There has been a marked increased interest in immittance measurements in the past decade. It is important that the relevancy of these findings be established by validation with the more traditional methods of examination and longitudinal observations. The various methods of evaluation, history, and physical examination complement the immittance observations. The correlation and limitations of both otoscopy and tympanometry are discussed in this presentation.

Acoustic Impedance Tests↗

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Diseases of the tonsils and adenoids in relation to rhinitis and sinusitis.

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Adenoidectomy↗

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Congenital cricopharyngeal achalasia.

Fifteen infants with congenital cricopharyngeal achalasia are reviewed. Although most of the patients had symptoms at birth, the diagnosis was frequently not confirmed until later in the first year of life. While four of the infants had only cricopharyngeal achalasia, 11 had associated diseases related to the central nervous system. Those patients without associated diseases improved spontaneously with conservative management; most of the infants with other abnormalities also improved, although their clinical progress was slower and more complicated. In three of the patients, the symptoms were persistent and there were two deaths related to associated diseases. Cricopharyngeal myotomy was performed on two children with only moderate improvement in symptoms. Congenital cricopharyngeal achalasia is more common than formerly recognized. When suspected, an esophagram with tele- or cineradiography is essential to confirm the diagnosis. Esophageal motility studies will quantify changes and also evaluate lower esophageal dysfunction not easily identified on esophagrams.

Deglutition Disorders↗

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Sinus histiocytosis with massive lymphadenopathy. Report of its occurrence in two siblings with retropharyngeal involvement in both.

Sinus histiocytosis with massive lymphadenopathy (SHML) was found in two siblings, both of whom had retropharyngeal involvement. In one of the children the retropharyngeal swelling appeared to produce obstructive symptoms, requiring excision of the involved lymph nodes. These cases appear to constitute not only the first proven familial occurrence of SHML but also the only reported instances of retropharyngeal involvement. SHML is an uncommon disease of unknown etiology that must be distinguished from other diseases associated with marked lymphadenopathy, particularly as its course is generally benign and not altered by any known form of medical treatment.

Child, Preschool↗

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Pulmonary edema following relief of acute upper airway obstruction.

Five children, aged one to five years, with severe upper airway obstruction, three of whom had epiglottitis and two of whom had laryngotracheobronchitis, developed acute pulmonary edema after the obstruction had been relieved by placement of an artificial airway. Although major physiologic changes, such as hypoxemia and massive sympathetic discharge, play a significant role in the development of acute pulmonary edema, we have postulated a possible etiological cause for the development of pulmonary edema in these children which involves a series of physiologic events. The generation of very high transpulmonary pressure gradients during inspiration is opposed by a decreased venous return due to the obstruction during exhalation. Airway pressures then fall abruptly with the insertion of the artifial airway, resulting in a sudden increase in venous return to the central circulation and marked increase in the intravascular hydrostatic pressures. The final result of this series of events is the development of pulmonary hyperemia and edema. The prevention of this situation must begin the moment the airway is inserted and involves the application of moderate amounts of continuous positive pressure to the airway, thus allowing time for circulatory adaption to take place.

Airway Obstruction↗

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Airway obstruction in a hemophiliac child.

The hemophiliac patient is in constant danger of death from hemorrhage. The danger of bleeding into the submucosal areas of the upper aerodigestive tract, however, does not primarily lie in the blood loss but rather is due to compression and edema of the upper airway. The treatment of choice, in addition to the direct treatment for the specific clotting factor deficiency, is elective nasotracheal intubation, since in most cases this interstitial bleeding, resulting in airway compromise, recedes in four to five days.

Airway Obstruction↗