0894 A Two Item Questionnaire Reflecting Parental Concern As An Indicator Of The Severity Of Obstructive Sleep Apnea In Children

Introduction

The currently available questionnaires based on parental reporting of OSA symptoms include large number of items and are not sufficient to the diagnosis and assessment of OSA severity. We aimed to evaluate a simple 2-item questionnaire regarding parental concern as a predictor of the severity of OSA in children as measured by polysomnography.

Methods

Prospective analysis of parental concern regarding their children referred for PSG due to suspected OSA. Parents of all study children completed the brief Parental Concern Scale (PCS) questionnaire and the validated Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder questionnaire (PSQ-SRBD). The PCS consisted of 1 question on the need for surgery and 1 question on concerns about the child’s breathing.

Results

Ninety-five children (mean age 4.2 ± 2.5 years, 52% males, mean body mass index z score 0.45 ± 1.8) were recruited. Twenty-three children (24%) had moderate-severe OSA and were referred for adenotonsillectomy. Significant correlations were found between the need for surgery score and the apnea-hypopnea index (r=0.22, P = .029), as well as the mean SpO2 levels (r=-0.24, P = .02). The likelihood for the diagnosis of moderate-severe OSA by PSG increased as parental ranking for the need for surgery increased (P = .003). The need for surgery score and the child’s age were the only predictors for moderate-severe OSA (P = .01 and P = .043, respectively).

Conclusion

Querying parents on their perception of their child’s need for surgery is a sensitive, practical, and easy-to-use tool that can help the clinician in prioritizing referral to PSG.

Support

 

Recurrent meningitis and cerebrospinal fluid leak-two sides of the same vestibulocochlear defect: report of three cases

Cochlear dysplasia is a rare congenital anomaly. However, early detection of this anomaly can prevent serious consequences. We describe three cases of cochlear dysplasia that presented with recurrent meningitis and cerebro-spinal fluid (CSF) leak in children in which early diagnosis prevented further complications.

Complications of Acute Otitis Media and Sinusitis

Otitis media and sinusitis are clinically identifiable infections of the middle ear and sinuses. Both conditions should be regarded as dynamic processes with a clinical spectrum, which may extend from a self-limiting condition to a prolonged and sometimes complicated disease. With the advent of antibiotics, the natural course of these diseases has changed significantly. Severe complications once characterized by high mortality and morbidity have become rare. This has led to a generation of general practitioners, otolaryngologists, and pediatricians trained in an atmosphere of complacency in the treatment of otitis media and sinusitis. However, several recent publications report an increasing incidence of serious complications associated with otitis and sinusitis, probably due to rising antibiotic resistance. A high index of suspicion, based on clinical grounds, is therefore warranted. The ultimate goal in the approach of these conditions is pharmacotherapeutic management, resorting to surgery for the restoration of function rather than for the eradication of the infectious disease. As new information becomes available on the etiology, pathogenesis, and bacteriology of these conditions, new strategies are being used to improve treatment and to prevent complications. These measures should include a more appropriate choice of antibiotics, the determination of the role of adjuvant therapy and surgical procedures, and the development of new vaccines.

Tongue-base suspension with a soft tissue-to-bone anchor for obstructive sleep apnea: preliminary clinical results of a new minimally invasive technique

The Repose system is a new minimally invasive technique for tongue-base suspension in the treatment of sleep-disordered breathing caused by tongue-base collapse. It involves the insertion of a titanium miniscrew with attached suture into the anterior intraoral mandible and passing the suture through the tongue base. The procedure was performed in 16 patients with sleep-disordered breathing. Fourteen patients reported an improvement in daytime sleepiness, and their bed partners reported an improvement in snoring. The mean respiratory distress index before surgery was 35. Two months after surgery, the mean respiratory distress index was 17, an improvement of 51.4% (P = 0.001, 2-tailed t test). These preliminary results show the initial efficacy and safety of this new surgical procedure.

Subjective comparison of Nd:YAG, diode, and CO2 lasers for endoscopically guided inferior turbinate reduction surgery

Lasers using different wavelengths and delivery systems have been used to reduce the inferior turbinate mass when hypertrophic inferior turbinates obstruct the nasal airway. Different laser systems produce different laser-tissue interactions. This study presents a comparison between three laser systems: CO2, Nd:YAG, and Diode lasers for inferior turbinate reduction surgery, all performed under endoscopic control. A total of 46 patients were randomized into three treatment groups and followed for more than 1 year. Subjective and objective data were collected. Subjective impressions of improved nasal airway was achieved in 41% (Diode), 47% (Nd:YAG) and 57% (CO2) and was not statistically significant. There was more postoperative bleeding in the CO2 laser group, with 3 patients requiring tamponade. The CO2 laser procedure also took longer to perform. These results failed to show a significant difference between the different lasers for inferior turbinate reduction. Overall, the results were not impressive.

Eosinophilic granuloma presenting as chronic otitis media: pitfalls in the diagnosis of aural polyps in children

The case of a 7-year-old boy with multifocal eosinophilic granuloma, initially presumed to be chronic otitis media, is presented. A review of other similar cases in the literature reveals that a delay in diagnosis is not uncommon, and a high index of suspicion is necessary to avoid an unfavourable outcome. Early in the evaluation of an aural polyp, sufficient biopsies should be performed and computerized tomography scanning should be considered.

Axial configuration of the velopharyngeal valve and its valving mechanism

The variability of the normal velopharyngeal (VP) closure mechanism was studied by investigating VP anatomy in relation to its closure mechanism in 60 patients. The axial configuration of the VP isthmus, as observed in axial CT scans at rest, was found to be correlated with VP function in terms of its closure patterns in speech as observed by nasendoscopy. A flat VP isthmus was found to be closed mainly in the anteroposterior direction, forming the coronal closure pattern. A deep VP isthmus is closed by movement of the velum and medial movement of the lateral pharyngeal walls, forming the circular closure pattern. A flat VP isthmus occurs when the hamuli are posteriorly located and the muscular slings, therefore, open more posteriorly. We conclude that posterior insertion of the velar muscles on to the skull base results in a flatter, larger VP axial configuration, whereas an anterior insertion results in a VP axial configuration that is deeper and less flat. A flat VP isthmus contracts mainly in an anteroposterior direction, exhibiting a coronal closure pattern, while a deep or round VP isthmus contracts centripetally, exhibiting a circular closure pattern. Variability of the VP valving mechanism is of anatomic and not of functional origin.

Experimental study of CO2 laser myringotomy with a hand-held otoscope and fiberoptic delivery system

CO2 laser myringotomy has previously been proven effective in patients with serous otitis media for short-term aeration of the middle ear. However, the system based on a microscope and a coaxially aligned laser is cumbersome and expensive. The advantage of CO2 laser energy is the high absorption coefficient in biological tissue, meaning minimal damage surrounding the desired lesion. The disadvantage is that conventional optical fibers do not transmit CO2 laser energy (lambda = 10.6 microns). We have developed a silver halide optical fiber of diameter 0.9 mm and lengths of several meters, with high transmission at 10.6 microns. Using a hand-held otoscope coupled to a fiberoptic delivery system, CO2 laser myringotomies were performed in guinea pigs. In the animal model the feasibility of the procedure was proven. Different irradiation parameters were studied and a "dose-dependent" relationship was found between the total energy used and the duration of a patent myringotomy. However, conventional histological studies failed to show a difference in circumferential damage with different energy parameters. CO2 laser myringotomy utilizing a hand-held otoscope coupled to an optical fiber capable of transmitting CO2 laser energy may prove simple and effective. The relationship between energy parameters and myringotomy patency may be instrumental in deciding on the optimal duration of aeration of the middle ear in secretory otitis media.

Immediate retinal adhesion by CO2 laser irradiation using a fiberoptic intraocular probe

Using an experimental fiberoptically guided CO2 laser system, we produced lesions on fresh bovine retinas. These lesions were shown to achieve immediate measurable chorioretinal adhesion. This model provides preliminary data on the use of a fiberoptic CO2 laser probe to produce chorioretinal lesions and possible future use in intraocular surgery for retinal detachment. The advantages of using CO2 laser energy are minimal damage surrounding desired lesion and its versatility as a coagulator and cutter. With modifications, CO2 endolaser may have a role in intraocular surgery.