Friday, July 16, 2010

Acute otitis media: to follow-up or treat?;

International Journal of Pediatric Otolaryngology  74 (8), 930-3 (Aug 2010)
Stevanovic T, Komazec Z, Lemajic-Komazec S, Jovic R; .

Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. Our study included 314 children, aged between 2 months and 6 years. Children were divided into two groups: the first group included children with less severe forms of AOM, who received symptomatic therapy and "wait-and-see" approach (237 children); the second group presented with purulent ear infection and received antibiotic treatment from the beginning (77 children). After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin. The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.

Thursday, July 15, 2010

The role of neuropeptides in pathophysiology of rhinitis

Post Dermatol Alergol 2010; XXVII, 3: 162–165 07/07/2010 (Not English)


(Advances in Dermatology and Allergology,
Gawlik R –

Neuropeptides and neuropeptide–containing nerves are proven to exist in the human nasal mucosa. The presence and distribution of NPY, CGRP, neurokinin A and SP nerve fibres and neuroendocrine cells have been confirmed. Released neuropeptides and kinins are involved in vasodilatation, increased vascular permeability, irritation of neural endings and inflammatory cell migration, causing symptoms of allergic rhinitis. Different studies have demonstrated that neuropeptides have a great potential biological role in inflammatory mechanisms in the nasal mucosa. The role of neuropeptides and kinins in nasal pathophysiology is discussed.

Effects of sulfurous, salty, bromic, iodic thermal water nasal irrigations in nonallergic chronic rhinosinusitis: a prospective, randomized, double-blind, clinical, and cytological study

American Journal of Otolaryngology Received 1 November 2009 published online 31 May 2010.
Giancarlo Ottaviano, MDa, Gino Marioni, MDa, Claudia Staffieri, MDb, Luciano Giacomelli, BDc, Rosario Marchese-Ragona, MDa, Andy Bertolin, MDa, Alberto Staffieri, MDa

Abstract

Objectives

Nasal irrigations are mentioned among the adjunctive measures for treating several sinonasal conditions. Hyperchromatic supranuclear stria (HSS) in the ciliated cells (CCs) has recently been suggested as a potential cytological marker of the anatomofunctional integrity of nasal mucosa. The aim of this study was to compare the effects of nasal irrigations with sulfurous, salty, bromic, iodic (SSBI) thermal water or isotonic sodium chloride solution (ISCS) in patients with nonallergic chronic rhinosinusitis, considering the endoscopic, functional, microbiological, and cytological evidence (including the ratio of HSS-positive CCs to total CCs [the HSS+ rate]).

Methods

In a prospective, randomized, double-blind setting, 80 patients were recruited for nasal irrigations with SSBI water or ISCS for 1 month.

Results

An endoscopically assessed significant clinical improvement was seen after both SSBI thermal water and ISCS irrigations. Before treatment, Staphylococcus aureus was isolated in 5 patients in the SSBI thermal water group and 4 in the ISCS group. After the nasal irrigations, there was no sign of the bacteria in either group. Only the SSBI water irrigations significantly reduced total nasal resistance, as determined by rhinomanometry. Mild nasal irritation (6 cases) and episodes of extremely limited epistaxis (5 cases) were only reported after SSBI thermal water irrigations. Neither type of nasal irrigation significantly increased the mean HSS+ rate at cytological control after 1 month.
Conclusions

Both types of nasal irrigation improved the endoscopic and microbiological features of patients with nonallergic chronic rhinosinusitis, whereas only SSBI irrigations significantly reduced total nasal resistance. Further investigations are needed based on longer treatments and follow-up periods to establish whether the HSS+ rate is useful for monitoring clinical improvements in chronic rhinosinusitis treated with nasal irrigations.

a Otolaryngology Section, Department of Medical and Surgical Specialties, University of Padova, Padova, Italy
b Otolaryngology Section, Department of Medical and Surgical Specialties, University of Padova, Treviso, Italy
c Anatomic Pathology Section, Department of Medical/Diagnostic Sciences and Special Therapies, University of Padova, Padova, Italy
Corresponding author. Otolaryngology Section, Department of Medical and Surgical Specialties, Via Giustiniani 2, 35128 Padova, Italy. Tel.: +39 0 49 8212010; fax: +39 0 49 8213113.

Friday, July 9, 2010

Imaging characteristics of children with auditory neuropathy spectrum disorder

Otology & Neurotology 31 (5), 780-8 (Jul 2010)


Roche JP, Huang BY, Castillo M, Bassim MK, Adunka OF, Buchman CA;


OBJECTIVE: To identify and define the imaging characteristics of children with auditory neuropathy spectrum disorder (ANSD). DESIGN: Retrospective medical records review and analysis of both temporal bone computed tomographic (CT) and magnetic resonance images (MRI) in children with a diagnosis of ANSD.

 SETTING: Tertiary referral center. Patients: One hundred eighteen children with the electrophysiologic characteristics of ANSD with available imaging studies for review.

INTERVENTIONS: Two neuroradiologists and a neurotologist reviewed each study, and consensus descriptions were established.

MAIN OUTCOME MEASURES: The type and number of imaging findings were tabulated. Results: Sixty-eight (64%) MRIs revealed at least 1 imaging abnormality, whereas selective use of CT identified 23 (55%) with anomalies. The most prevalent MRI findings included cochlear nerve deficiency (n = 51; 28% of 183 nerves), brain abnormalities (n = 42; 40% of 106 brains), and prominent temporal horns (n = 33, 16% of 212 temporal lobes). The most prevalent CT finding from selective use of CT was cochlear dysplasia (n = 13; 31%).

CONCLUSION: Magnetic resonance imaging will identify many abnormalities in children with ANSD that are not readily discernable on CT. Specifically, both developmental and acquired abnormalities of the brain, posterior cranial fossa, and cochlear nerves are not uncommonly seen in this patient population. Inner ear anomalies are well delineated using either imaging modality. Because many of the central nervous system findings identified in this study using MRI can alter the treatment and prognosis for these children, we think that MRI should be the initial imaging study of choice for children with ANSD.