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Bilateral Vocal Cord Paralysis after Disc Battery Ingestion
P256
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
ing head injury (in 63.5% of patients the tinnitus disappeared after vasoactive treatment), but in other groups tinnitus persisted in many cases - in 80% of patients after acoustic trauma, in 78% of patients after infection, and in 75% of patients after diving. CONCLUSION: The results of audiological tests in children with tinnitus were very variable. The tinnitus patients with head injuries usually had a large hearing loss (amounting to 35 to 80 dB across the whole frequency range) and unrecordable or very small otoacoustic emissions. In other tinnitus groups, hearing loss did not exceed 20 dB in any ear and evoked otoacoustic emissions (TEOAE, DPOAE) were either equal to or only slightly smaller than those measured in aged-matched controls. SOAE were present in 1/3 of ears regardless of the tinnitus group. The results of audiological tests in children with tinnitus demonstrate only a limited correlation with the origin of the tinnitus. Bevacizumab and Cidofovir Intralesional in Pediatric RRP Ramon Horcasitas, MD (presenter) OBJECTIVE: Study the effect of a local injection of cidofovir 7.5 mg/ml on one single dose, followed by 4 doses of bevacizumab 15 mg/ml each 21 days on the patients suffering recurrent respiratory papillomatosis. METHOD: Prospective and observational. From February 2009 to present, recurrent respiratory papillomatosis in a pediatric population in the Hospital Infantil del Estado de Chihuahua, Mexico was studied. Three patients enrolled in the study with the following criteria: female, 10 years old with a Derkay-Calterra score of 14, with 3 or more debulking procedures per year; male 5 years old, D-C score of 24 with two debulking procedures per year; male 4 years old with a D-C score of 20 with three or more debulking procedures per year. All the patients and parents included in the protocol signed informed consent. All procedures were done under general anesthesia. Every patient had an initial debulking procedure followed by the injection protocol, all the patients have a follow up examination every three months after the last injection. Voice, breathing and the time interval between debulking procedures are the outcome measures in our study. RESULTS: The ongoing results in our group of patients are very promising. All three patient’s voices improved. Two of the patient’s voices are normal, one was a little harsh. We had no breathing problems reported in the series. None of the patients have had a debulking procedure in the last 11 months. CONCLUSION: Combination of two drugs delivered locally in RRP have not been reported. We propose that the two have a synergistic effect on the tissue affected by the viral infection. This can prolong the regional effect of the treatment.
Bilateral Vocal Cord Paralysis after Disc Battery Ingestion David Burstein, MD (presenter); Mark Burstein, MD; Jason Mouzakes, MD; Perminder Parmar, MD; Sydney Butts, MD OBJECTIVE: 1) Reinforce the need to educate medical professionals and parents about the importance of the prevention and urgent workup and treatment of battery ingestion. 2) Suggest the need for close and prolonged follow-up of patients sustaining mucosal injury due to battery ingestion. METHOD: Two cases of bilateral vocal cord paralysis as a delayed complication after the ingestion of a disc battery are reported. The anatomical basis for this sequela and the literature regarding this topic are reviewed. RESULTS: A 13-month-old and a 15-month-old were referred to two different tertiary care centers after x-rays taken at outside institutions confirmed the presence of round foreign bodies in the upper esophagus. Direct laryngoscopy, rigid esophagoscopy, and foreign body removal were completed within six and four hours, respectively. Circumferential corrosive injuries of the esophageal mucosa were noted in both. The first patient was discharged home on postoperative day two but returned two days later with stridor. Laryngoscopy was significant for bilateral vocal cord immobility. She was followed closely and has regained partial mobility of her left vocal cord at three months follow up. The second patient was noted to be stridorous ten weeks after ingestion. Laryngoscopy also revealed bilateral vocal cord paralysis. This patient underwent elective tracheostomy and subsequent laryngotracheal reconstruction. To date, the patient remains tracheostomy dependent. CONCLUSION: Bilateral vocal cord paralysis is an uncommon yet potentially catastrophic complication of disc battery ingestion, and active follow-up with an otolaryngologist is necessary for timely identification and management. Chitinases in Hypertrophied Adenoids Dae Young Hur, MD, PhD (presenter); Seong Kook Park, MD, PhD; Young Il Yang, MD, PhD OBJECTIVE: Chronic rhinosinusitis (CRS), otitis media with effusion (OME), and allergic rhinitis (AR) are common conditions that have been associated with hypertrophied adenoids in children, and adenoidectomy is clinically recommended. We assayed the expression level and site of acidic mammalian chitinase (AMCase) and chitotriosidase (ChT) in hypertrophied adenoids of children to determine the expression levels of two chitinases in relation to CRS, OME, and AR. METHOD: Hypertrophied adenoids from 41 children were harvested during adenoidectomy. Medical records were reviewed, and the subjects were grouped according to the presence of CRS, OME, and AR. mRNA and protein expression of AMCase and ChT in adenoid tissues was assessed by reverse transcription polymerase chain reaction and Western blotting.
Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010
ing head injury (in 63.5% of patients the tinnitus disappeared after vasoactive treatment), but in other groups tinnitus persisted in many cases - in 80% of patients after acoustic trauma, in 78% of patients after infection, and in 75% of patients after diving. CONCLUSION: The results of audiological tests in children with tinnitus were very variable. The tinnitus patients with head injuries usually had a large hearing loss (amounting to 35 to 80 dB across the whole frequency range) and unrecordable or very small otoacoustic emissions. In other tinnitus groups, hearing loss did not exceed 20 dB in any ear and evoked otoacoustic emissions (TEOAE, DPOAE) were either equal to or only slightly smaller than those measured in aged-matched controls. SOAE were present in 1/3 of ears regardless of the tinnitus group. The results of audiological tests in children with tinnitus demonstrate only a limited correlation with the origin of the tinnitus. Bevacizumab and Cidofovir Intralesional in Pediatric RRP Ramon Horcasitas, MD (presenter) OBJECTIVE: Study the effect of a local injection of cidofovir 7.5 mg/ml on one single dose, followed by 4 doses of bevacizumab 15 mg/ml each 21 days on the patients suffering recurrent respiratory papillomatosis. METHOD: Prospective and observational. From February 2009 to present, recurrent respiratory papillomatosis in a pediatric population in the Hospital Infantil del Estado de Chihuahua, Mexico was studied. Three patients enrolled in the study with the following criteria: female, 10 years old with a Derkay-Calterra score of 14, with 3 or more debulking procedures per year; male 5 years old, D-C score of 24 with two debulking procedures per year; male 4 years old with a D-C score of 20 with three or more debulking procedures per year. All the patients and parents included in the protocol signed informed consent. All procedures were done under general anesthesia. Every patient had an initial debulking procedure followed by the injection protocol, all the patients have a follow up examination every three months after the last injection. Voice, breathing and the time interval between debulking procedures are the outcome measures in our study. RESULTS: The ongoing results in our group of patients are very promising. All three patient’s voices improved. Two of the patient’s voices are normal, one was a little harsh. We had no breathing problems reported in the series. None of the patients have had a debulking procedure in the last 11 months. CONCLUSION: Combination of two drugs delivered locally in RRP have not been reported. We propose that the two have a synergistic effect on the tissue affected by the viral infection. This can prolong the regional effect of the treatment.
Bilateral Vocal Cord Paralysis after Disc Battery Ingestion David Burstein, MD (presenter); Mark Burstein, MD; Jason Mouzakes, MD; Perminder Parmar, MD; Sydney Butts, MD OBJECTIVE: 1) Reinforce the need to educate medical professionals and parents about the importance of the prevention and urgent workup and treatment of battery ingestion. 2) Suggest the need for close and prolonged follow-up of patients sustaining mucosal injury due to battery ingestion. METHOD: Two cases of bilateral vocal cord paralysis as a delayed complication after the ingestion of a disc battery are reported. The anatomical basis for this sequela and the literature regarding this topic are reviewed. RESULTS: A 13-month-old and a 15-month-old were referred to two different tertiary care centers after x-rays taken at outside institutions confirmed the presence of round foreign bodies in the upper esophagus. Direct laryngoscopy, rigid esophagoscopy, and foreign body removal were completed within six and four hours, respectively. Circumferential corrosive injuries of the esophageal mucosa were noted in both. The first patient was discharged home on postoperative day two but returned two days later with stridor. Laryngoscopy was significant for bilateral vocal cord immobility. She was followed closely and has regained partial mobility of her left vocal cord at three months follow up. The second patient was noted to be stridorous ten weeks after ingestion. Laryngoscopy also revealed bilateral vocal cord paralysis. This patient underwent elective tracheostomy and subsequent laryngotracheal reconstruction. To date, the patient remains tracheostomy dependent. CONCLUSION: Bilateral vocal cord paralysis is an uncommon yet potentially catastrophic complication of disc battery ingestion, and active follow-up with an otolaryngologist is necessary for timely identification and management. Chitinases in Hypertrophied Adenoids Dae Young Hur, MD, PhD (presenter); Seong Kook Park, MD, PhD; Young Il Yang, MD, PhD OBJECTIVE: Chronic rhinosinusitis (CRS), otitis media with effusion (OME), and allergic rhinitis (AR) are common conditions that have been associated with hypertrophied adenoids in children, and adenoidectomy is clinically recommended. We assayed the expression level and site of acidic mammalian chitinase (AMCase) and chitotriosidase (ChT) in hypertrophied adenoids of children to determine the expression levels of two chitinases in relation to CRS, OME, and AR. METHOD: Hypertrophied adenoids from 41 children were harvested during adenoidectomy. Medical records were reviewed, and the subjects were grouped according to the presence of CRS, OME, and AR. mRNA and protein expression of AMCase and ChT in adenoid tissues was assessed by reverse transcription polymerase chain reaction and Western blotting.