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Sommaire Introduction: La chirurgie d'un jour est devenue une partie importante de la pratique ORL moderne. Par contre, les admissions post-operatoires imprevues demeurent un probleme. Objectif: Determiner l'incidence, les causes et les facteurs predictifs d'admission non prevues apres une chirurgie ORL en ambulatoire. Methode: Revue retrospective de tous les cas non prevus d'admission apres une chirurgie ORL ambulatoire dans un centre tertiaire entre 2000 et 2004. Nous avons collige les donnees demographieques, le statut physique, les procedures chirurgicales, les complications peri-operatoires et les raisons pour l'hospitalisation. A des fins de comparaison, nous avons apparie ces patients avec des controles qui eux n'ont pas ete admis. Resultats: Des 1106 patients traites en ambulatoire, 74 (6.7%) ont ete admis apres leur intervention. Cinquante-sept pourcent de ces patients etaient des hommes et leur moyenne d'âge etait de 48.9 ans. Les procedures qui ont mene a la majorite de ces admissions sont la biopsie ouverte d'un ganglion cervical (27%), la chirurgie endoscopique des sinus (20.3%) et la panendo-scopie (16.2%). Les raisons d'admission incluent le monitoring des voies respiratoires (37.7%), le saignement post-operatoire (28.6%), la douleur (19.5%), les complications anesthesiques (5.2%), les complications cardio-vasculaires (3.9%), une erreur clericale (3.9%) et une suspicion de fuite de LCR (1.3%). Les facteurs de risque que nous avons identifie sont une classe 3 ou plus de la classification de l'ASA, une chirurgie cervicale ouverte et une procedure de plus de 60 minutes. Les facteurs plus mineurs incluent l'anesthesie generale, le sexe masculin, un âge avance et un domicile eloigne de l'hopital. Conclusion: Cette etude propose des strategies pour reduire le nombre d'admissions imprevues: evalution et planification pre-operatoire diligente, selection des patients, planification des patients a haut risque et prise en charge appropriee de la periode post-operatoire.

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.

Nontuberculous mycobacteria (NTM) infections seem to be increasing in numbers and in severity in developed countries worldwide.To document the severity and to assess whether an increase in cases has occurred over the years, we described the epidemiology, clinical presentation, investigations, and treatment of NTM adenitis seen at the Montreal Children's Hospital.Cases were identified through revision of the microbiology laboratory database for positive NTM culture from any site and through retrieval by the medical records of charts of patients with a diagnosis of adenitis and a node biopsy or excision or a diagnostic code of NTM disease, between 1990 and 2004. These charts were reviewed retrospectively.Over the 15-year period, we identified 36 patients with a median age of 2.8 years with NTM adenitis. Of these cases, 22 (61%) occurred in the past 5 years. Only 3 children were born outside Canada. The majority (92%) presented with a cervicofacial mass, and 25% had constitutional symptoms or fever. There were 3 cases of mediastinal adenitis and 2 cases of cervical disease extending to the deep neck vessels, all of which occurred in the past 5 years. The purified protein derivative (PPD) test for tuberculosis was positive (or = 10 mm) in 11 of 15 patients tested (73%), none of whom had ever had contact with tuberculosis. Thirty-three patients had surgery. Of the 26 patients who had excisional biopsy or functional neck dissection, 15% required a second surgery for persistence or recurrence compared with 100% of those who had incision and drainage or curettage. Cultures were positive in 72% of the 32 specimens sent, mainly for Mycobacterium avium complex. Very few complications were noted.The number of cases of NTM disease has almost doubled between 2000-2004 compared with between 1990-1999, with more invasive cases seen in the past 4 years. The significance of this important rise in numbers is still unclear. Resolution of NTM adenitis is higher with complete surgical excision of affected lymph nodes. Moreover, given the proportion of PPDor = 10mm among those tested, a pan-Canadian study assessing the incidence of NTM disease compared with tuberculosis is required to determine if a change in the recommendations for PPD positivity is needed.

Treatment of tympanostomy tube otorrhea has evolved with numerous studies demonstrating the superiority of topical therapy in the form of eardrops over systemic antibiotic therapy. Many physicians have been concerned about ototoxicity with antibiotic eardrops because several ototopical agents have a risk of vestibular and cochlear damage, which may be permanent. An expert round table of pediatric and general otolaryngologists, pediatricians, and family physicians met in Quebec City in May 2004 to develop practical Canadian guidelines for the safe treatment of tympanostomy tube otorrhea. The recommendations and guidelines are outlined.

Objective The purpose of this article is to review the cases of bilateral cholesteatomas in a tertiary care pediatric otolaryngology department. We compare the presenting signs and symptoms and timing of ipsilateral and contralateral cholesteatomas and the initial audiometric findings. Methods Retrospective chart review. Setting Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON. Results Twenty-two patients with bilateral cholesteatomas were accrued. Nine patients had bilateral congenital cholesteatomas and presented at a substantially younger age than those with acquired disease (average of 5 years, 9 months vs 11 years). Sixteen of the 22 patients were initially diagnosed with bilateral cholesteatomas. The majority of the remaining patients had evidence on initial assessment of contralateral middle ear disease. A particular subset of patients with severe disease requiring numerous bilateral revision surgeries was also identified. These patients also underwent revision surgery after a substantially shorter follow-up period. Conclusions Bilateral cholesteatomas in the pediatric population are extremely rare. Bilateral congenital cholesteatomas are more common in males, whereas bilateral acquired cholesteatomas are more common in females. The outcome is generally poor. A small subset with particularly aggressive disease requires many more bilateral revision surgeries at an earlier period when compared with the remainder of the group.

Objectif: Le muscle cricothyroide (MCT) est innerve differemment des muscles intrinseques du larynx. Son action pourrait donc contribuer a la resistance a l'air cree dans le larynx des enfants qui souffrent d'une paralysie secondaire a une atteinte du nerf recurrent larynge (NRL). Nous proposons donc la resection du MCT comme moyen d'elargir indirectement la glotte des nouveau-nes avec une paralysie du NRL. Methode: Nous avons donc utilise un modele porcin pour simuler la paralysie du larynx et evaluer notre traitment. La paralysie a ete induite par une section des deux NRL chez sept porcelet. Nous avons ensuite reseque le MCT, chaque animal devenant son propre controle. Nous avons fait des mesures seriees de la resistance respiratoire autant en inspiration qu'en expiration durant les trois etapes de l'experience: (1) avant l'intervention, (2) apres la section du NRL, et (3) apres la resection du MCT. Certains animaux furent meme eveilles pour evaluer leur reaction clinique aux interventions. Nous avons utilise le test paire de Student pour l'analyse statistique. Resultats: La resistance inspiratoire etait significativement augmentee apres la section du NRL (p = .0062) et ensuite reduite apres la resection du MCT (p = .0005). La reponse clinique reflete cette evaluation objective. Conclusion: La resection du MCT diminue de facon significative la resistance des voies respiratoires en inspiration chez les porcelets chez qui on a cree une paralysie laryngee. La technique que nous proposons merite d'etre investiguee plus a fond.

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.

Computer-generated models are increasingly being used in otolaryngology for teaching purposes, preoperative planning, and clinical simulations, especially when dealing with small, complex areas such as the middle ear. One technique used to analyze the mechanics of complex models is the finite-element method, whereby the system of interest is divided into a large number of small, simple elements. The mechanical properties and applied forces are represented by functions defined over each element, and the mechanical response of the whole system can then be computed. We present a unique three-dimensional finite-element model of the human eardrum and middle ear. Our model takes advantage of phase-shift moiré shape measurements to precisely define the shape of the eardrum. The middle ear geometry is derived from histologic serial sections and from high-resolution magnetic resonance microscopy of the human ear. We discuss the importance of this model in terms of understanding and teaching the mechanics of the human middle ear, simulating various pathologic conditions, and designing ossicular prostheses.

Objectif: Determiner la prevalence d'inflammation autour de l'aimant des implants cochleaires. Methode: Enquete postale chez 232 enfants implantes a l'Hospital for Sick Children de Toronto evaluant la severite et l'horaire de l'inflammation cutanee associee a l'aimant. Resultats: Soixante-trois enfants (27%) ont presente au moins un episode d'erytheme cutane au site de l'aimant. Dans la majorite des cas, une reduction du champ magnetique a solutionne le probleme. Neuf enfants ont du arreter de porter leur appareil temporairement et 5 ont eu besoin d'antibiotiques. Une ulceration a ete notee chez deux enfants. Aucun traitement chirurgical n'a ete necessaire. Les reactions semblaient se produire chez les enfants plus jeunes (2.8 vs 4.3 ans; p = .002; Mann-Whitney rank sum test). Conclusions: Chez les enfants, une inflammation cutanee se produit frequemment entre l'aimant de l'emetteur et la bobine du recepteur. Si le probleme ne disparait pas en diminuant la puissance de l'aimant, il faudra interrompre le port de l'appareil temporairement. Des antibiotiques devront etre utilises dans les cas de cellulites qui menaceraient l'implant.