de corticoesteroides.Mètode. Es fa una revisió bibliogràfica.Resultats. Els cinc treballs analitzats, incloent-hi dues revisions sistemàtiques, suggereixen la manca de benefici delscorticoesteroides, ja que no observen que tinguin impacteen la recuperació experimentada pels pacients pediàtrics.Destaca, però, l’absència d’estudis prospectius aleatoritzats, de manera que l’evidència prové de treballs amb graud’evidència baix.Conclusions. La paràlisi de Bell en infants presenta taxes derecuperació espontània molt elevades (85-97%), tot i queles seqüeles també són possibles. Actualment, el tractament es basa en mesures generals. És dubtosa la necessitat d’ús de corticoesteroides, a l’espera de la publicació denous treballs els pròxims anys. (AU)

Fundamento. La parálisis facial periférica idiopática, o parálisis deBell, es la parálisis facial más frecuente en la población pediátrica. La clínica puede incluir manifestaciones motoras, sensitivas,autonómicas y emocionales. Representa un diagnóstico de exclusión, y es necesario descartar la presencia de signos o síntomas dealarma que sugieran una etiología diferente. El tratamiento se basaen medidas de protección e hidratación ocular, y el uso de loscorticosteroides en la edad pediátrica es controvertido.Objetivo. Describir la clínica, el diagnóstico diferencial y el tratamiento de la parálisis de Bell, analizando la evidencia disponibleactualmente sobre el uso de corticosteroides. Método. Se realiza una revisión bibliográfica.Resultados. Los cinco trabajos analizados, incluyendo dos revisiones sistemáticas, sugieren la falta de beneficio de los corticosteroides, pues no observan impacto de estos en la recuperaciónexperimentada por los pacientes pediátricos. Destaca, no obstante, la ausencia de estudios prospectivos aleatorizados, por loque la evidencia proviene de trabajos con un grado de evidenciabajo.Conclusiones. La parálisis de Bell en niños presenta tasas de recuperación espontánea muy elevadas (85-97%), aunque las secuelastambién son posibles. Actualmente, el tratamiento se basa enmedidas generales. Es dudosa la necesidad de uso de corticosteroides, a la espera de la publicación de nuevos trabajos en lospróximos años. (AU)

Background. Idiopathic peripheral facial palsy, or Bell’s palsy, isthe most common facial paralysis in the pediatric population. Theclinical presentation can include motor, sensory, autonomic, andemotional manifestations. It represents a diagnosis of exclusionand thus it is always necessary to rule out the presence of alarmsigns or symptoms that would suggest a different etiology.Treatment is based on eye protection and hydration measures,while the application of corticosteroids in children is controversial.Objective. To describe the clinical characteristics, differential diagnosis, and treatment of Bell’s palsy, including a review of the available evidence on the use of corticosteroids.Method. Literature review.Results. The five studies analysed, including two systematic reviews, suggest the lack of benefit of corticosteroids, since an impact on recovery experienced by pediatric patients has not beendocumented. However, the absence of prospective randomizedstudies limits the validity of the findings, since the only data available originates from studies with a low level of evidence.Conclusions. Bell’s palsy in children presents high recovery rates(85-97%), although sequelae are possible. Current treatment isbased in general supportive measures. The need of corticoids isstill a controversial issue and further research is needed. (AU)

Antibody cooperative adsorption onto AuNPs and its exploitation to force natural killer cells to kill HIV-infected T cells.

HIV represents a persistent infection which negatively alters the immune system. New tools to reinvigorate different immune cell populations to impact HIV are needed. Herein, a novel nanotool for the specific enhancement of the natural killer (NK) immune response towards HIV-infected T-cells has been developed. Bispecific Au nanoparticles (BiAb-AuNPs), dually conjugated with IgG anti-HIVgp120 and IgG anti-human CD16 antibodies, were generated by a new controlled, linker-free and cooperative conjugation method promoting the ordered distribution and segregation of antibodies in domains. The cooperatively-adsorbed antibodies fully retained the capabilities to recognize their cognate antigen and were able to significantly enhance cell-to-cell contact between HIV-expressing cells and NK cells. As a consequence, the BiAb-AuNPs triggered a potent cytotoxic response against HIV-infected cells in blood and human tonsil explants. Remarkably, the BiAb-AuNPs were able to significantly reduce latent HIV infection after viral reactivation in a primary cell model of HIV latency. This novel molecularly-targeted strategy using a bispecific nanotool to enhance the immune system represents a new approximation with potential applications beyond HIV.

Efficacy and Safety of Ciprofloxacin Plus Fluocinolone in Otitis Media With Tympanostomy Tubes in Pediatric Patients: A Randomized Clinical Trial.

Importance: Acute otitis media with tympanostomy tubes (AOMT) in children commonly presents with otorrhea and negatively affects their daily activities. Objective: To evaluate the efficacy and safety of topical ciprofloxacin, 0.3%, plus fluocinolone acetonide, 0.025%, otic solution relative to ciprofloxacin, 0.3%, otic solution alone and fluocinolone acetonide, 0.025%, otic solution alone in the treatment of AOMT in children. Design, Setting, and Participants: Two twin multicenter, randomized, double-blind clinical trials with identical designs were conducted from June 24, 2011, through June 23, 2014, at ear, nose, and throat pediatric practices, general practices, hospitals, and clinical research centers. The study population comprised 662 children (331 in each trial) with AOMT in at least 1 ear who presented with moderate or severe purulent otorrhea for 3 weeks or less. Data analyses were performed on an intention-to-treat basis. Interventions: Patients were randomly assigned to receive ciprofloxacin plus fluocinolone, ciprofloxacin alone, or fluocinolone alone twice daily for 7 days and were evaluated on days 1 (baseline), 3 to 5 (undergoing therapy), 8 to 10 (end of therapy), and 18 to 22 (test of cure). Main Outcomes and Measures: The primary efficacy measure was time to cessation of otorrhea. The principal secondary end point was sustained microbiological cure, defined as eradication or presumed eradication at end-of-therapy and test-of-cure visits. Results: A total of 662 children participating in the 2 studies were randomized to receive ciprofloxacin plus fluocinolone (n = 223), ciprofloxacin alone (n = 221), or fluocinolone alone (n = 218). The median age was 2.5 years (range, 0.6-12.7 years). The median time to cessation of otorrhea was 4.23 days (95% CI, 3.65-4.95 days) in patients receiving ciprofloxacin plus fluocinolone compared with 6.95 days (95% CI, 5.66-8.20 days) in those receiving ciprofloxacin and not estimable findings in those receiving fluocinolone alone (P < .001). The clinical cure rate at the test-of-cure visit was 80.6% in the ciprofloxacin plus fluocinolone group, 67.4% in the ciprofloxacin group (difference, 13.2%; 95% CI, 5.0%-21.4%; P = .002), and 47.6% in the fluocinolone group (difference, 33.0%; 95% CI, 24.0%-42.0%; P < .001). The sustained microbiological cure rate was 79.7% in the ciprofloxacin plus fluocinolone group vs 67.7% in the ciprofloxacin group (difference, 12.0%; 95% CI, 0.8%-23.0%; P = .04) and 37.6% in the fluocinolone group (difference, 42.1%; 95% CI, 29.3%-54.8%; P < .001). Only 7 (3.1%) of the patients receiving ciprofloxacin plus fluocinolone, 8 (3.6%) of the patients receiving ciprofloxacin, and 10 (4.7%) of the patients receiving fluocinolone presented with adverse events related to study medication. Conclusions and Relevance: The combination of ciprofloxacin plus fluocinolone is more effective than treatment with ciprofloxacin or fluocinolone alone for AOMT, and it is safe and well tolerated in children. Trial Registration: clinicaltrials.gov Identifiers: NCT01395966 and NCT01404611.

Etiology of Acute Otitis Media in Children Less Than 5 Years of Age: A Pooled Analysis of 10 Similarly Designed Observational Studies.

BACKGROUND: Acute otitis media (AOM) is an important cause of childhood morbidity and antibiotic prescriptions. However, the relative importance of the well-known otopathogens, Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hflu), remains unclear because of a limited number of tympanocentesis-based studies that vary significantly in populations sampled, case definitions and heptavalent pneumococcal conjugate vaccine use. METHODS: We conducted a pooled analysis of results from 10 AOM etiology studies of similar design, the protocols of which were derived from a common protocol and conducted in children 3 months to 5 years of age in different countries. Generalized estimating equations were used to account for within-study correlations. RESULTS: The majority, 55.5% (95% confidence interval: 47.0%-65.7%) of 1124 AOM episodes, were bacterial pathogen positive: 29.1% (24.8%-34.1%) yielded Hflu and 23.6% (19.0%-29.2%) Spn. Proportions of Hflu and Spn were higher and lower, respectively, in heptavalent pneumococcal conjugate vaccine-vaccinated children. Hflu and Spn were each isolated from 20% to 35% of children in every 1-year age range. Hflu was less likely to be isolated from first (vs. subsequent) episodes [relative risk (RR): 0.71 (0.60-0.84)]. Spn was more often isolated from sporadic (vs. recurrent) cases [RR: 0.76 (0.61-0.97)]; the opposite was true for Hflu [RR: 1.4 (1.00-1.96)]. Spn cases were more likely to present with severe (vs. mild) symptoms [RR: 1.42 (1.01-2.01)] and Hflu cases with severe tympanic membrane inflammation [RR: 1.35 (1.06-1.71)]. CONCLUSIONS: Spn and Hflu remain the leading otopathogens in all populations examined. While associated with overlapping symptoms and severity, they exhibit some differences in their likelihood to cause disease in specific subpopulations.

Etiología bacteriana de la otitis media aguda en España en la era de la vacuna neumocócica conjugada / Bacterial etiology of acute otitis media in Spain in the post-pneumococcal conjugate vaccine era

INTRODUCCIÓN: La otitis media aguda (OMA) es común en niños menores de 3 años. En España hay disponible una vacuna neumocócica conjugada (VNC) (VNC7; Prevenar (Pearl River, NY), Pfizer/Wyeth, EE. UU.) desde 2001, habiéndose alcanzado una cobertura vacunal del 50-60% en niños menores de 5 años. MATERIALES Y MÉTODOS: Se reclutó a niños de 3 a 36 meses con OMA confirmada por especialista en otorrinolaringología en 7 centros españoles (febrero 2009-mayo 2012) (Proyecto GSK: 111425). Se obtuvieron muestras de exudado del oído medio mediante timpanocentesis o de otorrea espontánea, y se hizo cultivo para identificación bacteriana. En muestras con cultivos negativos se realizó análisis adicional mediante reacción en cadena de la polimerasa (PCR). RESULTADOS: De 125 episodios de OMA confirmados en 124 niños, se analizaron 117 (edad mediana: 17 meses [rango: 3-35]); 8 episodios de OMA fueron excluidos del análisis. En total, combinando resultados de cultivo y PCR, se identificaron uno o más patógenos bacterianos en el 69% (81/117) de los episodios; identificándose Haemophilus influenzae (Hi) en el 44% (52/117) y Streptococcus pneumoniae (Spn) en el 39% (46/117). En 77 de los 117 episodios se hizo cultivo para uno o más patógenos, resultando positivo en 63, con mayor frecuencia para Spn (24/77; 31%) e Hi (32/77; 42%). La PCR en episodios con cultivos negativos detectó Hi en el 48% y Spn en el 55% de las muestras. El serotipo de Spn más común fue el 19F (4/24; 17%) seguido del 19A (3/24; 13%); todos los episodios en los que se identificó Hi correspondieron a Hi no tipificable (HiNT). Un total de 81/117 episodios de OMA (69%) se presentaron en niños que habían recibido una o más dosis de vacuna antineumocócica. CONCLUSIONES: HiNT y Spn resultaron ser los principales agentes etiológicos de la OMA en España. Para conocer el impacto de la vacunación antineumocócica en la OMA en España harán falta estudios adicionales cuando se haya alcanzado un nivel de cobertura mayor

INTRODUCTION: Acute otitis media (AOM) is common in children aged <3 years. A pneumococcal conjugate vaccine (PCV) (PCV7; Prevenar, Pfizer/Wyeth, USA) has been available in Spain since 2001, which has a coverage rate of 50-60% in children aged <5 years. MATERIALS AND METHODS: Children aged greater than or equal to 3 to 36 months with AOM confirmed by an ear-nose-throat specialist were enrolled at seven centers in Spain (February 2009-May 2012) (GSK study identifier: 111425). Middle-ear-fluid samples were collected by tympanocentesis or spontaneous otorrhea and cultured for bacterial identification. Culture-negative samples were further analyzed using polymerase chain reaction (PCR). RESULTS: Of 125 confirmed AOM episodes in 124 children, 117 were analyzed (median age: 17 months (range: 3-35); eight AOM episodes were excluded from analyses. Overall, 69% (81/117) episodes were combined culture- and PCR-positive for greater than or equal to 1 bacterial pathogen; 44% (52/117) and 39% (46/117) were positive for Haemophilus influenzae (Hi) and Streptococcus pneumoniae(Spn), respectively. 77 of 117 episodes were cultured for greater than or equal to 1 bacteria, of which 63 were culture-positive; most commonly Spn (24/77; 31%) and Hi (32/77; 42%). PCR on culture-negative episodes identified 48% Hi- and 55% Spn-positive episodes. The most common Spn serotype was 19F (4/24; 17%) followed by 19A (3/24; 13%); all Hi-positive episodes were non-typeable (NTHi). 81/117 AOM episodes (69%) occurred in children who had received greater than or equal to 1 pneumococcal vaccine dose. CONCLUSIONS: NTHi and Spn were the main etiological agents for AOM in Spain. Impact of pneumococcal vaccination on AOM requires further evaluation in Spain, after higher vaccination coverage rate is reached

[Bacterial etiology of acute otitis media in Spain in the post-pneumococcal conjugate vaccine era]. / Etiología bacteriana de la otitis media aguda en España en la era de la vacuna neumocócica conjugada.

INTRODUCTION: Acute otitis media (AOM) is common in children aged <3 years. A pneumococcal conjugate vaccine (PCV) (PCV7; Prevenar, Pfizer/Wyeth, USA) has been available in Spain since 2001, which has a coverage rate of 50-60% in children aged <5 years. MATERIALS AND METHODS: Children aged ≥3 to 36 months with AOM confirmed by an ear-nose-throat specialist were enrolled at seven centers in Spain (February 2009-May 2012) (GSK study identifier: 111425). Middle-ear-fluid samples were collected by tympanocentesis or spontaneous otorrhea and cultured for bacterial identification. Culture-negative samples were further analyzed using polymerase chain reaction (PCR). RESULTS: Of 125 confirmed AOM episodes in 124 children, 117 were analyzed (median age: 17 months (range: 3-35); eight AOM episodes were excluded from analyses. Overall, 69% (81/117) episodes were combined culture- and PCR-positive for ≥1 bacterial pathogen; 44% (52/117) and 39% (46/117) were positive for Haemophilus influenzae (Hi) and Streptococcus pneumoniae (Spn), respectively. 77 of 117 episodes were cultured for ≥1 bacteria, of which 63 were culture-positive; most commonly Spn (24/77; 31%) and Hi (32/77; 42%). PCR on culture-negative episodes identified 48% Hi- and 55% Spn-positive episodes. The most common Spn serotype was 19F (4/24; 17%) followed by 19A (3/24; 13%); all Hi-positive episodes were non-typeable (NTHi). 81/117 AOM episodes (69%) occurred in children who had received ≥1 pneumococcal vaccine dose. CONCLUSIONS: NTHi and Spn were the main etiological agents for AOM in Spain. Impact of pneumococcal vaccination on AOM requires further evaluation in Spain, after higher vaccination coverage rate is reached.

Frequent carriage of resistance mechanisms to ß-lactams and biofilm formation in Haemophilus influenzae causing treatment failure and recurrent otitis media in young children.

OBJECTIVES: Non-typeable Haemophilus influenzae are a major cause of acute otitis media (AOM), including chronic and recurrent otitis in young children. The objective of this study was to determine whether non-typeable H. influenzae isolates causing these infections produce biofilms and carry resistance mechanisms to ß-lactams. METHODS: A collection of 48 H. influenzae isolates was obtained by tympanocentesis or from otorrhoea samples from individual patients <3 years of age and diagnosed with recurrent or treatment failure AOM. Each isolate was surveyed for the presence of blaTEM genes, amino acid substitutions in the transpeptidase domain of penicillin-binding protein 3 (PBP3) and biofilm formation in microtitre plates. RESULTS: In 43 of the 48 isolates (89.6%), at least one of the three tested conditions was identified: biofilm formation (83.3%) and resistance mechanisms to ß-lactams (33.3%), modifications in the transpeptidase domain of PBP3 being the most prevalent (22.9%), followed by ß-lactamase production (10.4%). Additionally, 13 (27.1%) isolates had two or more of these three traits. In relation to biofilm formation, those isolates with an amoxicillin MIC ≤ 0.5 mg/L had higher optical density values than isolates with an amoxicillin MIC ≥ 1 mg/L (Mann-Whitney U-test, P=0.048). CONCLUSIONS: These findings suggest that the successful treatment of non-typeable H. influenzae causing chronic and recurrent AOM in young children may be compromised by the high biofilm-forming capacity of the isolates and the presence of ß-lactam resistance mechanisms, particularly PBP3 mutations.

Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era.

OBJECTIVE: To prospectively identify the bacterial aetiology and antimicrobial susceptibility of problematic (recurrent and treatment failure) acute otitis media in Spanish children several years after the introduction of 7-valent pneumococcal conjugate vaccine. METHODS: Tympanocentesis or careful sampling of spontaneous otorrhoea was performed on children aged 3 to <36 months with recurrent acute otitis media, acute otitis media treatment failure or unresolved acute otitis media. RESULTS: 105 acute otitis media episodes (77 sampled by tympanocentesis, 28 otorrhoea samples) were evaluated: 46 recurrent, 35 treatment failures, 24 unresolved acute otitis media. 74 episodes (70.4%) had at least one bacterium identified on culture: Streptococcus pneumoniae was identified in 21 episodes, Haemophilus influenzae (all non-typeable) in 44, Streptococcus pyogenes in 2, Moraxella catarrhalis in 2. No statistically significant difference in bacterial aetiology by episode type was detected. Non-typeable H. influenzae was the most commonly isolated pathogen in all acute otitis media types and in all age sub-groups. Forty percent of S. pneumoniae isolates were multi-drug resistant. Pneumococcal serotype 19A was the most frequently identified serotype (7/21 episodes). Multi-drug resistance was found in 56% of 19A isolates. Of non-typeable H. influenzae isolates, 15% were ampicillin resistant and 13% were amoxicillin/clavulanate resistant. S. pneumoniae and non-typeable H. influenzae DNA were each detected in 57% of samples culture negative for these pathogens, including 12 co-infections. CONCLUSION: Combining culture and polymerase chain reaction results, H. influenzae and S. pneumoniae may be implicated in 70% and 43% of clinically problematic bacterial acute otitis media episodes, respectively. The impact of new vaccines to prevent both S. pneumoniae and non-typeable H. influenzae acute otitis media may be substantial in this population and is worth investigating.

[EXIT procedure in the management of severe foetal airway obstruction. the paediatric otolaryngologist's perspective]. / Procedimiento EXIT en el manejo de fetos con severo compromiso respiratorio. La perspectiva del otorrinolaringólogo pediátrico.

The ex-utero intrapartum treatment (EXIT) procedure is a technique designed to allow partial foetal delivery via caesarean section with establishment of a safe foetal airway by either intubation, bronchoscopy, or tracheostomy while foetal oxygenation is maintained through utero-placental circulation. The most common indication for the EXIT procedure is the presence of foetal airway obstruction, which is usually caused by a prenatal diagnosed neck mass. We report three cases of head and neck tumours with airway obstruction treated by means of EXIT and with different solutions in the management of the airway. With the involvement of Paediatric Otolaryngologists in EXIT, new indications and select variations from the standard EXIT protocol should be considered.

Procedimiento EXIT en el manejo de fetos con severo compromiso respiratorio. La perspectiva del otorrinolaringólogo pediátrico / EXIT procedure in the management of severe foetal airway obstruction. The paediatric otolaryngologist's perspective

El ex-utero intrapartum treatment (EXIT) es una técnica diseñada para permitir un parto fetal parcial a través de una cesárea y el establecimiento de una vía aérea fetal segura a través de intubación, broncoscopia o traqueotomía mientras la oxigenación fetal se mantiene a través de la circulación uteroplacentaria. La indicación más frecuente de EXIT es la obstrucción de la vía aérea fetal, habitualmente causada por una masa cervical diagnosticada prenatalmente. Presentamos 3 casos de tumoraciones de cabeza y cuello con compromiso de la vía aérea tratados mediante EXIT y con diferentes soluciones en el manejo de la vía aérea. Con la implicación de los otorrinolaringólogos pediátricos en el EXIT, aparecerán nuevas indicaciones y podrán valorarse variaciones del protocolo básico

The ex-utero intrapartum treatment (EXIT) procedure is a technique designed to allow partial foetal delivery via caesarean section with establishment of a safe foetal airway by either intubation, bronchoscopy, or tracheostomy while foetal oxygenation is maintained through utero-placental circulation. The most common indication for the EXIT procedure is the presence of foetal airway obstruction, which is usually caused by a prenatal diagnosed neck mass. We report three cases of head and neck tumours with airway obstruction treated by means of EXIT and with different solutions in the management of the airway. With the involvement of Paediatric Otolaryngologists in EXIT, new indications and select variations from the standard EXIT protocol should be considered

[Morphometric study of the mastoid segment of the facial nerve]. / Estudio morfométrico del tercer segmento del nervio facial.

OBJECTIVE: Our study emphasizes the relationship between the temporal bone structures and the mastoid portion of the facial nerve. MATERIAL AND METHODS: Thirty-two temporal bones taken from adult cadavers of both sexes subjected to tympanoplastic procedure were used to make reference measures of the mastoid portion of the facial nerve. Appropriate instruments were used for measurement and statistic analysis was subsequently performed. RESULTS: The digastric ridge presented a positive correlation with the stylomastoid foramen in comparison with the sigmoid sinus (P=.03). There was a correlation between the position of the short apophysis of the incus and the position of the facial nerve (P=.001). The distance from the sigmoid sinus to the mastoid portion of the facial nerve presents a positive linear relationship throughout its length (P< .001). The tympanic membrane presented a positional correlation with the distal portion of the facial nerve (P< .008). CONCLUSIONS: The mastoid portion of the facial nerve is proportional to reference structures in the temporal bone and this may help us to define measures prior to surgical otologic procedures.

Estudio morfométrico del tercer segmento del nervio facial / Morphometric Study of the Mastoid Segment of the Facial Nerve

Objectivo: Enfatizamos en este estudio la relación entre las estructuras de referencia del hueso temporal y su relación con la tercera porción del nervio facial. Material y método: Nuestro estudio se ha realizado con 32 huesos temporales humanos, provenientes de cadáveres de adultos de ambos sexos a los que se practicó timpanoplastia con el objetivo de hacer mediciones de referencia de la porción mastoidea del nervio facial. Luego se las midió con instrumentos adecuados y se practicó análisis estadístico. Resultados: La cresta digástrica presenta una relación positiva con el agujero estilomastoideo en relación con el seno sigmoideo (p = 0,03). Existe relación entre la posición de la apófisis corta del yunque y la posición del nervio facial (p < 0,001). La distancia del seno sigmoideo respecto a la tercera porción del nervio presenta una relación lineal positiva por todo su recorrido (p < 0,001). La membrana timpánica presenta una relación de posición con la porción distal de nervio facial (p < 0,008). Conclusiones: La porción mastoidea del nervio facial presenta relación proporcional con estructuras de referencia del hueso temporal, lo que nos ayudará a definir medidas previas a intervenciones quirúrgicas otológicas

Objective: Our study emphasizes the relationship between the temporal bone structures and the mastoid portion of the facial nerve. Material and methods: Thirty-two temporal bones taken from adult cadavers of both sexes subjected to tympanoplastic procedure were used to make reference measures of the mastoid portion of the facial nerve. Appropriate instruments were used for measurement and statistic analysis was subsequently performed. Results: The digastric ridge presented a positive correlation with the stylomastoid foramen in comparison with the sigmoid sinus (P=.03). There was a correlation between the position of the short apophysis of the incus and the position of the facial nerve (P=.001). The distance from the sigmoid sinus to the mastoid portion of the facial nerve presents a positive linear relationship throughout its length (P<.001). The tympanic membrane presented a positional correlation with the distal portion of the facial nerve (P<.008). Conclusions: The mastoid portion of the facial nerve is proportional to reference structures in the temporal bone and this may help us to define measures prior to surgical otologic procedures

Nena d’onze mesos d’edat amb dificultat respiratòria i estridor progressius / No disponible

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Aspiració de cossos estranys: la nostra experiència / Foreign body aspiration: the experience of a single institution

Fonament. L'aspiració de cossos estranys és una patologiad'elevada incidència a l'edat pediàtrica, i té greuscomplicacions si passa desprevinguda.Objectiu. Analitzar els registres dels pacients ambsospita d'aspiració de cossos estranys, i intentar obtenirconclusions per millorar el diagnòstic i el maneig d'aquestspacients.Mètode. S'ha fet un estudi retrospectiu dels 68 infantsals quals es va fer una broncoscòpia sota l'orientaciódiagnòstica d'aspiració de cos estrany, entre gener de 1998i juny de 2002, analitzant les variables demogràfiques elementalsi les característiques més significatives de la històriaclínica i l'evolució.Resultats. L'edat mitjana dels pacients va ser de 2,85anys. La simptomatologia més freqüent va ser la tos. El91.2% dels casos presentava un antecedent d'ennuegada.La majoria eren fruits secs (82.3%). El temps mitjà d'evolucióva ser de 8.96 dies.Conclusions. Els avenços tècnics han permès millorarel tractament, però el diagnòstic continua basant-se ambl'anamnesi, l'exploració i la sospita clínica. La prevenció ésla mesura fonamental per millorar el maneig d'aquestaentitat

Background. Foreign body aspiration is commonin children, and may have important consequences ifundiagnosed.Objective. To review our experience with the evaluationof patients with a suspected foreign body aspiration,and to develop guidelines to improve diagnosis and treatment.Method. Retrospective study including children whounderwent a bronchoscopy for the presumptive diagnosisof aspiration of a foreign body, between January 1998 andJune 2002.Results. Sixty-eigh patients (median age 2.85 years)were identified. The most common symptom was cough.In 91.2% of the cases there was history of chocking. Inmost cases (82.3%), the foreign body was a nut. The mediantime of symptoms was 8.96 days.Conclusions. New technologies have contributed toimproved treatments, but the most important diagnostictools remain the clinical history, physical examination, andthe high level of suspicion; preventive measures are critical

Complicated acute pediatric bacterial sinusitis: Imaging updated approach.

Acute bacterial sinusitis is usually a clinical diagnosis. Orbital complications require emergent evaluation with computed tomography. Using the orbital septum as an anatomic landmark, such infections can be classified as pre- or postseptal and treated with the most adequate therapy, ie, oral or intravenous antibiotics or surgical endonasal drainage. Intracranial complications can be seen in 3.7% to 11% of these patients, often with subtle clinical symptoms and signs. Radiologists play a decisive role in the final management of these patients and should be familiar with the most relevant complications. In this article, we present a retrospective review of all pediatric patients referred to our department for paranasal sinuses and orbital computed tomography because of acute complicated bacterial sinusitis. They were studied with an emergent enhanced facial and cranial computed tomography within 24 hours of admission, followed by magnetic resonance imaging when intracranial complications were suspected. Particular emphasis is placed on the imaging algorithm and the most relevant complications; we correlate imaging findings with clinical and bacteriological data.

Imaging of complications of acute mastoiditis in children.

Acute mastoiditis is a serious complication of acute otitis media in children. Suppurative disease in the mastoid region occasionally spreads to the adjacent dura mater of the posterior and middle cranial fossae and the sigmoid sinus by means of thrombophlebitis, osseous erosion, or anatomic pathways, producing intracranial complications. Computed tomography (CT) should be performed early in the course of the disease to classify the mastoiditis as incipient or coalescent and to detect intracranial complications. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. CT is therefore a decisive diagnostic tool in determining the type of therapy. In addition, magnetic resonance imaging is performed in patients with clinical symptoms or CT findings suggestive of intracranial complications because of its higher sensitivity for detection of extraaxial fluid collections and associated vascular problems.

Hipoacúsia: de la sospita al tractament (i II) / Hearing impairment: from suspicion to treatment (and II)

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