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Bacterial tracheitis
Otolaryngology– Head and Neck Surgery Volume 129 Number 2
10:00
AM
Velopharyngeal Insufficiency Assessment: A Comparison of Nasal Endoscopy and Videofluoroscopy Derek J Lam BS (presenter); Jonathan A Perkins DO; Kathleen CY Sie MD; Linda E Eblen MA CCC-SLP Seattle WA; Seattle WA; Seattle WA; Seattle WA
Objectives: (1) To determine the correlation between two methods, nasal endoscopy (NE) and multiview videofluoroscopy (MVF), of assessing velopharyngeal gap (VPG) size. (2) To determine the relationship between these assessments and velopharyngeal insufficiency (VPI) severity, as measured by perceptual speech analysis. Methods: This was a retrospective review of consecutive patients with VPI at a tertiary-care children’s hospital, assessed with NE and MVF between 1996 and 2002. VPG areas calculated from NE values were compared to those calculated from MVF values using a Pearson correlation analysis. Ordinal logistic regression was used to analyze the relationship between the nasendoscopic and videofluoroscopic VPG areas and VPI severity. Covariates included in the analysis were gender, age, presence of coexisting medical conditions, and a cleft palate. Results: 151 patients were included, with a mean age of 9 ⫾ 5.6 years (range, 27 months to 44 years). 64 had coexisting medical conditions, and 59 had cleft palates. NE and MVF gap areas were positively correlated (R ⫽ 0.749, P ⬍ 0.01). Two variables were significantly related to VPI severity: (1) NE gap area was positively correlated with VPI severity (OR ⫽ 2.66, P ⫽ 0.02), and (2) presence of cleft palate was correlated with decreased VPI severity (OR ⫽ 0.33, P ⫽ 0.03). Conclusions: Although calculated NE and MVF gap areas were positively correlated to each other, only the NE assessment of VPG size was significantly predictive of VPI severity. Surprisingly, MVF gap area did not have a significant relationship with VPI severity when controlling for other covariates. 10:08
AM
Bacterial Tracheitis Frank Salamone MD (presenter); Charles M Myer III MD; Michael J Rutter MD FRCS; David Bradley Bobbitt MD; John H Greinwald Jr MD Cincinnati OH; Cincinnati OH; Cincinnati OH; Cincinnati OH; Cincinnati OH
Objectives: Bacterial tracheitis (BT) is a condition that can cause upper airway obstruction and death. We have established a method for evaluating children with suspected BT
and have found a number of patients with a less severe presentation. This retrospective study evaluates our experience with BT over 10 years to better define the disease process and treatment. Methods: Seventy-four charts from patients evaluated between 1991 and 2001 were studied. Historical, diagnostic, and treatment data were extracted. Initial diagnosis was based on the presentation, flexible endoscopy, and radiographs. Bronchoscopy confirmed the diagnosis. Results: Patients experienced a short prodrome characterized by cough, stridor, and retractions in 81%, 59%, and 30%, respectively. Thirty-eight percent had fever greater than 101.5°F at presentation. The male-to-female ratio was 1:1, with a mean age of 7.6 years. After evaluation, 70 of the 74 patients were taken to the OR, 59 of whom had thick, tenacious secretions and/or frank membranes in the trachea, with no significant involvement of the proximal or more distal airways. Forty patients were intubated postoperatively. Oropharyngeal flora and staphylococcus aureus were most commonly cultured. Only 2 patients presented to the ER in respiratory extremis. Conclusions: A subset of BT patients have a less severe clinical appearance than previously described. Nonetheless, these patients have membranous tracheal secretions that require debridement. Aggressive treatment has decreased the severe morbidity and mortality previously ascribed to BT. We propose that “exudative tracheitis” better describes this entity, as it is characterized by thick exudative tracheal secretions often yielding nonpathologic bacteria. 10:16
AM
Contact Diode Laser Myringotomy with Mitomycin C Riccardo D’Eredita MD (presenter) Padova Italy
Objectives: Pressure-equalizing (PE) tube insertion is the mainstay of surgical treatment for otitis media with effusion (OME) in children. However, the procedure presents certain disadvantages, and alternative techniques for prolonged middle ear ventilation are constantly pursued. We investigated with a prospective study the use of contact diode laser myringotomy (CLAM), combined with topical mytomicin C, as an alternative method for prolonged middle ear ventilation in children. Methods: Fifteen children, for whom PE tube insertion was indicated, were enrolled in the study at a tertiary-care pediatric institution. Institutional approval for the study and parental consent were obtained for all patients. Mitomycin C pledgets were applied for 5 minutes to the intact tympanic membrane (TM) in the right ears, while saline pledgets on the left side served as controls in all patients. CLAM was then performed in all ears. Main outcome measures included healing rate and scarring, ear infection, and long-term audiometric follow-up.
MONDAY
The fact that the mean Lund score for pediatric patients without CRS approaches 3 should be considered when determining the diagnostic likelihood of CRS in pediatric patients.
Scientific Session—Monday P83
10:00
AM
Velopharyngeal Insufficiency Assessment: A Comparison of Nasal Endoscopy and Videofluoroscopy Derek J Lam BS (presenter); Jonathan A Perkins DO; Kathleen CY Sie MD; Linda E Eblen MA CCC-SLP Seattle WA; Seattle WA; Seattle WA; Seattle WA
Objectives: (1) To determine the correlation between two methods, nasal endoscopy (NE) and multiview videofluoroscopy (MVF), of assessing velopharyngeal gap (VPG) size. (2) To determine the relationship between these assessments and velopharyngeal insufficiency (VPI) severity, as measured by perceptual speech analysis. Methods: This was a retrospective review of consecutive patients with VPI at a tertiary-care children’s hospital, assessed with NE and MVF between 1996 and 2002. VPG areas calculated from NE values were compared to those calculated from MVF values using a Pearson correlation analysis. Ordinal logistic regression was used to analyze the relationship between the nasendoscopic and videofluoroscopic VPG areas and VPI severity. Covariates included in the analysis were gender, age, presence of coexisting medical conditions, and a cleft palate. Results: 151 patients were included, with a mean age of 9 ⫾ 5.6 years (range, 27 months to 44 years). 64 had coexisting medical conditions, and 59 had cleft palates. NE and MVF gap areas were positively correlated (R ⫽ 0.749, P ⬍ 0.01). Two variables were significantly related to VPI severity: (1) NE gap area was positively correlated with VPI severity (OR ⫽ 2.66, P ⫽ 0.02), and (2) presence of cleft palate was correlated with decreased VPI severity (OR ⫽ 0.33, P ⫽ 0.03). Conclusions: Although calculated NE and MVF gap areas were positively correlated to each other, only the NE assessment of VPG size was significantly predictive of VPI severity. Surprisingly, MVF gap area did not have a significant relationship with VPI severity when controlling for other covariates. 10:08
AM
Bacterial Tracheitis Frank Salamone MD (presenter); Charles M Myer III MD; Michael J Rutter MD FRCS; David Bradley Bobbitt MD; John H Greinwald Jr MD Cincinnati OH; Cincinnati OH; Cincinnati OH; Cincinnati OH; Cincinnati OH
Objectives: Bacterial tracheitis (BT) is a condition that can cause upper airway obstruction and death. We have established a method for evaluating children with suspected BT
and have found a number of patients with a less severe presentation. This retrospective study evaluates our experience with BT over 10 years to better define the disease process and treatment. Methods: Seventy-four charts from patients evaluated between 1991 and 2001 were studied. Historical, diagnostic, and treatment data were extracted. Initial diagnosis was based on the presentation, flexible endoscopy, and radiographs. Bronchoscopy confirmed the diagnosis. Results: Patients experienced a short prodrome characterized by cough, stridor, and retractions in 81%, 59%, and 30%, respectively. Thirty-eight percent had fever greater than 101.5°F at presentation. The male-to-female ratio was 1:1, with a mean age of 7.6 years. After evaluation, 70 of the 74 patients were taken to the OR, 59 of whom had thick, tenacious secretions and/or frank membranes in the trachea, with no significant involvement of the proximal or more distal airways. Forty patients were intubated postoperatively. Oropharyngeal flora and staphylococcus aureus were most commonly cultured. Only 2 patients presented to the ER in respiratory extremis. Conclusions: A subset of BT patients have a less severe clinical appearance than previously described. Nonetheless, these patients have membranous tracheal secretions that require debridement. Aggressive treatment has decreased the severe morbidity and mortality previously ascribed to BT. We propose that “exudative tracheitis” better describes this entity, as it is characterized by thick exudative tracheal secretions often yielding nonpathologic bacteria. 10:16
AM
Contact Diode Laser Myringotomy with Mitomycin C Riccardo D’Eredita MD (presenter) Padova Italy
Objectives: Pressure-equalizing (PE) tube insertion is the mainstay of surgical treatment for otitis media with effusion (OME) in children. However, the procedure presents certain disadvantages, and alternative techniques for prolonged middle ear ventilation are constantly pursued. We investigated with a prospective study the use of contact diode laser myringotomy (CLAM), combined with topical mytomicin C, as an alternative method for prolonged middle ear ventilation in children. Methods: Fifteen children, for whom PE tube insertion was indicated, were enrolled in the study at a tertiary-care pediatric institution. Institutional approval for the study and parental consent were obtained for all patients. Mitomycin C pledgets were applied for 5 minutes to the intact tympanic membrane (TM) in the right ears, while saline pledgets on the left side served as controls in all patients. CLAM was then performed in all ears. Main outcome measures included healing rate and scarring, ear infection, and long-term audiometric follow-up.
MONDAY
The fact that the mean Lund score for pediatric patients without CRS approaches 3 should be considered when determining the diagnostic likelihood of CRS in pediatric patients.
Scientific Session—Monday P83