James S. Reilly

Treatment of acute maxillary sinusitis in childhood: A comparative study of amoxicillin and cefaclor

Maxillary sinus aspiration and quantitative culture of the aspirate were performed in 50 patients, ranging in age from 1 to 16 years, with clinical and radiographic evidence of acute sinusitis. Of 79 sinuses aspirated, at least one was found to be infected in 35 (70%) children. Streptococcus pneumoniae, Branhamella catarrhalis, and Haemophilus influenzae were the most common organisms recovered. All H. influenzae were nontypeable. Twenty percent of the H. influenzae and 27% of the B. catarrhalis organisms were beta-lactamase positive and amoxicillin resistant. The subjects received either amoxicillin or cefaclor at a dose of 40 mg/kg/day in three doses for 10 days. The clinical cure rate with amoxicillin was 81%, compared to 78% with cefaclor. Radiographic improvement was similar in both treatment groups. Antibiotic therapy failed in four patients; three had been given amoxicillin, and one cefaclor. In three of these, a beta-lactamase-positive antibiotic-resistant bacterial species was recovered from the maxillary sinus aspirate; the fourth aspirate was sterile.

Synchronous airway lesions in infancy.

Stridor in the young infant is evaluated by careful laryngoscopy. When a lesion of the larynx is diagnosed, the necessity and risk of bronchoscopy are challenged. To assess the need for careful examination of both the upper and lower respiratory tract, a 2-year retrospective study was performed at the Childrens Hospital of Pittsburgh. Of 103 infants who underwent diagnostic laryngoscopy and bronchoscopy for airway obstruction, stridor, or both, 18 (17.5%) had two or more synchronous airway lesions detected. Laryngoscopy alone, without further workup of the entire respiratory tract (ie, bronchoscopy, radiographic studies) may fail to detect concurrent disorders in infants with airway obstruction.

Increased incidence of head and neck abscesses in children

Objective To describe increasing incidence and changing microbiology of head and neck abscesses in children admitted to the hospital during the first quarters of 2000 through 2003. Study Design and Setting Retrospective data warehouse review identified 89 children less than 19 years of age admitted to a tertiary care pediatric hospital during the first quarters of 2000 through 2003 for suspicion of head and neck abscess involving the neck, face, and peritonsillar, retropharyngeal, and parapharyngeal spaces; and for orbital and intracranial complications of acute sinusitis. Outcome Measures Outcome measures included the incidence of infection admissions and description of infection location and microbiology, calculated by χ2 technique. Results The incidence of infections increased in 2003. The greatest increase was in neck abscesses and complications of acute sinusitis. Conclusions The increase in group A strep infections may be related to its biologic properties. Significance Group A strep remains a significant cause of head and neck infections in children.

Lyme disease and seventh nerve paralysis in children

PURPOSE This study was undertaken to determine the frequency of Lyme disease (LD) as a cause of transient facial nerve palsy (FNP) in children. Acute onset FNP in children has been primarily associated with acute otitis media (AOM). Recently, LD has emerged in regions where the deer-tick vector is present and has been associated with multiple cranial neuropathies. PATIENTS AND METHODS Fifty children with transient FNP were evaluated and treated at our institution over a 5.5-year period. RESULTS The rank of etiologies confirmed LD to now be the most common (50%), followed by AOM (12%), varicella (6%), Herpes zoster (4%), and coxsackievirus (2%). Thirteen children (26%) had idiopathic FNP consistent with Bells palsy. CONCLUSION We conclude that transient FNP in children is most commonly caused by LD for regions with endemic infections caused by Borrelia burgdorferi.

Tracheotomy in the Preterm Infant

Over the last decade, prolonged survival of preterm infants (gestation ≤ 36 weeks) who require lengthy periods of mechanical ventilation has necessitated that many of these infants undergo tracheotomy. The complication rate for tracheotomy in these preterm infants has not been reported. We compared 83 full-term (FT) infants who underwent tracheotomy in their first year of life with 41 preterm infants. Twenty-three preterm infants had birth weight ≥ 1,500 g (PT), and 18 of the preterm infants had gestational age ≤32 weeks and birth weight ≤ 1,500 g (PT-VLBW). Early complications (day 0 to 7) occurred in over 50% of the PT-VLBW compared to only 24% of the FT infants. Late complication rates were similar for all three groups. This higher early complication rate for PT-VLBW infants may be related to gestational age, low birth weight, and medical condition rather than surgical technique.

PREVENTION AND MANAGEMENT OF AERODIGESTIVE FOREIGN BODY INJURIES IN CHILDHOOD

Pediatricians have a critical role in the evaluation of children who experience a choking episode and foreign body injury. Familiarity with important symptoms and signs improves diagnostic skills and complements radiographic evaluation. Further reduction in injury prevention is assisted by parental education and avoidance of objects and foods that produce the greatest risk. Design modifications of toys and other products for childrens use is the next important step in this safety process.

The Role of Extraesophageal Reflux in Otitis Media in Infants and Children

Objectives/Hypothesis: Gastroesophageal reflux disease (GERD) is common in children, and extraesophageal reflux disease (EORD) has been implicated in the pathophysiology of otitis media (OM). We sought to 1) determine the incidence of pepsin/pepsinogen presence in the middle ear cleft of a large sample of pediatric patients undergoing myringotomy with tube placement for OM; 2) compare this with a control population of pediatric patients undergoing middle ear surgery (cochlear implantation) with no documented history of OM; 3) analyze potential risk factors for OM in children with EORD demonstrated by the presence of pepsin in the middle ear cleft; and 4) determine if pepsin positivity at the time of myringotomy with tube placement predisposes to posttympanostomy tube otorrhea.

Office-based insertion of pressure equalization tubes : The role of laser-assisted tympanic membrane fenestration

Objective: To describe the role of the hand‐held otoscope combined with a flashscanner CO2 laser, OtoLAM (ESC/Sharplan, Yokneam, Israel), for pressure equalization tube (PET) insertion in an office setting.

Pediatric button battery injuries: 2013 task force update

Over the last 10 years, there has been a dramatic rise in the incidence of severe injuries involving children who ingest button batteries. Injury can occur rapidly and children can be asymptomatic or demonstrate non-specific symptoms until catastrophic injuries develop over a period of hours or days. Smaller size ingested button batteries will often pass without clinical sequellae; however, batteries 20mm and larger can more easily lodge in the esophagus causing significant damage. In some cases, the battery can erode into the aorta resulting in massive hemorrhage and death. To mitigate against the continued rise in life-threatening injuries, a national Button Battery Task Force was assembled to pursue a multi-faceted approach to injury prevention. This task force includes representatives from medicine, public health, industry, poison control, and government. A recent expert panel discussion at the 2013 American Broncho-Esophagological Association (ABEA) Meeting provided an update on the activities of the task force and is highlighted in this paper.

A Pilot Survey of Vocal Health in Young Singers

The objective of this study was to determine the incidence of vocal problems in young choir singers and to correlate vocal problems with demographic and behavioral information. A questionnaire addressing vocal habits and hygiene was offered to 571 young choir singers, up to 25 years of age, who sing at least weekly; 129 (22.6%) responded. More than one-half of the respondents had experienced vocal difficulty, particularly older adolescents. Detrimental behaviors and circumstances surveyed were not reflective of the incidence of vocal difficulty, except for morning hoarseness, chronic fatigue, insomnia, and female gender after puberty. Voice care professionals should be aware that self-reported voice difficulties are common among young choral singers, especially postpubescent girls, and children with symptoms consistent with reflux (morning hoarseness) and emotional stress (insomnia). Laryngologists should communicate with choral conductors and singing teachers to enhance early identification and treatment of children with voice complaints, and to develop choral educational strategies that help decrease their incidence.