The influence of body mass on long-term cognitive performance of children treated for sleep-disordered breathing.

BACKGROUND: Long-term follow-up of children treated for sleep-disordered breathing (SDB) is limited, as the examination of factors potentially contributing to recovery is also limited. This study aimed to examine whether the recovery of neurocognitive function is achieved at four years post-adenotonsillectomy for SDB in children and whether body mass status influences the outcome. METHODS: This prospective longitudinal study of 3- to 12-year-old children recruited from an otolaryngology clinic compared cognitive performance, sleep, ventilation, and body mass before and at four years post-adenotonsillectomy in children with SDB and compared these parameters to those of untreated healthy controls during the same time points. RESULTS: Children were categorised as normal-weight control (n = 33), normal-weight SDB (n = 18), or overweight/obese SDB (n = 11). Body mass did not significantly differ at four year follow-up compared to the baseline in any subgroup (p > 0.05), and groups were matched on the basis of age and gender. Despite improved sleep and nocturnal ventilation at four years post-adenotonsillectomy, little gain was observed in neurocognitive performance in either nonobese or overweight/obese children with SDB. Overweight/obese children with SDB displayed worse neurocognitive performance than all other children. CONCLUSION: Adenotonsillectomy improves nocturnal ventilation and sleep quality but not neurocognitive performance in the long term. Excess body mass may place children with SDB at increased risk of neurocognitive performance deficits.

The posterior attic: An observational study of aboriginal Australians with chronic otitis media (COM) and a theory relating to the low incidence of cholesteatomatous otitis media versus the high rate of mucosal otitis media.

OBJECTIVE: The incidence of COM without cholesteatoma in Australian aboriginals is quoted as being between 25 and 47%. The incidence of cholesteatomatous OM is very low in comparison (between 1 and 3%). A comprehensive literature search found no studies offering an explanation for the large discrepancy between these two types of OM. We offer a theory to account for the disproportionate rates of the two types of OM together with an observational study on aboriginals with COM to substantiate our argument. METHOD/RESULTS: The crux of our hypothesis centres on the anatomy of the posterior attic. We found that in a study of 40 aboriginal patients undergoing tympanoplasty with audiometric evidence of an intact ossicular chain that, after posterior tympanomeatal flap elevation, no part of the incudostapedial assembly was visible in 95% of cases denoting its location behind the posterior attic wall. CONCLUSION: We hypothesise that in aboriginal ears the resulting 'crowding' of the posterior attic by the incudostapedial assembly results in narrowing of the epitympanic space which compromises atticoantral drainage, thus leading to mucosal COM, however supporting the posterior-superior segment of the tympanic membrane, impeding the formation of a retraction pocket, and cholesteatoma formation migrating into the mastoid antrum.