Lidia Zawadzka-Głos

Lower airway papillomatosis in children

Laryngeal papilloma in children is a frequent disease caused by human papilloma virus (HPV) type 6 or type 11. This disease has a tendency to recur and the changes are histologically benign. In some cases papilloma may affect the lower levels of the respiratory tract. In this study, among 90 patients treated for laryngeal papillomatosis, in four children papilloma of trachea, bronchi and lung tissue were detected in endoscopic and radiological examination. This constitutes 4.4% of all patients. Compact nodules and acquired cysts between 5 and 50 mm long were found in chest X-rays and in computerised tomography. These cysts appeared from 4 to 8 years after establishing a diagnosis of laryngeal papilloma, and 1 year after recognising papilloma in the trachea. In all four children the presence of nodules and cysts in the lungs was preceded by recurrent pneumonia, emphysema or atelectasis of the lungs. All children with laryngeal papillomatosis should have a chest X-ray. Detection of acquired cyst-like changes in lung tissue in children with laryngeal papillomatosis is a warning of future papilloma in the trachea and bronchi, with involvement of lung tissue. In differential diagnosis of these changes in the lungs we should take into consideration the presence of papilloma in the bronchi. A prognosis of papillomatosis in the lower airways in children is always serious.

Difficulties in diagnosis of laryngeal cysts in children

INTRODUCTION In larynx cysts may be localized in different regions: glottis, laryngeal pouch, epiglottis, aryepiglottic folds and subglottic area. It is difficult to estimate if the cyst is acquired or congenital. Symptoms of laryngeal cyst depend on the size and localization of the cyst and include: change in the tone of voice, dysphonia, hoarseness, dysphagia, laryngeal stridor and dyspnoea. Cysts of the larynx in infants are rare but the treatment is easy once the diagnosis is made. If mismanaged, the resulting respiratory obstruction can lead to serious complications. OBJECTIVE Analysis of cases of laryngeal cyst in children treated in the Department of Paediatric ENT Medical University of Warsaw. MATERIALS AND METHODS A retrospective analysis of 10 cases of laryngeal cyst in children treated in the Department of Paediatric ENT in Warsaw between 2000 and 2008 was made. RESULTS The authors analyzed indications to directoscopy, endoscopic presentation, problems with establishing the right diagnosis and management. CONCLUSIONS Using a direct laryngoscopy as a golden standard in children with stridor will reduce a number of false diagnosis.

Ceruminous adenoma (ceruminoma) arising in a nevus sebaceus of Jadassohn within the external auditory canal of a 3 year-old boy – A case report

Nevus sebaceus of Jadassohn is a congenital yellowish hairless skin lesion, mainly located on the head and neck. A common phenomenon is the coexistence of secondary tumors within the lesion. These are mainly benign tumors, the majority of which are trichoblastoma and syringocystadenoma papilliferum. A ceruminoma is a very rare tumor of the ceruminous glands located in the outer third of the auditory canal. It occurs almost exclusively in adults. We describe the case of a 3-year old boy diagnosed with ceruminous adenoma (ceruminoma) growing within a nevus sebaceus of Jadassohn.

The endoscopic treatment of postintubation laryngeal stenosis in children, using argon plasma coagulation.

Laryngeal stenosis of the larynx in children is becoming a more frequent problem. Endoscopic dilation of the lumen of the larynx is one of the many methods of treatment. The authors present their own method for the treatment of postintubation laryngeal stenosis by argon plasma coagulation (APC). The investigation was based on ten children with postintubation laryngeal stenosis from I to IV degrees according to the Myer-Cotton grading system. The method of treatment, and the advantages and disadvantages of the new method of endoscopic treatment of postintubation laryngeal stenosis, are discussed in the article.

Macroscopic findings during endoscopic sinus surgery for chronic rhinosinusitis in children

AIM Endeavor to intraoperative macroscopic evaluation of changes in children with CRSs. Analysis of the type and incidence of pathological changes observed macroscopically during FESS was undertaken as well as an parallel attempt to correlate the level of inflammation markers with severity of disease. MATERIALS AND METHODS Retrospective analysis of case records of 153 patients of the Department of Pediatric Otolaryngology, Medical University of Warsaw, hospitalized between 2010 and 2013. During that time 106 patients with a diagnosis of chronic maxillary sinusitis required surgical intervention. 102 children (avg-aged 11.5 years) were qualified to functional endoscopic surgery. The youngest patient was 3 years old and the oldest 18. 26 patients presented the polypoid lesions of sinuses or nasals. At 19 confirmed the coexistence of sinus polyps with nasal polyps. RESULTS 76 patients had oedematous-inflammatory lesions and 26 polypoid. Among the group of listed above 26 children, 19 had either sinuses or nasal polyps. 15% children with polyps were diagnosed with cystic fibrosis and 8.0% with asthma. A common deviation in the results of morphology in children with CRSs is higher level of monocytes. Inflammation markers within the population of FESS qualified children were low. CONCLUSIONS (1) Oedematous-inflammatory lesions are frequently intraoperatively identified. (2) The CRSs without polyps is the common type of chronic sinusitis in children. (3) Nasal polyps often coexist with sinus polyps. (4) If nasal polyps are found in pediatric population then diagnosis of CF, allergy and GERD should be considered. (5) Markers of inflammation in CRSs are low.

External laryngeal injuries in children—Comparison of diagnostic methods

OBJECTIVES The injuries of the larynx constitute around 1% of all injuries. The great majority of the injuries of the larynx happens during playing. The effects of these injuries may appear insignificant however, not always the direct clinical symptoms correlate with the degree of respiratory tract failure. The symptoms of laryngeal injuries depend on the extension and strength of the trauma and always relate to impair patency of respiratory tract. The aim of the study is to compare two diagnostic methods: laryngoscopy and ultrasonography in evaluation of laryngeal injuries in children. METHODS In the Department of Pediatric Otolaryngology, Medical University of Warsaw, in the period between 2004 and 2010 there were hospitalised 15 children with external injury of the larynx. RESULTS From among 15 hospitalized children, 7 were qualified as not serious trauma and were treated preservatively and the other 8 as sever trauma. The mechanism of traumas was diverse. Dyspnea was a predominating symptom, the others included hoarsness, change in voice quality, even aphonia, pain while speaking and swallowing, cough and hemoptysis. CONCLUSIONS Direct laryngoscopy is a standard in diagnostics of the injuries of the larynx. Ultrasonography of the larynx is recommended in every case of laryngeal injury as an additional non-invasive complementary diagnostic examination.

Diagnostic difficulties in salivary gland tumors in children

Introduction. Tumors of major salivary glands, due to their low incidence and the wide spectrum of possible diagnoses, are a challenge for physicians. Imaging studies are the key elements of the diagnostic process, although their results often do not provide a definitive diagnosis. Aim. The aim of the study was to assess the usefulness of additional tests in the diagnosis of tumors of major salivary glands in children. Material and Methods. A retrospective analysis of medical data of children with tumors of parotid or submandibular salivary gland hospitalized in the Department of Pediatric Otolaryngology of Medical University of Warsaw from the years 2012-2017 was performed. Results. In 8 girls and 7 boys aged between 4 months and 17 years, the following diagnoses were established: 6 mixed tumors, 3 hemangiomas, 1 lymphangioma, 1 rhabdomyosarcoma, and 1 mucoepidermoid carcinoma. In all of the patients, ultrasound (US) of salivary gland, computed tomography (CT) and/or magnetic resonance imaging (MRI) of the head were performed. US examination enabled to diagnose the majority (66%) of mixed tumors. US and CT or MRI with contrast enabled to recognize angiomas in all 4 patients with this lesion. In 2 patients, malignant neoplasm was diagnosed based on the histological examination. Conclusions. US remains the primary diagnostic test in patients with tumors of major salivary gland. When necessary, it can be supplemented with CT or MRI. In some cases, imaging studies do not enable to establish a definite diagnosis. The definite diagnosis of salivary gland tumors is established based on the results of the pathological examination (except for angiomas). The most common salivary gland tumor in older children is mixed tumor, and in infants – angioma. It must be remembered that very rare salivary gland tumors, such as sarcomas and carcinomas, may also occur in children. Keywords

Sudden bilateral deep hearing loss in a child – case study

Introduction. Sudden bilateral deep hearing loss is very rare in children. Its estimated prevalence is 2% among children with hearing loss. The causes include acute acoustic trauma, vascular disorders of the inner ear, sudden viral or bacterial infection, and trauma of the inner ear. Noise is currently an important risk factor for hearing impairment. Groups that are particularly vulnerable to noise damage include children and young adults. The effects of noise include hearing impairment of different degree and the more and more commonly diagnosed extra auditory effects of noise in the form of anxiety, irritability, cognitive impairment, reduced intellectual ability, difficulty in falling asleep, circulatory disorders, hormonal disorders, and changes in social behavior. Case report. We present a case of a 9-year-old girl who experienced sudden bilateral deep hearing loss of the left ear, which was caused by a school bell during a school break. Six weeks after the sudden hearing loss in the left ear, hearing loss in the right ear of the unknown etiology appeared. The girl was in good general condition, no vertigo and balance impairment were observed. In the tonal audiometry, bilateral deep mixed hearing loss was observed. The treatment in the hospital included surgery in the form of bilateral explorative tympanotomy of the middle ear with anterior tympanocentesis and tube insertion, as well as conservative treatment: dexamethasone, vipocentin, piracetam, B vitamins, xylometazoline, and hyperbaric oxygen therapy. Hospitalization lasted 14 days. A complete recovery of hearing was achieved. Conclusion. Sudden bilateral deep hearing loss in children can be caused by an acute acoustic trauma. Studies show that noise is an important disturbing factor in the school environment and may be harmful. Noise levels of ca. 80-85 dB measured in corridors during school breaks and in sports halls may pose a risk of hearing impairment. The consequences of trauma caused by noise in children are very difficult to predict. It is important to recognize the problem early, as well as to introduce a proper diagnostic process and implement the treatment quickly, which is a key to the positive outcome. Keywords

Parotitis in children hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in the years 2010-2017

Introduction. Parotitis can be divided into chronic and acute parotitis. Acute parotitis is caused by a viral or bacterial infection. Chronic parotitis includes chronic recurrent parotitis, parotitis due to sialolithiasis, parotitis related to angiomas, as well as parotitis as a symptom of autoimmune diseases. Aim. The aim of the study was to analyze the inflammatory changes in parotid salivary glands in children. Material and Methods. Between 2010 and 2017, 30 children were hospitalized in the Department of Pediatric Otolaryngology of the Medical University of Warsaw due to the swelling and pain of a parotid gland . Age, gender, etiology of the disease, location, laboratory findings, and comorbidities were assessed. Results. The cause of hospitalization was swelling and pain of a parotid salivary gland. The age of children ranged from 1 month to 15 years of age (mean age was 4.2 years). In 11 children, bilateral parotitis was diagnosed, in 19 children, the lesions were unilateral. In 7 children, acute parotitis was diagnosed. In these patients, elevated inflammatory markers, enlarged lymph nodes, or an abscess of the gland in the ultrasonographic examination was observed. In 20 children, chronic recurrent parotitis was diagnosed. In these patients, no elevated inflammatory markers were observed during exacerbations. In ultrasound, hypoechogenic foci were observed. Eleven children were diagnosed with autoimmune diseases. Three children were diagnosed with lymphangioma or hemangioma. None of the patients suffered from sialolithiasis nor pneumoparotitis. Conclusions. Parotitis that have its onset between 3 and 4 years of age may be recurrent parotitis. The diagnosis of chronic recurrent parotitis is based on clinical symptoms, ultrasound signs, and lack of elevated inflammatory markers. Bilateral chronic recurrent parotitis is related to an increased risk of autoimmunological diseases; chronic parotitis precedes their onset. Children with bilateral chronic recurrent parotitis require further testing for autoimmune diseases. Keywords

Hemorrhage risk factors assessment in pediatric patients undergoing adenoidectomy/adenotonsillotomy

Introduction. Hemorrhage is one of the most important complication of adenoidectomy (AT) and adenotonsillotomy (ATT) in children. The lack of hemostasis is an indication for Bellocq’s tamponade. Preoperative coagulation tests, complete blood count and blood type tests are taken to minimize the risk of bleeding after surgery. Material and methods. Data of 135 children with preoperative normal bleeding tests who underwent AT/ATT was collected. In study group (N = 41), postoperative hemorrhage requiring posterior nasal pack occurred. In the control group (N = 94), bleeding after AT/ATT resolved spontaneously and did not require nasal packing. Results. Hemorrhage was associated with older age. There was no relationship between hemorrhage and blood group, gender, type of the procedure and laboratory results obtained before the surgery. Conclusions. In our study, preoperative laboratory findings failed to effectively identify the patients at risk of hemorrhage after AT/ATT. However, a thorough medical interview and family history, as well as a detailed physical examination and laboratory testing might reveal bleeding disorders that had been asymptomatic. Keywords