C. Georgalas

Measuring quality of life in children with adenotonsillar disease with the Child Health Questionnaire: a first U.K. study.

Objective: To validate the Child Health Questionnaire (CHQ) and assess the quality of life of inner-city British children with adenotonsillar disease. n n n nMethods: The primary caregiver of a consecutive series of 43 patients referred for adenotonsillar disease to a pediatric otolaryngology clinic completed the Child Health Questionnaire. Questionnaires were analyzed for data quality and completeness, items/scale correlation, internal consistency and discriminant validity, interscale correlation, reliability estimates and external validity. n n n nResults: CHQ demonstrated excellent measuring characteristics in our population. In a comparison with healthy children, 11 out of 15 measures of quality of life were significantly depressed in our sample. Compared with children with rheumatoid arthritis, scores were equivalent in most areas, with the exception of the global health subscale and overall physical score, where our sample scored significantly lower. n n n nConclusion: The CHQ (PF 28 version) is an accurate and reliable way of assessing the impact of adenotonsillar disease on the quality of life in children in Britain. This appears to be quite significant in most aspects of a childs life.Objective: To validate the Child Health Questionnaire (CHQ) and assess the quality of life of inner‐city British children with adenotonsillar disease.

Medical Treatment for Rhinosinusitis Associated with Adenoidal Hypertrophy in Children: An Evaluation of Clinical Response and Changes on Magnetic Resonance Imaging

Objectives: The association between adenoidal hypertrophy and rhinosinusitis with upper airway inflammation is increasingly recognized; however, no study has used magnetic resonance imaging (MRI) to assess the changes in adenoid size after medical treatment of rhinosinusitis. Methods: Thirteen children referred to a tertiary allergy clinic with symptoms of rhinosinusitis received medical treatment over a 4-month period. All underwent MRI before and after treatment. The medical treatment regimen comprised a short course of oral antibiotics and oral steroids and a longer course of oral antihistamines and intranasal steroids. Results: The pretreatment MRI demonstrated enlarged adenoids and rhinosinusitis in all 13 children, with evidence of extensive rhinosinusitis in 9 of the 13. The treatment resulted in an improvement in overall symptom score; the most significant improvement was seen in mouth breathing. The posttreatment MRI showed a statistically significant reduction in adenoid size and adenoid/nasopharynx ratio, which was associated with a significant decrease in sinus involvement on MRI. Conclusions: There is a high association between adenoidal hypertrophy and rhinosinusitis in the context of an allergy clinic. Magnetic resonance imaging can document the changes in adenoid size associated with resolution of rhinosinusitis. Further studies are necessary to validate these pilot data and further assess the effects of medical treatment and the role of MRI in adenoidal hypertrophy.

Endoscopic transsphenoidal surgery for cholesterol granulomas involving the petrous apex.

•u2002Surgery for cholesterol granulomas involving the petrous apex has traditionally been performed via a lateral skull base approach.

The Association between Periodontal Disease and Peritonsillar Infection: A Prospective Study:

OBJECTIVE : To study the relationship between periodontal status and peritonsillar disease/recurrent tonsillitis. STUDY DESIGN AND SETTING : A total of 158 patients presenting over a 3-year period with peritonsillar abscess (PTA) confirmed by needle aspiration and a control group of 112 patients booked for elective tonsillectomy for recurrent tonsillitis (RT) were examined in terms of their periodontal status using the WHO Community Periodontal Index of Treatment Needs (CPITN). RESULTS : The mean CPITN index was 2.81 (Standard Deviation [SD], 1.10) in patients with PTA and 1.41 (SD, 0.92) in patients with RT. One hundred seven of 158 patients with PTA had significant periodontal pathology (CPITN, 3 or 4) compared with 12 of 112 patients with RT. These differences were statistically significant. CONCLUSION : Patients with peritonsillar abscess had an increased prevalence of periodontal disease as compared with patients with recurrent tonsillitis. SIGNIFICANCE : There is a need to further explore this correlation and determine its nature, although it could be the result of common pathogenic factors, a causal relation cannot be excluded.

Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation

The relationship between allergic rhinitis and chronic rhinosinusitis has been assessed in a number of observational and experimental studies. In this review, we attempt their synthesis and evaluation using the modified Bradford Hill guidelines for causation. Although there is no proof of causation, especially in the pediatric literature, an evaluation of underlying allergies is recommended at least as an initial measure of symptoms relief.

Health outcome measurements in children with sleep disordered breathing.

Objective:u2002 To validate the Child Health Questionnaire, measure quality of life in children with obstructive sleep apnoea and assess the impact of surgery.

The clinical value of peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index.

The aim of this study was to ascertain the most reliable objective measurement for the assessment of nasal patency by investigating the relationship between peak nasal inspiratory flow, peak oral inspiratory flow, and the nasal patency index in relation to the patients subjective perception regarding nasal obstruction.

Conservative management of a major post-intubation tracheal injury and review of current management

Tracheal rupture represents a rare but serious complication of intubation. We discuss a case of a major post-intubation rupture. After investigation with CT scan tracheoscopy and bronchoscopy a low tracheostomy was formed protecting the rupture from pressure changes associated with ventilation. The patient was managed with minimal surgical intervention, low tracheostomy with antibiotic cover and monitoring in the intensive care unit for 24xa0h before being woken and moved to a ward after 48xa0h. The patient made a full and uncomplicated recovery and was discharged 2xa0weeks after the original injury. Most of the literature on the subject is made up of review of case reports that conclude management of such a major tear must be with surgical repair. This however confers significant morbidity and an associated high mortality. We suggest an alternative management protocol.

Is bacterial colonisation of the tonsillar fossa a factor in post-tonsillectomy haemorrhage?

OBJECTIVESnTo identify if there is a link between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage.nnnSTUDY DESIGN AND SETTINGnProspective non-interventional study of 105 patients who underwent tonsillectomy during a seven-month period. The study took place in a secondary care centre, the West Middlesex University Hospital.nnnPARTICIPANTSnThe participants were 105 patients who consecutively underwent tonsillectomy. The exclusion criteria were any patients with suspected or known malignancy, or known bleeding dyscrasias. The participants underwent microbiological sampling of the tonsil pre-operatively.nnnMAIN OUTCOMES MEASURESnThe outcome measures were primary or secondary bleeding, defined as any evidence of haemorrhage in the tonsillar fossae.nnnRESULTSnTwenty-four per cent of patients undergoing tonsillectomy had positive cultures from their tonsils pre-operatively. Patients with bacterial colonisation of the tonsillar fossa pre-operatively had an increased rate of post-tonsillectomy haemorrhage (odds ratio: 3.8, 1.1-12.1, 95 per cent confidence intervals, p = 0.04).nnnCONCLUSIONnThis prospective study has found a relationship between bacterial colonisation of the tonsillar fossa and post-tonsillectomy haemorrhage. This suggests that there may be an argument for the use of antibiotics in those cases with positive pre-operative cultures. In view of the types of pathogens isolated, we feel that the management of a post-tonsillectomy bleed should include a beta lactamase inhibiting antibiotic.

The disinfection of flexible fibre-optic nasendoscopes out-of-hours: confidential telephone survey of ENT units in England

We present the results of a confidential telephone survey of ENT units in England on the disinfection of flexible fibre-optic nasendoscopes out-of-hours. The on-call residents of 124 units were contacted and questioned. In 35.1 per cent of units surveyed, the on-call resident was primarily responsible for cleaning the scopes after use. Only 46 per cent of these junior doctors had access to a chemical sterilant to allow for high-level disinfection of these scopes. Provision for disinfection of scopes was poorer in teaching hospitals and in units that served inner city populations. Only 12.1 per cent of Senior House Officers (SHOs) received any training in disinfection techniques and only 25.5 per cent of units kept a register of patients nasendoscoped out-of-hours for purposes of contact tracing.