Marko Velepic

Gastroesophageal reflux, allergy and chronic tubotympanal disorders in children

The purpose of this study is to examine the relation between gastroesophageal reflux and allergy as possible causes of chronic tubotympanal pathology. The 30 examined children (ages 2-13) were divided into two groups based on the otological criteria. The 16 examined children suffered from a secretory otitis, which lasted more than four months. Upon further examination with a microscope, seven of these children exhibited symptoms of the adhesive process of the middle ear. Furthermore, 14 patients suffered from a recurrent otitis, i.e. more than five cases of otitis per year, while five patients from this group suffered from a chronic otitis with a central defect of the tympanum. The method used for the examination of the gastroesophageal reflux consisted of a continual 24 h esophageal pH monitoring. The particular apparatus used for this included antimony electrode (Synetics Medical, Sweden), while the analysis we performed was processed through the PC software program Gastrosoft Inc. The reflux index higher than five was considered pathological. At the time of the gastroesophageal reflux examination, we also performed the allergological analysis. The presence of allergy was confirmed by three methods: the positive allergological anamnesis, the positive skin pick test and by the elevated quantities of specific IgEs (Pharmacia CAP system). The examination resulted in the following: 18 of the examined children suffered from the pathological gastroesophageal reflux (60%); further seven of our patients tested positive on the allergological test (23%); and the four who tested positive for allergy also suffered from the pathological gastroesophageal reflux (13%). In comparison with allergies, the pathological GER was substantially more frequent in the patients who suffered from chronic tubotympanal disorders.

Gastroesophageal reflux and sequelae of chronic tubotympanal disorders in children

Objective—To compare sequelae of chronic tubotympanal disorders in children with and without gastroesophageal reflux (GER). Material and Methods—In 32 patients with chronic tubotympanal disorders GER was studied by means of 24-h continuous esophageal pH monitoring. After a period of 2–6 years (mean 4 years) sequelae of the tubotympanal disorders were examined, together with the clinical status of the ears and hearing status. The criteria for classification into mild, moderate and severe sequelae were based on the clinical status of the ear. Hearing was determined using tonal audiograms. Conductive hearing loss was classified as either slight (≤ 35 dB hearing loss in speech frequencies) or severe (>35 dB hearing loss in speech frequencies). Results—In the group of 16 patients (mean age 6.1 years) with GER, sequelae were observed in 29 ears (mild, n=11; moderate, n=5; severe, n=13). Hearing impairment was determined in 20 ears (mild, n=8; severe, n=12). In the group of 16 patients (mean age 7.1 years) without GER, sequelae were observed in 17 ears (mild, n=11; moderate, n=1; severe, n=5). Hearing impairment was determined in 10 ears (mild, n=6; severe, n=4). Conclusion—The total number of ears with sequelae and the total number of ears with conductive hearing impairment were significantly higher in patients with GER.

Cartilage palisade tympanoplasty in children and adults: long term results

OBJECTIVE To show long-term anatomic and functional results of full thickness cartilage palisade tympanoplasty in children and adults. METHODS In 51 patients (56 ears); 9 children (12 ears) and 42 adults (44 ears) full thickness cartilage palisade tympanoplasty and interposition with malleus head autograft was performed. On average 11 years after the tympanoplasty, an otomicroscopy and a tonal audiogram were done to assess anatomic and functional results. RESULTS Anatomic results of 56 ears: 40 (71.43%) tympanic membranes have no anatomic irregularities; 14 (25.00%) have cartilage resorption (11 of them minor and 3 major resorptions), 2 (3.57%) have secondary perforation. In the group of children all ears tympanic membrane were with no or minor resorption and no perforations. Functional results (51 audiograms performed: in children 12 and in adults 39): pre- and post-operative average pure tone average air-bone gaps were 27.29 ± 10.26 and 10.73 ± 7.90 dB, respectively. In the group of children pre- and post-operative average pure tone average air-bone gaps were 29.44 ± 10.30 and 6.81 ± 3.47 dB, respectively. In the group of adults pre- and post-operative pure tone average air-bone gaps were 26.63 ± 10.30 and 11.93 ± 8.50 dB, respectively. The differences between the two groups preoperatively (z=0.733; p=0.463) and postoperatively are irrelevant (z=1.723; p=0.085). The hearing gain is bigger in children (F=4.788; p=0.033). CONCLUSION The full thickness cartilage palisade tympanoplasty with malleus autograft interposition is also nowadays a successful method in solving of an advanced ear pathology also in children.

Cartilage palisade tympanoplasty and diving.

Objective To determine whether a patient with a serious defect of the tympanic membrane (TM) will be able to dive after surgery. Patients and Methods The authors describe three patients who were divers with serious defects of the TM (more than 75% of TM). In all three cases, cartilage palisade tympanoplasty was used to reconstruct the TM. Results Six months after surgery, the patients passed clinical examinations, audiograms (hearing restored to normal), tympanometry (increased stiffness of the TM), and pressure tolerance tests in hyperbaric chamber (30-m immersion was simulated for 4 minutes), and they began to dive again. Approximately 2 years after the surgery, all three patients are able to dive without any difficulties. Conclusion The authors conclude that patients can dive after cartilage palisade tympanoplasty.

The significance of rhinomanometry in evaluation of postlaryngectomy olfactory rehabilitation by polite yawning technique.

OBJECTIVE To corroborate the result of postlaryngectomy olfactory rehabilitation evaluating the efficacy of the Polite Yawning Technique (PYT) with rhinomanometry and odours with the Smell diskettes Olfaction test (SDOT). MATERIALS AND METHODS Thirty-two laryngectomised patients were subjected to olfactory rehabilitation consisting of 15-minute training and independent exercising for two weeks. The sense of smell and nasal airflow in laryngectomised patients were examined before and after implementation of PYT. RESULTS The differences in SDOT results prior to and after introduction of PYT were statistically significant, most patients achieving better results after rehabilitation. A significant positive correlation was obtained in results of SDOT and rhinomanometry prior to and after introduction of PYT. The results of measurements after rehabilitation showed that 75% of patients had improved nasal breathing, 78% of patients had a better sense of smell and 40% of patients became normosmic. CONCLUSIONS PYT has proved to be an effective method in olfaction rehabilitation following total laryngectomy. Using rhinomanometry, evaluation of the rehabilitation success is substantiated while the technique is simplified.

The clinical status of the eardrum: An inclusion criterion for the treatment of chronic secretory otitis media in children

OBJECTIVE To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. METHODS 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. RESULTS The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. CONCLUSION A criterion that could influence the approach to the therapy of CSOM in children.

Congenital laryngeal cyst: one or two cysts

The case presented is of a neonate with extreme respiratory distress immediately after birth, caused by a large laryngeal cyst. The vertical diameter of the cyst was larger than the height of the neonatal larynx. First excision of the cyst was performed in the region of the prominent aryepiglottic fold. Three weeks later, because of a recurrence of dyspnea, excision of the prominent wall of an obstructing cystic lesion was performed in the ventriculus Morgagni.