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The assessment and airway planning of patients with airway pathology can be challenging as the current bedside airway assessment tools are often inadequate due to their low sensitivity and specificity. Almost all of these patients would have had a multi-plane computerised tomography (CT) of the head and neck as part of the diagnostic process. In addition to this many would also have had a flexible nasal endoscopy with an associated hand-drawing by the surgeon or a still image in the notes. With three-dimensional (3-D) reconstruction and virtual endoscopy (VE) performed either by the radiologist, anaesthetist or surgeon on an Apple Mac workstation with easily available software such as OsiriX® and HOROS, an inside simulated view of the airway or the pathology can be obtained. This can then be utilised to formulate an airway management plan. Three-dimensional reconstruction of the patient’s head and neck anatomy gives a better understanding of how it is affected by pathology in and around the upper airway. This well-established tool has already shown its value in diagnosing intra-luminal lesions of the airway and bronchial tree and there is now growing evidence demonstrating the benefits of this technology in visualising and mapping out an airway management plan in patients with head and neck pathology.

The prevalence and clinical significance of specific polysaccharide antibody deficiency (SAD) in children are poorly understood. The authors sought to determine the prevalence of SAD in children with chronic wet cough, through a retrospective study of all children with chronic wet cough attending our tertiary respiratory clinic over a 12-month period. Antibody levels to 13 pneumococcal serotypes were measured following vaccination with the unconjugated pneumococcal polysaccharide vaccine, Pneumovax II, and clinical data were reviewed. Twenty-four children over 2 years of age with chronic wet cough were vaccinated. Fourteen (58%) failed to mount an adequate antibody response, consistent with SAD. Children with SAD were more likely than children with normal antibody responses to require intravenous antibiotics (p=0.035) and to have abnormal chest radiographs (p=0.029). The authors conclude that SAD is present in a significant number of children with chronic wet cough. The clinical significance and long-term outcome of SAD warrant further investigation in prospective studies.