Mohamed A. Bitar

Management of congenital subglottic hemangioma: Trends and success over the past 17 years

OBJECTIVE: To evaluate the success and complications of various treatment options of congenital subglottic hemangioma. STUDY DESIGN AND SETTINGS: Reported cases were grouped by treatment modalities and corresponding outcome evaluated. RESULTS: From 1986 through 2002, 372 patients were reported in 28 series. Carbon dioxide laser had 88.9% success rate yet 5.5 % significant subglottic stenosis. It shortened the tracheotomy duration by 13.7 months. Corticosteroids were not that beneficial (useful in only 24.5%) with 12.9% side effects. Intralesional corticosteroids were successful in 86.4% with 5.6% complication rate. Surgical excision (as young as 2.5 months), was useful in 98% with 10% complication rate, using cartilage grafts in 34%. Other modalities were less popular. CONCLUSION: Treatment should be individualized. Guidelines are suggested. Priority is given to secure the airways. The CO2 laser is useful when used cautiously. Steroids may be beneficial. Excision is for stubborn cases.

How frequent is adenoid obstruction? Impact on the diagnostic approach

Background:  The rate of adenoidectomy has increased over the past years. The initial assessment methods are sometimes overused. The aims of the present study were to evaluate the use of these methods, estimate the incidence of obstructive adenoid and refine the approach to this problem.

Does Helicobacter pylori colonize the nasopharynx of children and contribute to their middle ear disease

Objective. There is growing interest in studying the presence of HP in the upper aerodigestive tract. It was shown in several pilot studies that it colonizes the area, while other authors found no evidence of its presence there and a third group of authors believed that it had only a transient presence there. In this study we investigated a possible role for HP in middle ear disease in children. Material and methods. Consecutive patients undergoing myringotomy and adenoidectomy for chronic otitis media with effusion or recurrent otitis media were enrolled. Middle ear fluids were cultured on three types of agar plate (Brucella + laked horse blood; Brucella + sheep blood; and chocolate). A double polymerase chain reaction (PCR) was run to detect urease-C and adhesion subunit genes. Rapid urease enzyme testing and PCR were used on the adenoid specimens. Parents were interviewed regarding symptoms suggestive of gastroesophageal reflux in their children. Results. Eighteen patients were enrolled in the study (mean age 4.4 years; age range 3–8 years) with an equal gender distribution. All 28 middle ear fluid cultures were negative in all 3 media. Twenty-one of the 28 samples contained DNA, yet PCR revealed that none of them belonged to HP. Ten of the 13 adenoid specimens obtained were positive on rapid urease testing, but none on PCR. Seven of the 18 patients had at least 1 symptom suggestive of gastroesophageal reflux during the 6 months preceding the study but this did not have an impact on any of the results. Conclusion. There was no evidence from this study that Helicobacter pylori (HP) colonizes the nasopharynx of children with middle ear disease, whether dyspeptic or not. There is also no apparent role for this bacterium in middle ear pathology.

Plunging congenital epidermoid cyst of the oral cavity

Abstract. Epidermoid cysts are rare lesions in the oral cavity. They usually present early in life and are confined to one anatomical area. Simple excision is all that is needed. However, they may present late in life and be large in size, making their excision a real challenge. We present a case of congenital epidermoid cyst of the sublingual space that presented late, at the age of 17 years, after it plunged into the submental area. The presentation of the patient and the surgical approach are discussed.

Spontaneous sublingual haematoma: a rare entity.

Sublingual haematoma, also known as pseudo-Ludwig phenomenon, is an entity commonly described in patients on anticoagulation therapy. Spontaneous sublingual haematoma is a rare subtype. It is thought to be due to aneurismal changes in the facial or lingual arteries, occurring mostly in the elderly hypertensive population. Two case reports of spontaneous sublingual haematomas have been reported so far in the literature. Both cases were elderly patients and presented with a sublingual mass and elevation of the floor of the mouth. One patient was intubated whereas the other underwent an emergency tracheotomy. The authors present the third case of spontaneous sublingual haematoma that was afebrile and had a sudden onset of sore throat that progressed to dyspnoea and required a life-saving tracheotomy. The patient recovered quickly postoperatively and could be discharged home in a couple of days and was decannulated in 1 week. No recurrence of the haematoma was noticed on follow-up after 1 year.

Who needs admission among infants with acute otitis media

Aim:  Management of acute otitis media (AOM) in infants younger than 2 months old is controversial. It varies between treatment on an outside basis, and hospitalization for intravenous antibiotics and sepsis work‐up based on variability of the reported AOM pathogens in this particular group. Our aim is to identify clinical indicators that may suggest a need for an invasive medical work‐up and/or hospitalization of these young patients, and compare their management to that of older infants.

Rare disease: Spontaneous sublingual haematoma: a rare entity

Sublingual haematoma, also known as pseudo-Ludwig phenomenon, is an entity commonly described in patients on anticoagulation therapy. Spontaneous sublingual haematoma is a rare subtype. It is thought to be due to aneurismal changes in the facial or lingual arteries, occurring mostly in the elderly hypertensive population. Two case reports of spontaneous sublingual haematomas have been reported so far in the literature. Both cases were elderly patients and presented with a sublingual mass and elevation of the floor of the mouth. One patient was intubated whereas the other underwent an emergency tracheotomy. The authors present the third case of spontaneous sublingual haematoma that was afebrile and had a sudden onset of sore throat that progressed to dyspnoea and required a life-saving tracheotomy. The patient recovered quickly postoperatively and could be discharged home in a couple of days and was decannulated in 1 week. No recurrence of the haematoma was noticed on follow-up after 1 year.

Alterations In Immunity After Total vs Partial Tonsillectomy

Problem Palatine tonsils are secondary lymphoid organs active in sampling antigens entering the upper respiratory tract and in producing immunoglobulin (Ig) both locally and distally through migrating tonsillar B cells. Their size has been found to be directly proportional to the number of B and T cells. The aim of this study is to compare the change in serum and saliva Ig levels after total and partial tonsillectomy. Methods Children with obstructive tonsils and/or adenoid undergoing total or partial tonsillectomy were recruited in a pilot study. Patients with history of recurrent infections or immunodeficiency were excluded. Blood and saliva samples were obtained immediately preoperatively and at the 1st follow-up visit. Serum Igs (G,M&A) concentrations were determined using radial immunodiffusion. Saliva secretory IgA was measured using an Enzyme Immuoassay (EIA). Results Twenty five patients (13 partial and 12 total) were included. There were no statistically significant changes in serum Igs levels after total or partial tonsillectomy, except for IgM which increased (1.317 to 1.632 g/L) after partial tonsillectomy, more significantly in males, in those aged 5 years and older, and when the postoperative samples were taken within a 2 month-period. Moreover, there was statistically non-significant decrease in secretory IgA level after both total and partial tonsillectomy. Conclusion The effect of partial or total tonsillectomy on immunoglobulin level seems reassuring. The increase in IgM and the non-significant decrease in SIgA may represent a kind of immunological readjustment after tonsillar surgery. Significance This is the first study (to our knowledge) that compares the changes in immunoglobulin levels (in serum & saliva) after partial vs. total tonsillectomy. The obtained results are preliminary and are reassuring to the parents and physicians who have concerns regarding the immunological sequalae of tonsillectomy in children. A longer follow up will be done in a larger future study. Support This study was supported by Medtronic.

Nasal obstruction in children: Evaluation of common assessment methods

Abstract Objectives: To evaluate the commonly used methods in assessing nasal obstruction in children. Methods: Children with chronic nasal obstruction were enrolled. All patients had anterior rhinoscopy. The tonsils were graded on a 4-point scale. The adenoid pad size was rated on endoscopy using a 3-grade scale (grade 1, 75%). The degree of obstruction on true lateral soft tissue roentgenograms was reported as mild, moderate, or severe. Each method was evaluated based on the treatment outcome. Results: We enrolled 213 patients aged 6 months to 13 years (mean, 5.1 years). The clinical picture directed the approach to the patient, occasionally pinpointing the definite diagnosis. Grade 1 adenoids had associated abnormalities causing the nasal obstruction. Grade 2 adenoids required surgery only in 33.3%. All grade 3 adenoids required removal. Patients with mild obstruction on x-rays had some false-negative results. Those with moderate to severe obstruction required surgery in more than 85%. There was a significant interobserver agreement only in the extremes. Conclusions: The clinical picture helps orient the assessment of children with nasal obstruction. Nasal endoscopy offers the best evaluation method. In case of an uncooperative child or refusing parents, a true lateral soft tissue film may be useful.