Dexamethasone in the prevention of postextubation stridor in children

287 infants (8 full-term and 5 preterm). Respiratory movements and airflow were recorded as were sucks and swallows (intraoral and intrapharyngeal pressure). Sucks did not interrupt breathing or decrease minute ventilation during nonnutritive sucking. Minute ventilation during bottle feedings was inversely related to swallow frequency, with elimination of ventilation as the swallowing frequency approached 1.4/s. Swallows were associated with a 600-ms period of decreased respiratory initiation and with a period of airway closure lasting 530 k 9.8 (SE) ms. Occasional periods of prolonged airway closure were observed in all infants during feedings. Respiratory efforts during airway closure (obstructed breaths) were common. The present findings indicate that the decreased ventilation observed during bottle feedings is primarily a consequence of airway closure associated with the act of swallowing, whereas the decreased ventilatory efforts result from respiratory inhibition during swallows. Evaluation of ventilating tubes and myringotomy in the treatment of recurrent or persistent otitis media Le C.T.; Freeman D.W.; Fireman B.H. PEDIATR. INFECT. DIS. J. (1991) 10/l (2-11) In a prospective controlled study of the efficacy and sequelae of ventilating tubes. 44 children with bilateral recurrent acute otitis media ( > h episodes/year) and 13 children with bilateral persistent middle ear effusion ( > 3 months) received unilateral ventilating tube insertion in a randomly selected ear. The contralateral ears were randomized to receive either myringotomy alone or no surgery. Clinical. otoscopic, tympanometric and audiologic examinations were performed before the study and 2 to 4 weeks later, then at 3.month intervals for up to 2 years and at 36 months after surgical randomization. Medical therapy and antibiotic prophylaxis were used whenever indicated. While the ventilating tubes remained functional (mean duration, 10 months) the ears with a tube had significantly fewer episodes of otitis media than their contralateral ear (P < 0.001; 95% confidence intervals - 0.7. - 1.7) and had more hearing improvement (P = 0.005; 95% confidence intervals, -5.9. - 1.2). After tube extrusion there was a tendency for surgically treated ears to have more otitis and worse hearing. but not at a significant level. Tympanosclerosis, retraction and atrophy were more common in ears that received tubes. The majority of ears treated medtcally also improved. There is need for a more cautious and selective use of ventilating tubes. Attachment of bacteria to tonsillar epitbelium during acute tonsillitis Stenfors L.-E.; Raisanen S. .I. LARYAGOL. OTOL. (1991) 105/l (29-32) Epithelial cells were scraped from the tonsillar surfaces of 15 patients with current acute tonsillitis (AT) and of 1.5 individually matched healthy persons. The cellular mixture was stained with acridine orange and bacteria seen to be attached to the epithelial cells under the fluorescent microscope were calculated. Conventional bacterial culturing was also performed simultaneously. Significantly more bacteria were attached to epithelial cells from the AT group than from the controls ( > 10 attached bacteria per cell P = 0.0103, > 50 attached bacteria per cell P = 0.0212). In vivo determination of bacteria attached to epithelial cells offers prospects of gaining a better understanding of the aetiopathogenesis of acute tonsillitis. Dexametbasone in the prevention of postextubation stridor in children Tellez D.W.; Galvis A.G.; Storgion S.A.; Amer H.N.; Hoseyni M.; Deakers T.W. J. PEDIATR. (1991) 118/2 (289-294) To assess whether there is any advantage in the use of corticosteroid to prevent postextubation stridor in children, we conducted a prospective, randomized, double-blind trial of dexamethasone versus saline solution. The patients were evaluated and then randomly selected to receive either dexamethasone or saline solution according to a stratification based on risk factors for postextubation stridor: age. duration of intubation, upper airway trauma, circulatory compromise, and tracheitis. Dexamethasone. 0.5 mg/kg, was given every 6 hours for a total of six doses beginning 6 to 12 hours before and continuing after endotracheal extubation in a pediatric intensive care setting. There was no statistical difference in incidence of postextubation stridor in the two groups; 23 of 77 children in the placebo group and 16 of 76 in the dexamethasone group had stridor requiring therapy (P = 0.21). We conclude

288 that the routine use of corticosteroids for the prevention of postextubation cated pediatric intensive care airway management is unwarranted.

stridor during uncompli-

Nasal dermoid sinus cysts: association with intracranial extension and multiple malformations Wardinsky T.D.; Pagon R.A.; Kropp R.J.; Hayden P.W.; Clarren S.K. CLEFT PALATE J. (1991) 28/l (87-95) Nasal dermoid and sinus cysts (NDSC) are uncommon congenital anomalies that may have intracranial extension and can be associated with other anomalies. We identified 22 patients in a retrospective review of cases diagnosed with NDSC at our institution over the past 10 years. Nine (41 percent) had associated anomalies and ten (45 percent) had intracranial extension of the sinus. In half of the patients with intracranial extension, the sinus traversed either the cribriform plate or foramen cecum and attached to the dura; in the other half, the sinus extended to cysts within the falx or other brain structures. Of the patients with multiple anomalies, six (67 percent) had intracranial extension. Presurgical complications occurred in a total of eight patients (36 percent): two had meningitis, two had osteomyelitis, four had periorbital-nasal cellulitis, three had nasal abscess, and four had nose anomalies requiring rhinoplasty.

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