How I do it: emergency nasal packing using an umbilical cord clamp to secure a Foley catheter for posterior epistaxis.

Posterior nasal balloon tamponade using a Foley catheter is a well-known, easy, and quick way to bring an end to a posterior epistaxis in emergency situations. To prevent loosening and displacement of the balloon away from the choana, some metallic devices that may crush or tear the catheter are often used. Being light and easy to install, a plastic umbilical cord clamp is a good alternative. While providing a stable double grip on the catheter, the Hollister umbilical clamp does not crush it. When the clamp is removed, saline can be aspirated from the balloon and the catheter left in place with the nasal packing. Afterward, if needed, the saline can be reinjected to restore the tamponade.

Acute epiglottitis in children: results of a large-scale anti-Haemophilus type B immunization program.

The incidence of acute epiglottitis in children is declining in the province of Quebec, Canada. In 1988, a PRP-D anti-Haemophilus type B vaccine was introduced into the routine vaccination schedule of 18-month-old children. A substantial reduction in the occurrence of acute epiglottitis was perceived by clinicians. Since 1992, improved new vaccines (PRP-T, HbOC, PRP-OMPC), given to 2-month-old infants, have been expected to increase the efficacy of the immunization program. The impact of the immunization program on preventing acute epiglottitis was verified using a provincial database system called Med-Echo. In the presumably vaccinated target population (0 to 6 years old), 15 children suffered acute epiglottitis in 1993, whereas 97 cases were reported on the average for each yearly period from 1984 to 1987, just before the program's inception. Thus, the incidence of acute epiglottitis in preschoolers was reduced to 15.4% of its former level. The overall efficacy of the immunization program in preventing acute epiglottitis, therefore, is estimated to be 84.6%.

Radiology case of the month: a tooth in the nose.

Ectopic teeth are seldom found in the nose, although a few reports can be retrieved in the literature. Such a case is hereby presented and briefly discussed. This benign condition is certainly a curiosity.

Acute epiglottitis: historical highlights and perspectives for future research.

Acute epiglottitis was classified under more than 35 headings before 1960. It is the purpose of this article to review and examine the crucial events that have marked, but also often impeded, the conceptualization of this disease. As is the case for other diseases, the history of acute epiglottitis depended upon the evolution of technology in medicine. From this review the author has produced a "catalogue raisonné" of material snatched from the immensity of obsolete publications. It can be considered as an overview of the historical highlights of this very peculiar disease, acute epiglottitis. It also stresses areas of potential research, as our medical forefathers had imagination but lacked the technical capabilities which are now at our disposal. Finally, it gives the reader a unique opportunity to glance at the making of otolaryngology.

Acute epiglottitis in children and adults: a large-scale incidence study.

With the introduction of an anti-haemophilus type B vaccine, a standard incidence rate for acute epiglottitis is needed to judge its efficacy. Epiglottitis is thought to be more common in children than in adults, but this relation has never been clearly established. This article attempts to evaluate the incidence of this disease. A review of the literature regarding the incidence is correlated to new data from the 1981 Census of Canada and the Med-Echo System of the province of Quebec. It suggests that the incidence rate is approximately 60/million for children (1/17,000), whereas it is 10/million for adults (1/103,000). These rates are based on the analysis of 712 pediatric cases and 257 adult cases. After a review from various sources, my estimation is that a slightly lower than 3-to-1 ratio of cases is probable between the pediatric and adult cases of acute epiglottitis.

The pale epiglottitis--a misnomer or not?

Several leading authors on acute epiglottitis have reported a pale appearance of the swelling of the epiglottis in otherwise seemingly classical cases of acute epiglottitis. In order to understand this phenomenon better, a thorough review of the literature was done but only scarce comments were gathered. There seems to be a spectrum of appearance of the epiglottis in acute epiglottitis, the erythema as well as the edema varying independently from mild to marked. A striking feature of this type of epiglottitis is that, despite seemingly appropriate treatment, a most treacherous evolution was reported: four out of 12 cases presented a severe sudden apnea and two others developed an abscess. Aggressive antibiotherapy and steroidotherapy are suggested as well as a prophylactic nasotracheal intubation.

Nasotracheal intubation--a modality in the management of acute epiglottitis in adults.

Acute epiglottitis in adults is usually treated by close observation or tracheostomy. In the last decade, this therapeutic attitude has been challenged by the impressive results obtained by nasotracheal intubation in the treatment of pediatric cases. Many authors have suggested the use of nasotracheal intubation in adults as well as in children: it would be a natural complement to close observation when airway shunting becomes advisable thus rendering tracheostomy unnecessary. Three conditions have to be met before safe nasotracheal intubation can be considered: interested anesthesiological service, supportive otolaryngological assistance, and dependable nursing care. The case of a young woman treated by close observation proceeding to nasotracheal intubation, as the sole way to secure the airway is presented.

Traumatic rupture of the eardrum with round window fistula.

Traumatic perilymphatic round window fistula may manifest itself with minimal cochleovestibular symptoms. Its association with tympanic membrane perforation secondary to ear washing has previously never been published. The rapid complete recuperation of cochleovestibular function after a conservative obliteration of the round window niche with fat and a myringoplasty, leads us to suggest early surgical intervention when there is evidence or high suspicion of perilymphatic fistula with a traumatic membrane perforation.

[Recurrent meningitis and cerebrospinal fluid fistula across the footplate of the stapes]. / Méningite récidivante et fistule de L.C.-R. à travers la platine de l'étrier.

The clinical observation of a patient who presented an association of recurrent meningitis, unilateral deafness, and congenital anomaly of the ear is presented. The surgical exploration permitted us to find a CSF leak through the footplate of the stapes. The present concepts concerning especially the diagnosis and treatment of this pathology are discussed.