Petr Matoušek

Globus Pharyngeus and Extraesophageal Reflux: Simultaneous pH <4.0 and pH < 5. 0 Analysis

Weakly acid refluxes seem to play an important role in the pathogenesis of extraesophageal reflux. The aim of this study was to evaluate how proportional representation of patients with extraesophageal reflux in a group of patients with globus pharyngeus changes when we use both pH <4.0 as well as pH <5.0 as a pathological threshold for an extraesophageal reflux episode.

Primary pediatric endonasal dacryocystorhinostomy—A review of 58 procedures

OBJECTIVES The objectives of this study are to report the outcomes of pediatric patients with lacrimal system obstruction who underwent primary endoscopic dacryocystorhinostomy (EDCR). STUDY DESIGN The authors conducted a retrospective noncomparative case series. METHODS The operative and postoperative data have been collected in 58 children aged between 3 months and 13 years (mean 4.1 years). The total of 58 primary EDCRs has been performed by two surgeons using a standardized surgical technique. The EDCRs were performed 52 times on one eye, 6 times on both eyes (3 times simultaneously, 3 times at the separate sitting with an interval of 4-6 months). The follow-up evaluations include taking history, clinical examinations including a fluorescein disappearance test. RESULTS The follow-up interval ranged from 12 to 36 months (mean 17 months, median 15 months). The success rate was 51/58 (87.9%) in all 58 EDCRs. The success rate was 47/51 (92.2%) in the group of postsaccal obstructions, 3/5 (60.0%) in the group of postsaccal and suprasaccal obstrutcions and 1/2 (50.0%) in presaccal obstructions. The procedures were successful in all eight children aged under 1 year old (100%) and in 14 of 15 children between 1 and 2 years old (93.3%). The silicone intubation was used in 54 EDCRs. CONCLUSIONS The endoscopic DCR is a safe and effective procedure for most children with the success rate comparable to that achieved in the external DCR and in adults. The success rate of the postsaccal obstructions is significantly higher than in presaccal or combined pre- and postsaccal obstructions.

Diagnosis of extraesophageal reflux in children with chronic otitis media with effusion using Peptest

INTRODUCTION The aim of the study was to investigate whether Peptest, an immunoassay used to detect pepsin, could be used to diagnose extraesophageal reflux (EER) in children with chronic otitis media with effusion (OME). The results obtained using this fast, simple and non-expensive method were compared with the results of previous studies. METHODS Children 1-7 years old who had been diagnosed with OME and who were undergoing myringotomy with insertion of a ventilation tube were included in the prospective study. Middle ear fluid obtained during myringotomy was analyzed with Peptest to determine the presence of pepsin, and hence EER. RESULTS Bilateral and unilateral myringotomy was performed in 15/44 (34.1%) and 29/44 (65.9%) children, respectively. Pepsin in the middle ear was detected in 14/44 (31.8%) children and in 19/59 (32.2%) middle ear specimens. Serous and mucous samples were positive for pepsin in 11/32 (34.4%) and 6/27 (22.2%) cases, respectively. Pepsin in the middle ear was detected in 3/7 children (42.9%) with bronchial asthma (p=0.662). CONCLUSIONS Pepsin was detected in 1/3 of middle ear specimens of patients with OME. These patients probably suffer from more severe reflux and therefore would be potential candidates for antireflux therapy. However, this has to be confirmed in further studies.

Atypical Cogan's syndrome: A case report and summary of current treatment options

Cogans syndrome is a rare chronic vasculitis, characterized in its typical form by progressive sensorineural bilateral hearing loss, vestibular symptoms and non-syphilitic interstitial keratitis. Only a few cases have been reported in children, most of whom have been diagnosed with the typical form. Early diagnosis and treatment are crucial to ensure a favorable prognosis. Systemic treatment usually begins with high dosage corticosteroids. In case the initial treatment fails, other immunosuppressive drugs are used (cyclophosphamide, methotrexate, cyclosporine A and azathioprine). Additional treatment possibilities, such as plasmapheresis, TNF-alpha blockers (etanercept and infliximab), rituximab, tocilizumab and mycophenolate mofetil have been described over the past few years.

Drug-Induced Sleep Endoscopy Changes the Treatment Concept in Patients with Obstructive Sleep Apnoea

The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (n = 17, 33.3%), followed by palatal and oropharyngeal collapse (n = 12, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.

Extraesophageal Reflux: What Is the Best Parameter for pH-Monitoring Data Analysis from the Perspective of Patient Response to Proton Pump Inhibitors?

Objectives. To analyze the pH-monitoring records of patients with suspected extraesophageal reflux (EER) using three different parameters (number of refluxes (NOR), acid exposure time (AET), and reflux area index (RAI)), with a view to determining which type of analysis is best at selecting the patients who will respond to a proton pump inhibitor (PPI). Methods. Demographic data were obtained and the level of the complaint was assessed using the Visual Analogue Scale. A dual probe pH-monitoring study was conducted. NOR greater than six, AET more than 0.1%, and RAI higher than 6.3 mpH were taken to be the thresholds for EER. Subsequently the response to a 12-week PPI trial was analyzed. Results. A total of 81 patients were analyzed. The percentages of patients with substantial EER based on NOR, AET, and RAI were 36%, 28% and 26%, respectively. Statistically significant, often positive PPI trials were confirmed in the group identified as having substantial EER using all three types of analysis. When using AET and RAI, the significance was more pronounced (P = 0.012 and P = 0.013, resp.) in comparison with NOR (P = 0.033). Conclusions. Patients with EER diagnosed using AET or RAI will respond to PPI significantly often.

Errors associated with the concentration of epinephrine in endonasal surgery

This paper presents two cases of using erroneous concentrations of epinephrine during endonasal surgery. The two patients discussed were part of a larger study aimed at monitoring the absorption of epinephrine upon injection into the nasal mucosa. During this study, we observed major cardiovascular reactions in two consecutive patients—ventricular tachycardia with ventricular extrasystole and a significant rise in systolic and diastolic blood pressure and pulse rate. This state required pharmacological intervention. In hindsight, it was found that an erroneous application of ten times higher (1:10,000) concentration of epinephrine than the usual was injected. The applied solution was prepared in our institutional pharmacy and was labelled incorrectly (1:100,000 instead of 1:10,000). The authors have analysed the steps leading to the erroneous applications and recommend safety precautions for the prevention of errors in the concentration levels of epinephrine. Epinephrine injections in concentrations of 1:10,000, followed by analyses of epinephrine levels in venous blood, have not yet been described in available literature.

Does the length of intubation affect the success of treatment for congenital nasolacrimal duct obstruction

Purpose: To compare success rates of intubation for 2 versus 5 months in congenital nasolacrimal duct obstruction in children between 15 and 30 months of age. Methods: This prospective, randomized study evaluated drainage function in 145 eyes of children aged between 15 and 30 months and treated for congenital nasolacrimal duct obstruction using silicone stents with the fluorescein dye disappearance test. The tubes were removed 2 months (group I, 48 eyes) and 5 months (group II, 47 eyes) after stent placement. Thereafter, the children were followed for 6 months after tube removal. Fifty eyes were excluded from the study because of incomplete follow-up. Results: The full resolution of symptoms (fluorescein test 0–1) was 33 of 48 in group I and 33 of 47 in group II at the time of tube removal (2 vs. 5 months). Six months after tube removal, the success rate was 43 of 48 (89.6%) in group I and 43 of 47 (91.5%) in group II. After the stents were removed, no relapses were observed in children having a fluorescein test 0–1 with the tubes remaining in the lacrimal system. Conclusions: The effects of intubation for 2 versus 5 months on the function of the nasolacrimal duct during and after intubation in children between 15 and 30 months of age are comparable. The fluorescein dye disappearance test is the test of choice for monitoring lacrimal drainage function.

Endonasal Dacryocystorhinostomy Location of Lacrimal Sac with Forceps

INTRODUCTION Endonasal dacryocystorhinostomy (EDCR), first described in 1893 by Caldwell, did not gain popularity and was not used for many years because of limited visualization, complications associated with endonasal surgery, and difficulty in locating the sac endoscopically. EDCR became the widely accepted procedure for lacrimal surgery in the 1980s and the 1990s with the advent of new instrumentation—rigid fiberoptic endoscope and techniques for endoscopic sinus surgery—with which EDCR can be performed easily and safely. At present, external and endonasal dacryocystorhinostomies are used to correct primary and recurrent nasolacrimal obstruction, and both approaches have their advantages and limitations. The most important step in the successful performance of EDCR is proper intranasal identification of the lacrimal sac. There are many methods used for lacrimal sac location, including endonasal transillumination with the transcanalicular light pipe and the knowledge of intranasal anatomic landmarks. Despite the fact that the sac is consistently near the superior attachment of the middle turbinate to the lateral nasal wall, it can not always be easily identified. Orientation can be more difficult in patients with a narrow nasal cavity, anteriorly located head of the middle turbinate, and with septal deviation, or if EDCR is complicated by bleeding. The loss of orientation can lead to increased risk of complications such as misdirected drilling, and adverse effects include orbital fat prolapse, hematoma, emphysema, mucosal burn, or the damage of other structures. In this article, we present a simple method of lacrimal sac location with the help of a nasal bayonet forceps.

Sialoendoscopy, sialography, and ultrasound: a comparison of diagnostic methods

Abstract Objective To compare the accuracy of ultrasound, sialography, and sialendoscopy for examining benign salivary gland obstructions. Methods In this prospective study, patients with symptoms of obstruction of the major salivary gland duct system presenting at the ENT Clinic University Hospital, Ostrava, from June 2010 to December 2013 were included. All patients (n=76) underwent ultrasound, sialography, and sialoendoscopy. The signs of sialolithiasis, ductal stenosis, or normal findings were recorded after the examinations. Statistical analysis of the sensitivity and specificity of all the methods was performed, as well as a comparison of the accuracy of each method for different kinds of pathology (sialolithiasis or stenosis). Results The sensitivity of ultrasound, sialography, and sialoendoscopy for sialolithiasis findings were 71.9%, 86.7 %, and 100%, respectively. The sensitivity of sialography and sialoendoscopy for stenosis of the duct was 69.0%, and 100%, respectively. The study showed impossibility of ultrasonic diagnostics of ductal stenosis. The sensitivity of sialoendoscopy for both pathologies was significantly higher than that from ultrasound or sialography (p<0.05). The specificity of sialoendoscopy was significantly higher than that from by ultrasound or sialography (p<0.05). Conclusion Sialoendoscopy was the most accurate method for examination ductal pathology, with significantly higher sensitivity and specificity than by ultrasound or sialography.