Reccurent Tonsillitis and Carditis...?
A not-too-recent study from Turkey (Pac A et al, Int J Pediatr Otorhinolaryngol. 2005 Apr;69(4):527-32.) compared cardiac function in children with or without adenotonsillar hypertrophy and concluded that a correlation exist between adenotonsillar hypertrophy and possible silent carditis following frequent tonsillitis

Abstract: OBJECTIVE: Comparison of cardiac function in children with and without adenotonsillar hypertrophy. METHODS: We examined 28 pediatric patients with adenotonsillar hypertrophy mean aged 7.3+/-2.9 years comprised of 14 females and 14 males (group I). The control group were chosen from 35 healthy sex and age matched children mean aged 7.37+/-2.7 years (group II). Both groups were examined by an otorhinolaryngologist and adenotonsillar hypertrophy was diagnosed with nasal endoscopic method or lateral neck X-ray. All the patients in group I underwent adenotonsillectomy. Cardiologic and echocardiographic examinations were performed in both groups. Echocardiographic examination was done twice in group I (preoperative and postoperative first month) however in group II only once. Preoperative findings of group I compared with the findings of group II. Preoperative and postoperative echocardiographic findings were also compared within group I. The chi-square test and the independent paired-sample t-test were used for statistical analysis. RESULTS: The tricuspid end-diastolic time was the only significant difference in echocardiographic findings between the two groups (104.8+/-28.8 ms versus for 86.4+/-17.32 ms p<0.05). There was no statistical difference between preoperative and postoperative echocardiographic findings in group I. Brady-tachyarrhythmia was detected on electrocardiography - performed with 24h ambulatory electrocardiography - in one patient. To our surprise, in group I five patients had cardiac valve damage: mitral and/or aortic valve insufficiency. These findings were interpreted as silent carditis.CONCLUSION: There was no significant difference in right ventricular function between the children with and without adenotonsillar hypertrophy.Whereas, there was shortening of tricuspid end-diastolic time in group I.However, five patients having adenotonsillar hypertrophy developed a cardiac dysfunction which was not observed in the control group.Therefore, we assumed a correlation between adenotonsillar hypertrophy and possible silent carditis following frequent tonsillitis.
 

---

Coming Events of Importance to Otolaryngologists in Africa...
 

1. Annual West Africa College of Surgeons Conference, Accra, Ghana, Feb 2006.
2. Association of Paediatric Otolaryngologists of India 12th Annual Conference and CME in Paediatric Otolaryngology
   February 25-26, 2006; New Delhi, India
3. 8th International Otology Course of the Jean Causse Ear Clinic
   June 22-24, 2006; Béziers, France
4. 110th American Academy of ORL,Head & Neck Surgery Annual Meeting & OTO EXPO
   September 17-20, 2006;
   Toronto, Canada.
5. 42nd South African ENT Congress joint meeting with the British Association of Otolaryngology - Head & Neck Surgery
   October 29-November 1, 2006;
   Cape Town, South Africa.

         For more courses and workshops and conferences....Click Here

---

Paediatric Cholesteatoma - What Approach Is Best.....?       

Schraff SA et al in a retrospective review on best surgical approach to paediatric cholesteatoma reviewed 262 cases and concluded that the management needs to be individualized.

Abstract: OBJECTIVES: The optimal treatment for pediatric cholesteatoma is controversial. Management decisions including intact canal wall versus open cavity techniques, second look procedures and staging ossicular reconstruction continue to be debated. In an attempt to clarify this issue we conducted an 11-year retrospective analysis of our experience with cholesteatoma presenting in our pediatric population. STUDY DESIGN: Retrospective review of children undergoing surgical intervention for cholesteatoma at a tertiary care pediatric hospital between 1 July 1992 and 1 July 2003 by the senior author. METHODS: Comparison of recurrence rates in intact canal wall (ICW) versus canal wall down (CWD) procedures; with analysis of second-look procedures, ossicular chain reconstruction (OCR) and hearing results in the management of pediatric cholesteatoma. RESULTS: Two hundred and sixty-two children with 278 cases of cholesteatoma underwent surgical resection. Of these children, 221 were managed via an ICW approach while the remaining 57 underwent a CWD procedure. The overall recurrence rate in this series was 16%, with 17% in the ICW group and 12% in the CWD group. OCR was performed in 97% of the ICW cases at time of second-look procedure, with 75% undergoing reconstruction with partial ossicular reconstruction prosthesis. The average air-bone gap improvement in these patients was 10.8dB, with an average hearing improvement of total ossicular reconstruction of 5.8dB. The average hearing improvement in the CWD group, all managed with cartilage interposition grafts, was 3.7dB. CONCLUSIONS: Management of pediatric cholesteatoma requires a highly individualized approach that takes into account anatomic, clinical and social factors to determine the most successful surgical treatment paradigm.

 

What is the diagnosis?

• Parting Shot...
  If you have an interesting case to discuss or share with other Otolaryngologists all over Africa, feel free to email Me or at best go to otolaryngology in Africa blogsite and post your case
• Also, if you are among those who requested for a copy of DODA at the last ORLSON Meeting @ Port Harcourt, please take time to view the DODA - FAQ page, and expect your copy anytime now. The program is being shipped to you.
• An online video demonstration of doda is available at http://www.otolaryngologyinafrica.net/doda_video.htm  This video takes about 30 - 45 minutes to fully load on a broad band network the first time, but once fully loaded could be viewed over and over again

Till Next Week,

Biodun

---