Text Box: Abstract:  Study Design: Prospective and retrospective collection of evaluative data on infants with congenital laryngomalacia at two tertiary care pediatric referral centers. Methods: Two hundred one infants with laryngomalacia were divided into three groups on the basis of disease severity (mild, moderate, severe). Patients were followed prospectively every 8 to 12 weeks until symptom resolution or loss to follow-up. Sensorimotor integrative function of the larynx was evaluated in 134 infants by laryngopharyngeal sensory testing (LPST) of the laryngeal adductor reflex (LAR) by delivering a duration- (50 ms) and intensity- (2.5–10 mm Hg) controlled air pulse to the aryepiglottic fold to induce the LAR. Medical records were retrospectively reviewed for medical comorbidities. Results: The initial LPST was higher (P < .001) in infants with moderate (6.8 mm Hg) and severe disease (7.4 mm Hg) compared with those with mild disease (4.1 mm Hg). At 1, 3, and 6 months, infants with moderate and severe disease continued to have a higher LPST compared with those with mild disease. At 9 months, the LPST decreased in all subjects (3.1–3.5 mm Hg, P = .14), which also correlated with symptom resolution. Neurologic, genetic, and cardiac diseases were more common in infants with severe disease (P < .001). Gastroesophageal reflux disease (GERD) and feeding problems more common in those with moderate and severe disease (P < .001). Apgar scores were lower in those with severe disease (P < .001). Most symptoms resolved within 12 months of presentation. Those with GERD benefited from treatment. Supraglottoplasty resulted in few complications. Multiple comorbidities (>3) influenced the need for tracheotomy. Conclusions: Laryngeal tone and sensorimotor integrative function of the larynx is altered. The degree of alteration correlated with disease severity, indicating that factors that alter the peripheral and central reflexes of the LAR have a role in the etiology of signs and symptoms of laryngomalacia. GERD, neurologic disease, and low Apgar scores influenced disease severity and clinical course, explaining the spectrum of disease symptoms and outcomes. Sensorimotor integrative function improved as symptoms resolved.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Text Box: June  16 2007

Text Box: Otorhinolaryngology News

Text Box: Inside This Issue · LigSensorimotor abnormality & Laryngomalacia..? · IMAgeing Brain & Presbycusis...? · TinBIJV Sampling for PTH Assay & Localization of HPT...? *     Case of the Week

Case Review Clinical Photograph of The Week
 

An 8 months old male was referred to the ENT clinic on account of persistent tearing from the left eye. Mother gave no history of nasal obstruction or rhinorrhoea. Clinical examination revealed the feature displayed on the opposite picture. Contrast dacryocystography revealed accumulation of contrast in the lacrimal sac with no visualization of the nasolacrimal duct >>>>

 

 

 

What is the Diagnosis & the Best Management Option?

 

1.    16th Annual general meeting and scientific conference of otorhinolaryngological society of Nigeria (ORLSON), November 21 - 24, 2007. See Here For details.

2. . Further Conference Announcement? Click Reed our Feed or Check the Conference Announcement Page

 

 

 

 
 

Text Box: Ageing Brain & Presbycusis...?

This interesting study from Winscosin ( Ito F, et al, Annals of Surgery, Volume 245(6), June 2007, pp 959-963) observed that in patients with hyperparathyroidism undergoing surgery, bilateral internal jugular venous sampling with rapid PTH assay is safe, effective and provide additional info in localization of diseased parathyroid gland.


Abstract:

Objective: To determine the utility of routine perioperative bilateral internal jugular venous sampling of parathyroid hormone (BIJ PTH) for localization during parathyroid surgery.

Summary Background Data: Venous sampling for PTH is a useful tool for parathyroid localization in patients undergoing reoperative surgery for hyperparathyroidism (HPT). With the development of intraoperative rapid PTH (ioPTH) testing, internal jugular PTH sampling with ioPTH testing to guide operative localization has been shown to be possible in select, difficult cases. However, the value of BIJ PTH for patients with HPT is unclear.

Methods: Between May 2004 and February 2006, 216 consecutive patients underwent neck exploration for HPT by one surgeon. Of these, 168 patients had BIJ PTH. Internal jugular venous blood was drawn from both left and right sides and analyzed for PTH using a rapid PTH assay. BIJ PTH levels were defined as lateralizing if >5% differences were observed between the right and left internal jugular vein samples.

Results: Of the 168 patients, 120 (71.4%) had a single parathyroid adenoma, 15 (8.9%) had double adenoma, and 33 (19.6%) had hyperplasia. The cure rate after parathyroidectomy was 98.2%. There were no complications related to BIJ PTH sampling. Sensitivity and positive predictive value of BIJ PTH for primary hyperparathyroidism were 80% and 71%, respectively. BIJ PTH was diagnostic in 95 cases (62.9%) in primary HPT. BIJ PTH successfully localized an abnormal gland in 26 of 45 (57.8%) in patients with negative sestamibi scanning. BIJ PTH was especially helpful in 18 of 168 (10.7%) cases when intraoperative peripheral parathyroid hormone did not fall by 50% and BIJ PTH successfully localized the hyperfunctioning glands.

Conclusions: In patients with HPT, BIJ PTH is safe and effective, providing additional localization information in the majority of cases. BIJ PTH is particularly useful in the setting of negative sestamibi scanning and in complex multigland disease cases.

 

     Journal Watch : Endoscopic management of limited attic cholesteatoma. Tarabichi M., 2004
 

 1.   The otolaryngologyinafrica.net resident's page has been re-designed. The current forum page is now separated from the archive page. FEEL FREE  to view the new design and recommend to your residents

 2.  From  http://www.otolaryngologyinafrica.net/grandround/  is a new addition - a recent conference poster presentation. This presentation is available at http://www.otolaryngologyinafrica.net/grandround/archive.htm .

 3.   DODA has been redesigned. Take time to view the new look of this program at the DODA Images Page... You may also download DODA Video, mobile devices edition, which can be installed on your cell phone (Note:  a multimedia cell phone is required).

 4.   otolaryngologyinafrica.net website is being re-organized to enable multi-language access. Take time to review the new HomePage. When Completed, it might be possible to assess the contents of the site in the six major languages widely spoken all over Africa

 5.  Otolaryngologyinafrica.net is experimenting with use of SMS notification of newsletter release. Feel free to air your view on this issue by emailing orl-mailer@otolaryngologyinafrica.net .

 Till Next Week, Welcome to 2007!

 Biodun

 
 

This is a free online newsletter circulating to Otolaryngologists in Africa, and interested Otolaryngologists elsewhere. If you know anyone interested in receiving this free newsletter, feel free to forward a copy to such person or encourage them to email orl-mailer@otolaryngologyinafrica.net  for free subscription

Post a Comment To This Newsletter

                          © Copyright Dr 'Biodun Olusesi,  2005 - 2007

 
Request for Free DODA

Otolaryngology in Africa Feed

Auditory Neuropathy

Text Box: Reed our Feed