New progress in diagnosis and treatment of congenital laryngomalacia in infants / 临床耳鼻咽喉头颈外科杂志

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.

Analysis of cases of laryngeal airway diseases in infants / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the clinical data of laryngeal airway diseases in infants and provide reference for the standardized diagnosis and treatment of the disease. Methods:From June 2022 to August 2023, analyze the clinical data of 4 cases of children with laryngeal airway diseases recently admitted to Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, and summarize the experience and lessons of diagnosis and treatment by consulting relevant literature. Results:Three cases had symptoms such as laryngeal wheezing, dyspnea, backward growth and development, etc. After electronic laryngoscopy, the first case was diagnosed with laryngeal softening （severe, type Ⅱ）, and the angular incision was performed. While cases 2, 3 diagnosed with case 2 and 3 were diagnosed with laryngeal cyst and underwent laryngeal cyst resection. All three cases underwent low-temperature plasma surgery under visual laryngoscope, and the symptoms were relieved after operation. Case 4 was laryngeal wheezing and dyspnea after extubation under general anesthesia. The electronic laryngoscopy showeded early stage of globetic stenosis, and endoscopic pseudomembrane clamping was performed, and the postoperative symptoms were relieved. Conclusion:Infants and young children with laryngeal airway diseases should pay attention to the early symptoms and be diagnosed by electronic laryngoscopy as soon as possible. With good curative effect and few complications, low-temperature plasma surgery under visual laryngoscope is recommended. The formation of pseudomembrane under the gluteal caused by tracheal intubation causes rapid onset and rapid development. The pseudomembrane extraction by clamping is convenient and fast, with good curative effect.

Audiological Detection in the Diagnosis of Children with Acute Non-Suppurative Otitis Media (AN-SOM) / 听力学及言语疾病杂志

Objective To study the potential roles of acoustic immittance,distortion product otoacoustic e-mission (DPOAE),and the brainstem response audiometry (ABR)in the diagnosis of children with acute non-sup-purative otitis media (AN-SOM).Methods A retrospective analysis was administered to 182 cases with AN-SOM at the otolaryngology department between March 2014 and March 2015.We compared the results of the acous-tic immitance of 218 symptomatic ears and 146 asymptomatic ears,and also the proportion of DPOAE abnormity and ABR abnormity.We analyzed the specialty of symptomatic ears and asymptomatic ears in 3 terms of audiology test results.Results The proportions of abnormal tympanograms,DPOAE,ABR for symptomatic ear were 64.7%, 72.0%,and 57.8%,which were significantly higher than those of in 41.8%,39.7%,and 35.6% in asymptomatic ear.The difference were statistically significant(P<0.05).A further analysis of audiologic results showed that at least one abnormal result was as high as 196 ears (89.9%)in the asymptomatic ear,90 ears (61.6%)showed no symptoms.The differences were statistically significant(P<0.05).The results of audiology tests showed that tym-panograms in symptomatic ears showed diversity,that were 60.6% for type B or C,35.3% for type A,4.1% for the As.Conclusion The early detections by using acoustic immitance,DPOAE and ABR are very important to the diagnosis of children with acute non-suppurative otitis media.It can improve the sensitivity,and reduce the misdi-agnosis.

Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months.</p><p><b>RESULTS</b>The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ² were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was only 43.2% (χ² = 36.189, P < 0.05). B2 and B3 subgroups cured after coblation adenotonsillectomy, but no decrease of the adenoid and tonsil size was found in B1 subgroup (P > 0.05). The nasal endoscopic examination scores of B1, B2 and B3 subgroups showed significant decrease after the treatment, but re-increase was found in both B1 and B2 subgroups at the 6 months (F = 1 614.244, P < 0.05), no significant re-increase was found in the B3 subgroup. The PSG monitor of B3 subgroup was 100.0% normal at 3 months after treatment, B2 subgroup 73.4%, and B1 subgroup only 57.4% (χ² = 90.846, P < 0.05).</p><p><b>CONCLUSIONS</b>The treatment method of children with OSAHS should be selected according to the age, condition of disease, and size of the adenoid and tonsil. Adenoid and tonsil ≤ degree III should select conservative treatment; while for degree IV adenoid and (or) tonsil, surgical treatment should be primary choice. Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.</p>

The relationship between obstructive sleep apnea hypopnea syndrome and adenoid size as well as tonsil size in children / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and adenoid size as well as tonsil size in Children.@*METHOD@#A total of 545 patients, 338 OSAHS patients (treated group) diagnosed by PSG and 207 patients with vocal cord nodules but symptoms of upper airway obstruction (control group), were enrolled from inpatient and outpatient between June, 2008 and October, 2010. The oropharynx and electron-nasopharyngolaryngoscopy examination records of the two groups were retrospectively analyzed. The patients in the treated group were also divided into mild group, moderate group and severe group according to obstructive apnea index (OAI) or AHI. SPSS 17.0 was used for statistical analysis.@*RESULT@#In the treated group, 89.7% had grade III-V adenoid and 68.4% had grade III-IV tonsil, compared with 30.9% (adenoid) and 13.5% (tonsil) in the control group. The significant differences were found (all P < 0.01). The comparison between patients with different grades of adenoidal size and tonsil size in the treated group had indicated that patients with grade IV adenoid or grade IV tonsil have a higher risk of OSAHS than patients with grade III adenoid or grade III tonsil. In the treated group, the ratio of patients with different severity of adenoid or tonsil had increased with the severity of OSAHS (P < 0.01). This retrospective study had also found that most of the grading results from Electron-nasopharyngolaryngoscopy examination were consistent with that from oropharynx examination. 13 (37.1%) of 35 patients with grade I or II tonsil diagnosed by Oropharynx examination were considered as grade III by Electron-nasopharyngolaryngoscopy examination.@*CONCLUSION@#Adenoidal hypertrophy and tonsil hypertrophy are the risk factors for OSAHS in children. The risk of OSAHS and the severity of OSAHS are positively associated with the severity of adenoid and tonsil. The electron-nasopharyngolaryngoscopy examination is an important examination method for diagnosing OSAHS in children, as well as determination of tonsil size.