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To document the most important postoperative adenotonsillectomy morbidities, with an emphasis on prolonged hospitalization and readmissions.Retrospective chart analysis.We reviewed 2067 cases of adenotonsillectomies performed at our institution over a period of 6 years.Of these cases, 1927 patients had undergone tonsillectomy by electrocautery and adenoidectomy by suction-coagulator, of whom 9.3% required admission. The incidence of admissions owing to bleeding was 1.7%, whereas admissions owing to respiratory and gastrointestinal complications represented 3.7% and 5.2%, respectively. Compared with the literature and our institution's previous results, these morbidity values were found to be either comparable or significantly lower (p.05).We attribute this improvement to our use of electrocautery-based techniques not only for tonsillectomy but also for adenoidectomy.

Objective: To compare the analgesic efficacy of hydrogen peroxide (H2O2) mouth rinse with control for post-tonsillectomy pain management. Design: Double-blinded, prospective, randomized, controlled clinical trial. Patients and Methods: Thirty-seven patients from 5 to 14 years old undergoing electrocautery tonsillectomy were randomized to either the H2O2 mouth rinse or the water rinse (control) group. For 14 days, patients recorded pain levels twice daily using a visual analogue scale. Analgesic uses, as well as any complications, were also noted by the patients. Results: Thirty-seven patients completed the study, 21 in the treatment group and 16 in the control group. Mean postoperative days of pain were 10.3 and 8.3, respectively, and differed significantly (p = .008). Mean postoperative days of analgesic use were 9.0 and 6.7, respectively, and differed significantly (p = .005). Only one incidence of postoperative hemorrhage occurred in the study group. Conclusion: In our study, the H2O2 mouth rinse does not provide a better analgesic effect than the water rinse for posttonsillectomy pain relief.

Sommaire L'etiologie des masses parotidiennes chez les enfants est tres variee, depuis la parotidite infectieuse a la tumeur benigne en passant par la lesion vasculaire ou congenitale. Nous avons donc revu notre experience des 10 dernieres annees dans un centre de pediatrie tertiaire pour ce qui est du management chirurgical des tumeurs benignes de la parotide. Nous avons denombre 15 patients qui ont subi une intervention chirurgicale a ce niveau. Cinq enfants avaient un diagnostic de kyste lymphoepithelial ou de kyste branchial; trois enfants avec des abces dont un a mycobacterie atypique; et finalement trois lymphangiomes, deux inflammation chronique et un kyste epidermoide. Un des enfants initialement considere comme ayant un kyste parotidien a finalement ete diagnostique comme porteur d'un neurofibrome plexiforme du nerf facial. C'est la seule enfant qui a developpe une paresie post-operatoire (branche orbitaire). Nous avons revu la presentation et les complications post-operatoires de ces masses traitees chirurgicalement. Ce sont l'histoire et l'examen physique qui sont les plus utiles pour predire le diagnostic bien que l'echographie et la tomodensitometrie soient aussi utiles. La cytoponction n'a pas ete bien toleree par les les enfants et n'apparait pas d'une grande utilite puisque le diagnostic est donnee de toute facon par le specimen pathologique au moment de la chirurgie.

Objective: Retrospective analysis of all patients treated for retropharyngeal infection in a tertiary care pediatric hospital. Methods: Charts were reviewed for demographic data, duration of symptoms, radiologic workup, antibiotic choice, microbiologic findings, surgical approach, complications, and duration of medical therapy. Surgical findings were correlated with computed tomographic (CT) scans. Results: Sixty-eight patients were included in the study. Empirical intravenous clindamycin was started for a trial of conservative medical therapy. Fifty-one patients (75%) responded to medical treatment, and only 17 patients (25%) required surgical intervention. The CT scan showed a sensitivity of 43% and a specificity of 63% in this series. None of the patients with retropharyngeal infection died, had a major complication, or had a recurrence. Conclusion: Based on the current study, we propose that all patients should be given a trial of medical treatment with intravenous clindamycin. Surgery should be reserved for those who do not respond. An extensive review of the literature is presented.

Introduction: L'otite moyenne avec effusion (OME) est une manifestation de la dysfonction de la trompe d'Eustache. Des etudes ont montre la predominance de mediateurs des T helper (Th2) dans l'effusion d'enfants atopiques, suggerant que l'allergie aurait un role dans la pathogenese de l'OME. Puisque l'oreille moyenne est contigue aux voies respiratoires superieures, l'inflammation allergique vue dans l'oreille moyenne des patients atopiques avec OME se retrouve peut-etre aussi dans le nasopharynx. Objectif: Nous avons emis l'hypothese que les enfants atopiques ont un profil cellulaires et de cytokines dans leurs effusions different de celui des enfants non-atopiques et que cette reaction allergique se retrouve autant dans l'oreille moyenne que le nasopharynx. Methode: Nous avons recrute 45 patients qui subissaient l'insertion de tubes de ventilation et une adenoidectomie pour une hypertrophie des adenoides. Nous avons aussi determine le statut atopique en utilisant des kits cutanes standards. Les profil cellulaires et les cytokines ont ete evalues par immunocytochimie et hybridization in situ dans les effusions, la region du torus tubarius et dans les adenoides. Resultats: Nos resultats indiquent que chez les patients atopiques, il existe une similarite des profils cellulaires et des cytokines entre les trois regions. On remarque en effet une expression predominante de l'interleukin-4 (une cytokine des Th2) et une infiltration accrue d'eosinophiles compare aux patients non atopiques. Conclusion: Ces trouvailles confirment l'association de l'allergie et de l'OME et supporte l'hypothese que l'oreille moyenne fait partie integrante du concept des voies repiratoires unies.

Objective: To evaluate the usefulness of adynamic lateral neck radiographs and dynamic video rhinoscopy in assessing adenoid size and the relationship of these methods to associated symptoms and thus the severity of the disease. Methods: Children with suspected adenoid hypertrophy underwent standard lateral neck soft tissue radiographs: the percentage of airway occlusion, adenoid to nasopharynx (AN) ratio, airway to soft palate ratio, and adenoid thickness were assessed by a radiologist. The percentage of airway closure was assessed by direct fibre-optic rhinoscopy in an ear, nose, and throat clinic. Associated clinical symptoms were assessed by parents using a standardized questionnaire, evaluating the severity of symptoms (snoring, sleep apnea, mouth breathing, and otitis media) to give a total symptom score out of 16. Results: Nonparametric statistical analysis using Spearman’s correlation coefficients was performed on 32 patients. There was a weak correlation, which approaches significance, between the percentage of airway occlusion assessed by fibre-optic rhinoscopy and the total symptom score (r = .344, p = .054). However, this correlation becomes significant when the frequency of otitis media is omitted (r = .367, p = .039). There was also a significant correlation between airway occlusion assessed by rhinoscopy and the percentage of airway occlusion as determined by lateral neck radiography (r = .431, p = .014). There was no correlation between any of the measurements taken by lateral soft tissue neck radiography and total symptom score. Conclusion: Dynamic video rhinoscopy is more accurate at assessing adenoid hypertrophy, and the percentage of airway occlusion, as estimated by video rhinoscopy, is better correlated to the severity of symptoms than are values obtained by lateral neck radiography. Sommaire

Introduction: Les complications orbitaires de la sinusite sont rares mais peuvent entrainer une morbidite importante si elles ne sont pas traitees de facon appropriee. Objectif: Revoir la presentation clinique, le diagnostic, le traitement, et les resultats des complications orbitales des sinusites chez des enfants traites dans notre institution sur une periode de 10 ans. Methodes: Nous avons revu les dossiers de 139 enfants qui ont ete vus au Montreal Children's Hospital entre janvier 1990 et mars 2000 avec des complications orbitaires de sinusite. Les complications sont classees en deux groupes principaux, dependant de la penetration de la periorbite: les complications preseptales (pas de penetration) et les postseptales, ces dernieres etant sous-divisees en cellulite ou abces. Resultats: Soixante-douze pourcent des patients se sont presentes avec une cellulite preseptale, 19% avec une cellulite orbitaire, et 9% avec un abces sous-perioste. Une ophtalmoplegie et une proptose etaient predicteurs d'atteinte postseptale mais une tomodensitometrie etait necessaire pour differencier l'abces de la cellulite. Les atteintes preseptales ont toutes ete gueries par antibiotherapie. Pour les pathologies postseptales, outre le traitement medical, la chirurgie a ete utilisee dans quelques cas mais ne semble affecter les resultats qu'en de rares occasions. Conclusions: Les complications preseptales de la sinusite peuvent etre diagnostiquees cliniquement sans tomodensitometrie et devraient etre traitees avec un antibiotique approprie. Les complications postseptales seront reconnues par la presence de proptose et d'ophtalmoplegie et necessitent une tomodensitometrie pour differencier un abces d'une cellulite. Le traitement de ces cas est avant tout medicamenteux, reservant l'intervention chirurgicale pour des cas speciaux.

Objective The aim of the study was to evaluate the efficacy of ultrasonography and videobronchoscopy in measuring the subglottic diameter in the paediatric population. Design A double-blinded, prospective clinical study carried out at the Montreal Children's Hospital, McGill University. Methods Children undergoing non-life-threatening bronchoscopy for various reasons had the subglottic diameters measured with ultrasonography, videobronchoscopy, and the traditional method of endotracheal tube sizing during the operative period. Ten patients were enrolled in the study. Parental consent was obtained prior to the procedure. Results Statistical analysis revealed that although ultrasonography was highly correlated with both videobronchoscopy and endotracheal tube sizing in measuring the subglottic diameter in the paediatric population, the measurements were not accurate in giving an exact value of the diameters in question. Videobronchoscopy was found to highly correlate with endotracheal tube sizing but had values that were slightly larger. Conclusion This study is the first to examine the ability of ultrasonography and videobronchoscopy in evaluating the subglottic diameter in the paediatric population. Videobronchoscopy was shown to correlate highly with the present standard of measurement, namely, endotracheal tube sizing. The difference in measurement between the two was shown to be statistically significant, with videobronchoscopy being the consistently larger of the two. These results are in keeping with the limitations of measurement by the endotracheal tube. Similarly, ultrasonography was also correlated with both videobronchoscopy and endotracheal tube sizing. In contrast, ultrasonography was found to provide measurements that were significantly smaller than the other two methods. This suggests that ultrasonography may be a good technique to follow the change in lesions of the subglottis but may be poor for absolute measurements of this area as it always underestimated the size of the lumen.

Functional endoscopic sinus surgery (FESS) has become a widely used and effective tool in treating chronic sinusitis refractory to medical therapy. Reported success rates, defined mainly on the basis of improvement of preoperative symptoms, have been encouraging and ranged between 71 and 93%. However, in most of these studies, a second-look endoscopy under general anaesthesia was performed 2 to 3 weeks following the initial surgery in order to débride and clean the operative site. In this study, we present the outcome of FESS in our centre, where a second-look endoscopy was never performed. A retrospective study on all of the patients operated on between May 1987 and May 1997 was undertaken. All 35 patients had symptoms of sinusitis and had received initial medical therapy for at least 2 months. Only those who did not improve were considered candidates for surgery. Prior to the operation, all patients had computed tomography scan of the sinuses to document the extent of their disease. Eleven patients (31%) had asthma, 3 patients had cystic fibrosis, 1 had leukemia, 1 had immotile cilia, and 1 had Kartagener's syndrome. The period of follow-up ranged between 3 months and 5 years. Success was determined by resolution or improvement of the preoperative symptoms as assessed during their latest follow-up visit. Our data show an overall success rate of 74%. More than half of the patients (56%) who had recurrence of symptoms had an underlying systemic condition (cystic fibrosis, leukemia, or ciliary dyskinesia); however, these patients showed an initial improvement during the first few months following FESS. Also, five patients (14%) required revision FESS within 1 to 3 years following their initial surgery; four of those patients (80%) had an underlying systemic condition. Based on these results, we conclude that second-look endoscopy is of no benefit following routine FESS since our success rates are comparable to those reported in the literature.