Bacterial communication encourages chronic, resistant ear infections

Bacterial communication encourages chronic, resistant ear infections

Complications of adenotonsillectomy

Current Opinion in Otolaryngology & Head & Neck Surgery:

December 2010 - Volume 18 - Issue 6 - p 539–543

doi: 10.1097/MOO.0b013e3283404dcc

Pediatric otolaryngology: Edited by Lisa Buckmiller

Statham, Melissa M

Abstract

Purpose of review: Tonsillectomy and adenoidectomy are two of the most commonly performed pediatric surgical procedures. As with all surgical intervention, tonsillectomy and adenoidectomy are associated with a host of potential complications. Fortunately, for most children undergoing adenotonsillectomy (T&A), complications are rare. This review is intended to summarize recent reports, which may lead to prevention and treatment of T&A complications.

Recent findings: The presented reports of complications and risk factors for complications in children undergoing T&A highlight perioperative medical management as a means to decrease perioperative complications. Certain tonsillectomy techniques, such as microdebrider intracapsular tonsillectomy, may lead to decreased posttonsillectomy hemorrhage and dehydration. Despite published recommendations, preoperative assessments for bleeding diatheses vary among practitioners. Conversely, guidelines for evaluation of posttonsillectomy hemorrhage are lacking. Some pediatric populations, such as children with coagulopathy, neurologic disease, and obesity, have increased risk of perioperative complications, and recent reports regarding their care are presented.

Summary: We present recent data pertinent to the contemporary management of medical and surgical complications of T&A, with particular focus on specific at-risk pediatric populations. In the patient groups illustrated in this review, anticipation of complications may decrease complications or lead to improved management of complications when they occur.

Acute epiglottitis: epidemiology and Streptococcus pneumoniae serotype distribution in adults

The Journal of Laryngology & Otology 

25 Nov 2010

M Isakson^a1 and S Hugosson^a1 c1

^a1 Department of Otolaryngology, Örebro University Hospital, Sweden

Abstract

Objectives: We studied the incidence and bacterial epidemiology of acute epiglottitis presenting in the first 16 years following the introduction of general childhood vaccination against Haemophilus influenzae type b. Our main objectives were to analyse (1) the incidence of Streptococcus pneumoniae epiglottitis in adults and (2) the distribution of pneumococcal serotypes involved.

Materials and methods: The medical records of patients with acute epiglottitis (International Classification of Disease code J05.1) were investigated. Streptococcus pneumoniae serotyping was performed using gel precipitation.

Results: The overall incidence of acute epiglottitis was 0.98 cases/100 000/year, compared with 4.5 cases/100 000/year before the vaccination programme. The incidence was reduced both in children and adults, compared with pre-vaccination values. However, the incidence of Streptococcus pneumoniae epiglottitis in adults increased from 0.1 to 0.28 cases/100 000/year over the same time period. The causative agent was Streptococcus pneumoniae in 10 adults. Nine of 10 pneumococcal strains could be serotyped. All but one serotype is represented in the 23-valent pneumococcal polysaccharide vaccine (PPV23) used in adults.

Conclusion: In acute epiglottitis, now a disease of adults, the most important bacterial aetiology is Streptococcus pneumoniae. The serotype distribution found in this study indicates that the infection is preventable by PPV-23 vaccination with the 23-valent polysaccharide vaccine.

(Accepted July 07 2010)

Key words

• Epiglottitis; 
• Epidemiology; 
• Streptococcus Pneumoniae; 
• Vaccination

Correspondence:

^c1 Address for correspondence: Dr Svante Hugosson, Dept of Otolaryngology, Örebro University Hospital, SE-701 85 Örebro, Sweden Fax: +46 19 10 33 01 E-mail: svante.hugosson@orebroll.se

Footnotes

Dr S Hugosson takes responsibility for the integrity of the content of the paper

Competing interests: None declared

Postoperative bleeding in paediatric ENT surgery. First results of the German ESPED trial

Hämostaseologie 30 (41), S108-11 (Nov 2010)

Bidlingmaier C, Olivieri M, Stelter K, Eberl W, von Kries R, Kurnik K; 

Bleeding after ear-nose-and throat surgery in children is a serious complication. With the help of the German Surveillance Unit for Rare Paediatric Disorders (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland; ESPED) a two year survey was performed to record the incidence, severity, reasons and treatment of haemorrhages. During the study period, 1069 bleeds were reported from 720 paediatric hospitals and departments of otorhinolaryngology after adenoidectomy and tonsillectomy. 713 reports could be analyzed. Two deaths occurred after adenoidectomy.

Although laboratory screening was performed in more than 70% of all cases, bleeding complications were neither foreseeable nor preventable. Inherited coagulopathies were rare and in most cases not detected, neither by laboratory screening nor by taking a history.

Since preoperative measures cannot help much to improve the situation, all efforts have to be taken to improve the postoperative period, especially since more than 20% of the hemorrhages occurred during weekends. Guidelines on postoperative care and behaviour should therefore be implemented and parents and patients must be informed on bleeding risks and on what to do in case of emergency. If bleeding occurs, extensive coagulation testing is mandatory.

Safety of intranasal Bevacizumab (avastin) treatment in patients with hereditary hemorrhagic telangiectasia-associated epistaxis

The Laryngoscope (Nov 2010)

Chen S, Karnezis T, Davidson TM; 

OBJECTIVES/HYPOTHESIS:: Assess for complications of intranasal Bevacizumab application in patients with hereditary hemorrhagic telangiectasia (HHT)-associated epistaxis. 

STUDY DESIGN:: Retrospective chart review. 

METHODS:: In 58 patients presenting with recurrent HHT epistaxis, Bevacizumab was applied intranasally either as a submucosal injection or as a topical spray between October 2006 and June 2010. In many of the injected patients, the potassium titanyl phosphate (KTP) laser was used adjunctively for vessel photocoagulation. A phone interview was performed in July 2010 to assess for treatment complications. 

RESULTS:: Of the 58 treated patients 52 were contacted. Patient surveys were performed 1.5 to 46 months following their initial Bevacizumab treatment. Within the treatment population, five patients had sustained a septal perforation. Notably, these patients were treated early in the study period at which time the cartilaginous septum was often both injected and lasered. Subsequently, the treatment protocol was changed and the cartilaginous septum was neither lasered nor injected. After these changes were made no additional septal perforations were identified. No other adverse events were associated with intranasal Bevacizumab treatment. 

CONCLUSIONS:: Bevacizumab applied as either a submucosal injection or as a topical nasal spray, with or without application of the KTP laser, is a safe treatment regimen. Still, when Bevacizumab injections are performed, the cartilaginous nasal septum should be avoided as patients may develop septal perforations. Laryngoscope, 2010.

ENT morbidity at high altitude

The Journal of Laryngology & Otology

• FirstView Article
• doi: 10.1017/S0022215110002331 (About doi)
• Published online by Cambridge University Press 17 Nov 2010

B K Prasad

Department of ENT and Head and Neck Surgery, Command Hospital (Eastern Command (EC)), Kolkata, West Bengal, India

Abstract

Background: People suffer unique health problems in high altitude areas, due to such factors as elevation, aircraft ascent and descent, extreme cold, hypoxia, hypobaria, and low relative humidity. This study was conducted to evaluate ENT morbidity at high altitude.

Methods: Serving soldiers introduced to a high altitude environment who presented with various ENT symptoms were examined to identify ENT disease. In addition, patients undergoing hyperbaric chamber therapy, tracheostomy and treatment of cold injuries were also examined for ENT problems.

Results: The following were detected: 13 cases of otic barotrauma, 11 cases of sinus barotrauma, three cases of vertigo, six cases of pinna frostbite, three cases of barotrauma caused by hyperbaric chamber therapy, an unusually high incidence of epistaxis, and innumerable patients with high altitude pharyngitis.

Conclusion: Diseases of the ear, nose and throat contribute significantly to high altitude morbidity. In a military context, health education of troops is necessary to avoid such problems.

(Accepted June 28 2010)

Correspondence:

^c1 Address for correspondence: Lt Col (Dr) B K Prasad, Department of ENT and Head and Neck Surgery, Command Hospital (EC), Alipore Road, Kolkata 700027, West Bengal, India Email: bipin_rupa@rediffmail.com

Footnotes

Presented at the 62nd Annual Conference of the Association of Otolaryngologists of India, 8 January 2010, Mumbai, India