Patrick J. D. Dawes

Changes in Behavior and Attentional Capacity after Adenotonsillectomy

The objective of this study was to quantify behavioral and attention capacity changes in children aged 4–11 y before and 3 mo after adenotonsillectomy (A/T). Overnight cardiorespiratory recordings were performed in 61 “behaviorally normal” children 1 wk before A/T. Tests of sustained attention using visual and auditory continuous performance tests (CPT) were completed by children 1 wk before and 3 mo after A/T. Behavioral Assessment Scales for Children (BASC) and a sleep questionnaire were completed by the parent/s at these same times. Results from overnight cardiorespiratory recordings showed that the children had mild sleep-related breathing disorders (SRBD) preoperatively with a mean apnea/hypopnea index of 3.0/h and a movement awakening index of 2.5/h. The majority had parent-perceived sleep and breathing difficulties that significantly improved post-A/T. BASC T scores for externalizing and internalizing behaviors improved post-A/T, e.g., behavioral symptom index mean pre-A/T was 56.2 (95% confidence interval, 52.8–59.6) compared with 50.9 (48.5–53.5) post-A/T. Some measures indicative of impulsivity and attentiveness obtained from the visual CPT before surgery, improved post-A/T, but no change was observed in any auditory CPT measures. Our data confirm improvements in subjective measures of sleep problems in children treated for SRBD and strengthen the notion of treating the disorder, not only related to the obvious clinical condition but also to the underlying sleep problems and adverse effects on daytime behavior and attention.

Personality and perception of tinnitus

Objectives: Tinnitus has high prevalence and a wide range of etiologies and of impacts on sufferers. Our objective was to develop understanding of the role of personality in the perception of tinnitus in the general population. As a theoretical basis for this, we combined elements of a general model of signal detection with the ideas of ignition (development) and promotion (neural transmission) of tinnitus, and considered plausible roles for personality factors within this conceptual framework. Design: We interviewed a birth cohort of 970 people aged 32 yr sampled from the general population. On the basis of questioning, we divided them into three groups, those without tinnitus, those with occasional tinnitus (including those with transient tinnitus of very brief duration), and those who experienced tinnitus most of the time. We also established how annoying or distressing the tinnitus was, and assessed personality using the Multidimensional Personality Questionnaire. Results: Tinnitus was experienced rarely by 38.2% and half the time or more by 6.8% of those studied. Men and women did not differ in the amount of tinnitus reported, but women were more likely to find it annoying. People from lower socioeconomic backgrounds were more likely to report tinnitus. People with tinnitus were more socially withdrawn, reactive to stress, alienated, and less Self-Controlled. People who were more annoyed by tinnitus were more socially withdrawn, and men were more stress reactive and alienated. Conclusions: Our interpretation of the findings is that personality influences the persistence of tinnitus by influencing the tendency to be aware of it. Consideration of personality factors may improve the ability to tailor tinnitus therapies, and the concept of awareness may benefit treatment outcomes by showing tinnitus sufferers a means of internalizing the locus of control over their symptoms.

Preliminary investigations of the colonisation of upper respiratory tract tissues of infants using a paediatric formulation of the oral probiotic Streptococcus salivarius K12

A powder preparation of the oral probiotic Streptococcus salivarius K12 has been given to 19 young otitis media-prone children following a 3-day course of amoxicillin administered as a preliminary to ventilation tube placement. In two subjects, the use of strain K12 appeared to effect the expansion of an indigenous population of inhibitory S. salivarius. In other children, strain K12 colonisation extended beyond the oral cavity to also include the nasopharynx or adenoid tissue. The relatively low proportion (33%) of subjects that colonised was attributed to failure of the amoxicillin pre-treatment to sufficiently reduce the indigenous S. salivarius populations prior to dosing with strain K12 powder.

15-YEAR AUDIT OF POST-TONSILLECTOMY HAEMORRHAGE AT DUNEDIN HOSPITAL

Post‐tonsillectomy haemorrhage is a significant complication because of its frequency and consequences. Increases in post‐tonsillectomy haemorrhage prevalence have been reported. There is a controversy about whether increasing the use of diathermy techniques or anti‐platelet aggregation effects of analgesia could have caused this increase. We carried out an audit of post‐tonsillectomy haemorrhage and examined the rates of readmission for bleeding during the period 1990–2004. We also recorded the surgical technique used and the use of perioperative non‐steroidal anti‐inflammatory drugs and corticosteroids. During this period there has been a significant increase in post‐tonsillectomy haemorrhage with an average annual increase of 15.3% (P < 0.0001, 95% confidence interval 8.5–22.5%). The increase is coincidental with the change‐over to predominant diathermy technique and a routine use of postoperative non‐steroidal anti‐inflammatory drugs and steroids.

Clinical anatomy of the chorda tympani: a systematic review.

OBJECTIVE The chorda tympani is at risk of iatrogenic injury throughout its course. This paper reviews the clinical anatomy of the nerve in adults. DESIGN Systematic literature review. METHOD Relevant English-language articles were identified using five electronic databases and one search engine. Data from approximately 70 scientific papers were supplemented with information from selected reference texts. RESULTS The anatomy of the chorda tympani differs from standard descriptions, particularly regarding its exit from the middle ear and area of lingual innervation. Whilst it is known to convey taste sensation from the anterior two-thirds of the tongue and parasympathetic innervation to the submandibular and sublingual salivary glands, the chorda tympani probably has additional sensory and secretomotor functions. CONCLUSION A detailed understanding of the anatomy of the chorda tympani may help to reduce the risk of iatrogenic injury during head, neck and middle-ear surgery, and to explain the variable consequences of such injury.

The management of severe infectious mononucleosis tonsillitis and upper airway obstruction

Acute tonsillectomy has been advocated for severe infectious mononucleosis (IM) pharyngotonsillitis with upper airway obstruction (UAO) and not responding to corticosteroids. This paper reviews and rationalizes our management. A five-year chart review was carried out with a follow-up telephone survey. There were 36 admissions. Nine had UAO of whom 89 per cent (eight of nine patients) had a tonsillectomy. The diagnosis of UAO was not standardized. Twenty-seven patients did not have UAO and only a small proportion of these patients, 16 per cent (four of 25) went on to have an elective tonsillectomy. Corticosteroids made no significant difference to the tonsillectomy rate. UAO appears to identify patients with more severe disease who are likely to suffer recurrent tonsillitis. Acute tonsillectomy is an appropriate treatment option for this subgroup. The diagnosis of significant IM UAO is not defined and a schema is proposed. Recurrent tonsillitis is an uncommon sequela of severe IM pharyngotonsillitis without UAO.

Sleep Disordered Breathing and Academic Performance: A Meta-analysis

BACKGROUND AND OBJECTIVE: Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance. METHODS: Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I2) were conducted. RESULTS: Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES –0.31; P < .001; I2 = 74%), math (ES –0.33; P < .001; I2 = 55%), and science (ES –0.29; P = .001; I2 = 0%), and with unsatisfactory progress/learning problems (ES –0.23; P < .001; I2 = 0%) but not general school performance. CONCLUSIONS: Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.

Iatrogenic injury of the chorda tympani: a systematic review.

OBJECTIVE To review the currently available literature on iatrogenic injury of the adult chorda tympani. DESIGN Systematic literature review. METHOD Five electronic databases and one search engine were used to access available English language literature on the chorda tympani, focusing on iatrogenic injury. RESULTS The chorda tympani is most often injured during middle-ear surgery, after which at least 15-22 per cent of patients experience symptoms, mostly changes in taste and dryness of the mouth. Numerous factors influence whether injury to the chorda tympani causes symptoms, including the extent of injury, type of surgery, age of the patient, anatomical variables and subjective adaptation. Although most patients experience gradual symptomatic recovery, complaints can be persistent and troublesome. CONCLUSION Care should be taken to preserve the chorda tympani during middle-ear surgery, and to warn patients pre-operatively about this potential complication. This is particularly important if surgery is bilateral.

Anatomical variations of the paranasal sinuses in Polynesian and New Zealand European computerized tomography scans.

OBJECTIVE: This study was designed to compare the incidence of anatomical variations displayed on computerized tomography scans of individuals that identify as Polynesian or New Zealand Europeans. STUDY DESIGN: A retrospective analysis of computerized tomography of the paranasal sinuses. All scans were examined for a number of anatomical variations and the prevalence directly compared according to ethnic group. SETTING: All scans were performed at a tertiary referral center (Dunedin Public Hospital). SUBJECTS: Participants underwent computerized tomography of the paranasal sinuses for various indications. Ethnicity was determined from the electronic hospital record. RESULTS: There was no significant difference in the prevalence of anatomical variations between Polynesians and New Zealand Europeans. Our study results are comparable with other studies of Caucasian paranasal sinus anatomy. CONCLUSIONS: When performing endoscopic sinus surgery on those with Polynesian ethnicity, there are no specific anatomical variations to take into account.

Head and neck fascia and compartments: no space for spaces.

An accurate understanding of the arrangement of cervical fascia and its associated compartments is essential for differential diagnosis, predicting the spread of disease, and surgical management. The purpose of this detailed review is to summarize the anatomic, clinical, and radiological literature to determine what is known about the arrangement of cervical fascia and to highlight controversies and consensus. The current terminology used to describe cervical fascia and compartments is replete with confusing synonyms and inconsistencies, creating important interdisciplinary differences in understanding. The term “spaces” is inappropriate. A modified nomenclature underpinned by evidence‐based anatomic and radiologic findings is proposed. This should not only enhance our understanding of cervical anatomy but also facilitate clearer interdisciplinary communication.