Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries

Childhood caries experience is influenced by family characteristics and oral health practices in the context of many social-commercial determinants. The aim of this study was to explore the relationship between families' number of children, oral health practices and child caries experience in a convenience sample of 1374 children aged 6 months through 6 years and their families from Ecuador, Nepal, and Vietnam. Data were collected by mother interviews and child dental exams. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between number of children, oral health practices and decayed, missing or filled teeth (dmft). Families had a mean of 2.2 children (range 1-12); 72% of children had tooth decay, with mean dmft of 5.4. Adjusting for child age, sex, and urban/rural location, a greater number of children in the family was associated with significantly less likelihood of unhealthy bottle feeding practices, having a toothbrush/toothpaste and parent helping child brush, and being cavity-free; higher number of dmft, and greater likelihood of having a dental visit. Early childhood oral health promotion should include focus on oral hygiene and healthy feeding-particularly breastfeeding and healthy bottle feeding practices-as well as access to family planning services and support for childcare.

Role of operative airway evaluation in children with recurrent croup: a retrospective cohort study

OBJECTIVE

Determine which risk factors in children with recurrent croup warrant bronchoscopic evaluation.

DESIGN

Retrospective cohort study.

SETTING

Tertiary paediatric hospital.

PARTICIPANTS

Children with recurrent croup who underwent a rigid bronchoscopy between 2001 and 2013.

MAIN OUTCOME MEASURES

Bronchoscopy findings, classified as normal, mildly abnormal or significantly abnormal.

RESULTS

Two hundred and thirty-five children underwent a rigid bronchoscopy and 110 underwent a flexible oesophagoscopy. One hundred and forty-five children (61.7%) had a mildly abnormal exam, and 27 children (11.5%) had significant findings that required a surgical intervention or grade 2 or greater subglottic stenosis. The significantly abnormal group included 4 children with laryngomalacia, 2 with a subglottic cyst, 8 with grade 2 or 3 subglottic stenosis and 13 children who underwent a surgical procedure for subglottic stenosis. Sixty-seven children had a preoperative diagnosis of asthma, 62 were atopic and 78 had symptoms of gastro-oesophageal reflux. Oesophagoscopy was diagnostic of gastro-oesophageal reflux in 19 of 110 cases, and 106 children (45.1%) had bronchoscopic findings suggestive of GERD. Eight children had eosinophilic oesophagitis. After multivariate analysis, significantly abnormal bronchoscopy was significantly associated with chronic cough (P = 0.02), have a previous intubation (P = 0.002) or be younger than 3 years old (P = 0.01).

CONCLUSION

Significant findings on bronchoscopy that warranted further surgical intervention were uncommon in this cohort. Nearly half of the patients had evidence of gastro-oesophageal reflux. In patients without risk factors for significant abnormalities, empiric medical management may be beneficial prior to endoscopy.

Clinical course of pediatric congenital inner ear malformations

OBJECTIVE

To determine any factors that could improve the early detection and management of congenital inner ear malformations.

STUDY DESIGN

A retrospective review was performed of all patients with a diagnosis of inner ear malformation at Loyola University Medical Center (LUMC) and the Hospital for Sick Children (HSC) between 1987 and 1995. Clinical records and audiometric data were accumulated. One neuroradiologist reviewed every temporal bone computed tomography (CT) scan.

METHODS

Forty-six pediatric patients with congenital inner ear anomalies evaluated at two tertiary care hospitals.

RESULTS

The average patient age at initial assessment was 25.7 months. A family history of hearing loss was noted in only five patients (12.8%). A major nonotological deformity was seen in 41% of patients. The average hearing threshold was 88 dB. All three patients with sudden hearing loss had vestibular aqueduct enlargement. Two of the three patients with common cavity anomalies had a history of recurrent meningitis. Twenty-seven patients had a vestibular aqueduct deformity, the most frequent radiographic abnormality in the series.

CONCLUSIONS

Because inner ear malformation was diagnosed after 24 months of age in a significant percentage of patients, we recommend increased parental education and vigilance by primary care practitioners. Universal newborn screening may be the key to earlier detection of these infants. For children with idiopathic sensorineural hearing loss, we recommend a temporal bone CT scan. Patients with vestibular aqueduct enlargement must be counseled about the risk of progressive sensorineural hearing loss, meningitis, and the need to avoid contact sports. Patients with common cavity abnormalities should be considered for exploratory tympanotomy and also educated about the risk for meningitis.

Recurrent laryngeal nerve monitoring during cricotracheal resection

Cricotracheal resection has been advocated in the management of severe subglottic stenosis. One of the possible complications of this procedure is injury to the recurrent laryngeal nerve (RLN). We describe a new technique in which electrodes are placed directly through the thyroid cartilage to monitor the RLN intraoperatively. Nine cats' left vocal cords were monitored, and 3 cats had unilateral vocal cord injury postoperatively: 1 right cord and 2 left cords. Even though this technique was efficacious, our ability to monitor the RLNs was difficult secondary to difficulty interpreting the nerve monitor's wave morphologies. The future use of RLN nerve monitoring during cricotracheal resection will depend upon the ability to distinguish true stimulation from artifact. Monitoring of the RLN could be beneficial in patients with previous operations for subglottic stenosis.

Suspected foreign body aspiration in a child with endobronchial tuberculosis

Endobronchial tuberculosis is a form of pulmonary tuberculosis, thought to result from rupture of an infected node through the bronchial wall or from lymphatic spread to the mucosal surface of the bronchial tree. With the presence of multidrug resistant isolates of TB, and its incidence in an increasing number of foreign-born persons immigrating to the US, otolaryngologists must be aware of its often subtle presentation. The following case is an unusual presentation of endobronchial tuberculosis initially diagnosed as an airway foreign body.

Endoscopic versus traditional approaches to choanal atresia

With the introduction of endoscopic techniques and powered instrumentation for pediatric sinusitis, one would expect that the definitive treatment of congenital choanal atresia has been established. An international survey of pediatric otolaryngologists and the plethora of surgical approaches in the literature, however, indicate that there is still much controversy in its management. This article addresses this controversy between endoscopic and traditional approaches to neonatal bilateral bony choanal atresia and proposes guidelines for optional treatment.

Comparison of thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in an animal model

OBJECTIVE

To evaluate and compare the use of autogenous thyroid cartilage with that of auricular and costal cartilage in laryngotracheoplasty (LTP).

DESIGN

A blinded comparison of LTP techniques using anterior thyroid, auricular, or costal cartilage as graft material in a rabbit model. Histological and anatomical analyses were performed on the laryngeal specimens 1, 4, and 6 weeks after surgery. The following factors were analyzed in each specimen: graft viability, cartilage proliferation, perichondrial viability, degree of necrosis, inflammatory response, and degree of epithelialization.

SUBJECTS

Fifty-seven New Zealand adult male rabbits, aged 6 months, were divided into 3 study groups (19 animals in each group) initially and equally into the 3 time periods.

RESULTS

No episodes of respiratory compromise occurred in any of the animals in the 3 study groups. Gross inspection of the laryngotracheal complex in the thyroid cartilage group revealed no evidence of laryngeal structural compromise. There was no statistical difference between the 3 types of cartilage used for reconstruction for the variables of graft or perichondrial viability, degree of necrosis, or inflammatory response at 1, 4, or 6 weeks. Cartilage proliferation in the thyroid cartilage group was decreased compared with that in the other 2 groups at 1 week. The amount of proliferation increased in this group and was equal to the amount present in the other 2 groups 4 and 6 weeks after surgery. Complete epithelialization of the graft material was present in all 3 groups at 4 and 6 weeks after reconstruction.

CONCLUSIONS

The use of autogenous thyroid cartilage for LTP compares favorably with that of other methods of reconstruction that use either auricular or costal cartilage in the rabbit model. This technique is a viable alternative for single-stage LTP and has the added advantage of using a single incision.

Gender differences in motion sickness history and susceptibility to optokinetic rotation-induced motion sickness

PURPOSE

The present study investigated gender differences in motion sickness history and susceptibility to optokinetic rotation-induced motion sickness.

METHODS AND RESULTS

The study included two phases. In Phase 1, 485 subjects filled out a survey of previous incidence of motion sickness. Results indicated that women reported significantly greater incidence of feeling motion sickness than did men on buses, on trains, on planes, in cars, and on amusement rides before the age of 12 yr; and on buses, on trains, on planes, in boats, on ships, in cars, on amusement rides, and on swings between the ages of 12 and 25 yr. Women also reported significantly higher incidence of being actually sick than did men on buses before the age of 12 yr and on buses, on ships, and in cars between the ages of 12 and 25 yr. In Phase 2, each of the 47 subjects viewed an optokinetic rotating-drum for 16 min. Subjects' subjective symptoms of motion sickness (SSMS) were obtained during drum rotation. The results showed that there were no significant differences on SSMS scores between men and women.

CONCLUSION

Although women reported greater incidence in motion sickness history, women did not differ from men in severity of symptoms of motion sickness while viewing a rotating optokinetic drum.

Effect of harvesting autogenous laryngeal cartilage for laryngotracheal reconstruction on laryngeal growth and support

OBJECTIVE

Determine the effect of harvesting autogenous thyroid cartilage on subsequent laryngeal growth and stability in a kitten model.

STUDY DESIGN

Prospective controlled trial in animals.

METHODS

Seventeen kittens were divided into three groups. Group one (n = 5) included kittens that underwent a unilateral thyroid cartilage resection. Group two (n = 5) included kittens that underwent a bilateral cartilage resection. Group three (n = 7) comprised kittens that did not undergo any surgical procedure (controls). All animals underwent endoscopic examination followed by the surgical procedure designated for that group. Kittens were then assessed daily for 2.5 months. At the end of that period the now "adolescent" cats were examined endoscopically then euthanized. The larynx was removed for gross and histopathologic analysis.

RESULTS

All kittens tolerated the surgical procedure without airway compromise. Subsequent endoscopic examination 2.5 months after surgery revealed normal vocal cord function. Measurements of the true vocal cord and aryepiglottic and subglottic diameter did not differ significantly (one-way analysis of variance, P = .05) with respect to the side or the group. Histopathologic evaluation of the laryngeal sections indicated a patent airway, stable and viable thyroid cartilage, and no evidence of cartilaginous regrowth.

CONCLUSIONS

The removal of unilateral and bilateral superior thyroid alar cartilage can be performed in kittens without postoperative respiratory or wound problems. The harvesting of autogenous thyroid cartilage has no apparent effect on subsequent laryngeal growth and stability in a kitten model.

A novel approach to tracheostomal collapse: the use of an endoluminal Palmaz stent

There are a number of surgical treatments for tracheostomal collapse of the pediatric airway. The techniques include tracheoplasty with costal cartilage graft, the placement of a tracheostomy tube and partial tracheal resection and primary tracheal anastomosis to name a few. Since each child may possess unique medical and social factors in additional to the tracheal pathology, the surgical approach must be individualized. A case history of a 1-year-old Vietnamese child with a tracheostomal collapse is presented. In this case, an endoluminal Palmaz stent was placed endoscopically to support the collapsed tracheal segment for 3 months. After 3 months, the stent was removed, and the child has done well without any airway intervention for 2 years. The indications for this novel approach, the technique of insertion and removal of the stent are the focus of this paper.

Age differences in self-reported susceptibility to motion sickness

Questionnaire responses of 485 college volunteers were examined for sex by age variance in the incidence of motion sickness across eight types of motion.

The role of functional endoscopic sinus surgery in asthmatic patients

OBJECTIVE

This study was conducted to determine the efficacy of FESS (functional endoscopic sinus surgery) on sinus and asthma symptoms.

METHOD

Seventy-nine patients with asthma and medically unresponsive sinusitis were evaluated. Maximal medical therapy was attempted to relieve both sinus and asthma symptoms. The surgical procedures involved standard FESS techniques. Fifty-six percent of patients had undergone a sinus procedure prior to the FESS. Nasal polyposis was noted in 73% of the group. The majority of patients had pansinusitis.

RESULTS

Eighty-six percent of patients stated that FESS improved their sinusitis. Nine of 11 sinus symptoms recorded preoperatively diminished significantly (p < .05) following surgery. Eighty percent of patients noted improvement of their asthma following FESS. The factors associated with treatment failure and the unique characteristics of this disease process were evaluated.

CONCLUSIONS

FESS is a viable option in the treatment of asthma when medical therapy fails.

A protocol for management of a catastrophic complication of functional endoscopic sinus surgery: internal carotid artery injury

Injury to the cavernous portion of the internal carotid artery is a well recognized and dreaded complication of functional endoscopic sinus surgery. Little information, however, has been presented in the Otolaryngology literature regarding the etiology, prevention, or treatment of this complication. The purpose of this study is to present a case report of a cavernous carotid artery injury during functional endoscopic sinus surgery. Relevant anatomy, preventive measures, and treatment approaches are discussed for this difficult problem.

Patterns of Kawasaki syndrome presentation

Kawasaki syndrome (KS) is a systemic disorder of unknown etiology that can lead to coronary artery aneurysm and thrombosis in a significant number of children. It is defined by a number of clinical guidelines set by the Centers for Disease Control (Rauch, A.M., Hurwitz, E.S. (1985) Centers for Disease Control (CDC). Case Definition for Kawasaki syndrome. Pediatr. Infect. Dis. 4, 702-703). Many of the symptoms of this illness may lead the patient to the otolaryngologist. These criteria include injected or fissured lips, injected pharynx, strawberry tongue and cervical lymphadenopathy. When administered in the first 10 days of the illness, gamma globulin has been demonstrated to reduce the prevalence of coronary artery abnormalities (Newburger, J.W., Takahashi, M., Burns, J.C. et al. (1986) Treatment of Kawasaki syndrome with intravenous gamma globulin. N. Engl. J. Med. 315, 341-347). Unfortunately, when a diagnosis of KS is not considered or if a patient presents with unusual symptoms that are not consistent with the CDC guidelines, the diagnosis and treatment of KS can be delayed or even missed. We present a series of patients with KS to illustrate its patterns of presentation.

Suction drain management of salivary fistulas

Salivary fistulas remain an unpleasant complication of upper aerodigestive tract surgery. To avoid a disastrous outcome such as carotid rupture, clinicians "medialize" (i.e., incise the skin flap in the anterior aspect of the neck and insert a Penrose drain) to divert fistula fluid from the carotid sheath and then perform laborious wound care. Meanwhile, patients endure the unpleasant odor, discomfort due to the wound dressing, occasional secondary surgical procedures, a lengthened hospital stay, and increased financial costs. In an effort to mitigate these problems, suction drains that had been placed at the time of the original surgical procedure were used as an alternative management technique. Out of a population of 118 reviewable patients who underwent standard or extended variations of supraglottic laryngectomy, partial laryngopharyngectomy, near-total laryngectomy, or total laryngectomy between 1988 and 1992, 16 patients appropriate for inclusion in this study developed postsurgical fistulas. Eight of these patients were treated with traditional medialization procedures, and the other 8 patients were treated with suction drainage. Comparison of the two groups revealed no significant difference with respect to complications or time to fistula closure. The advantages of simplified postsurgical care, less patient discomfort, reduced time demands on the clinician, and cost containment were noted for the group treated with suction drainage.

A case of intractable sneezing: 'a pleasure sent from God?'

Sneezing or sternutation is usually the physiologic response to nasal irritation. The reflex follows a very complicated pathway requiring coordinated communication between the trigeminal and nervous terminalis afferent impulses as well as from glottic and inspiratory muscles in the efferent limb. When the reflex pathway is unbalanced, sneezing can increase in frequency and severity to the extent that some patients become disabled. We present the clinical examination, differential diagnosis, and treatment modalities for the case of an adolescent male who experienced debilitating intractable sneezing for more than one year. As for many of the patients described with this elusive diagnosis, our patient appears to have a functional etiology.

Complications of inflammatory diseases of the sinuses

The great majority of cases of sinusitis are uncomplicated. These infections, however, can result in significant morbidity and often mortality. One must be vigilant in detecting orbital or intracranial spread and iatrogenic injury from surgery because manifestations of these complications can be protean. A good knowledge of the anatomy, the clinical signs, and some key laboratory data is crucial to successful treatment of this challenging disease.