Frans Gordts

Management of rhinosinusitis in children

The authors provide definitions for the different forms of pediatric rhinosinusitis, with an enumeration of the main symptoms and signs. They also provide the indications for CT scan examination and microbiological investigations. In addition, they emphasize the importance of concomitant systemic disease, such as allergy and immunological disorders. The adequate medical management, which is mandatory before any surgery, is considered and discussed, and the indications for surgery are provided.

Prevalence of Sinusitis Signs in a Non-ENT Population

Relatively little is known about the prevalence of sinusitis in a general population. Patients with suspected intracranial neurological disease can be considered as representative of the general population. On magnetic resonance imaging nearly 60% of the sinuses were affected. If the most common lesion (a maxillary polyp or cyst) was excluded, still 40% of the sinuses were affected. Above all the maxillary sinuses are involved with 40% abnormal images followed by the anterior ethmoidal sinuses with 14%. The other sinuses are less likely to be affected with 2.5% of the sphenoidal, 2% of the frontal and 1.5% of the posterior ethmoidal sinuses.

Bacteriology of the middle meatus in children

Little is known about the bacteriology of the middle meatus in children. Therefore, middle meatal samples were obtained from 50 children who underwent adenoidectomy or adenotonsillectomy, while a group of 50 children submitted to minor non-ENT surgical procedures, were used as a control group. Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae were the most frequent cultured organisms, not only in the ENT group (in 68, 50 and 60% of the children respectively) but also in the control group (40, 34 and 50%). These three potential pathogens were more frequently seen among the children of the ENT group but only for H. influenzae was the observed difference statistically significant (P = 0.009). On semiquantitative analysis, there seemed to be more negative cultures or cultures with only a few colonies in the control group, while the richer cultures were obtained from the ENT group. Again, only for H. influenzae, these differences reached a statistical significance (P = 0.003). Streptococcus viridans and Neisseria species, both organisms that might be able to inhibit colonisation by some of the pathogens, were more frequently cultured in the control than in the ENT group: Strep. viridans 30 vs. 10% (P = 0.025) and Neisseria species 14 vs. 2% (P = 0.069).

Reference data for DPOAE in healthy newborns

Distortion Product Otoacoustic Emissions (DPOAE) can be used as an alternative to Transient Evoked Otoacoustic Emissions (TEOAE). This study aims to establish normal values for DPOAE in healthy newborns. DPOAE were determined with the Madsen Celesta 503 at 0.5, 1, 2, 4 and 8 kHz with an unequal stimulus level of the primaries (L 1 = 65 dB SPL, L 2 = 50 dB SPL). DPOAE were present in 92.4% of the ears of the 185 babies tested at 4 days after birth. The 5% quantile and the median of the DPOAE of the right and left ears were calculated for the five frequencies tested. At 4 kHz there was a significant sex effect (mean amplitude of DPOAE was higher in female than in male babies) and at 2 kHz a significant interaction effect was found between sex and side. The calculated reference limits are open to comparison with data obtained using other commercial equipment.