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PubMed1990

Inflammatory torticollis in children.

Acute torticollis is commonly seen in the pediatric emergency department. It often results from an inflammatory process that irritates the cervical muscles, nerves, or vertebrae. Posturing of the head occurs with unilateral spasm of the sternocleidomastoid muscle such that the child will position the head with the occiput rotated to the affected side and the chin rotated to the contralateral side. We recently treated 26 children who presented to the emergency department with acute nontraumatic torticollis. The most common causes were upper respiratory infection, sinusitis, otomastoiditis, cervical adenitis, and retropharyngeal abscess or cellulitis. Four patients had subluxation of the atlantoaxial joint as a result of the inflammatory process. Children with acute torticollis need careful evaluation for either overt or occult otolaryngologic infections. Computed tomography and magnetic resonance imaging are helpful in determining the cause of the acute torticollis and in ruling out rotatory subluxation of the atlantoaxial joint.

Atlanto-Axial Joint↗
PubMed1992

Phlegmonous and abscess-forming ENT infections: comparative efficacy of ceftriaxone versus amoxicillin-clavulanic acid.

In this randomized trial, 100 patients received ceftriaxone or amoxicillin-clavulanic acid in phlegmonous or abscess-forming ENT infections. Clinical and bacteriological results confirm that both antibiotics are equally effective, the advantage of ceftriaxone being one administration a day. Drainage surgery is necessary when an abscess has already formed. In 4 cases (ceftriaxone: 3; amoxicillin-clavulanic acid: 1), no positive response could be observed. Systemic and local tolerance was, as a general rule, excellent, and side effects were reported in 3 cases of the ceftriaxone group and in 3 cases of the amoxicillin-clavulanic acid group.

Adult↗
PubMed2006

Tonsillitis to mediastinitis.

Parapharyngeal abscess secondary to quinsy is a well understood complication; however, its incidence has significantly declined following early use of effective antibiotics. Tracking of infection from the parapharyngeal space through the anatomical planes to cause mediastinitis has a significant mortality rate and requires early detection and aggressive management. A case of quinsy leading to mediastinitis, pericarditis and pleural effusions is presented. It highlights the potentially life-threatening complications of a commonly encountered ENT problem.

Humans↗
PubMed2005

Head and neck infections caused by Streptococcus milleri group: an analysis of 17 cases.

BACKGROUND: Streptococcus milleri group (SMG) is a common inhabitant of the mouth and gastrointestinal tract, and can be an aggressive pathogen causing abscess formation at various sites in the body. However, it has rarely been listed as a cause of head and neck infections. OBJECTIVES: The present study was performed to evaluate the clinical significance of SMG by reviewing the microbiology and clinical records of patients with SMG in head and neck infections retrospectively. STUDY DESIGN: A retrospective review of all patients diagnosed as having SMG bacterial infections at Onomichi General Hospital, Hiroshima, between the years 2001 and 2002 was performed; 17 patients developed head and neck infections with SMG. Here, we describe the clinical features and management of SMG in head and neck infection. RESULTS: The patient population consisted of 12 males and 5 females with a median age of 62 years (age range, 8-78 years). The sites of infection were as follows: maxillary sinus (n=6), peritonsillar region (n=4), subcutaneous (n=3), submandibular space-retropharyngeal space (n=1), deep neck-mediastinum (n=1), parapharyngeal space (n=1), submandibular space (n=1), tonsil (n=1), parotid gland (n=1), and masseter muscle (n=1). Ten cases (59%) were of suppurative diseases. Six cases (35%) had mixed SMG with anaerobe infection. Three cases showed deteriorating clinical courses, and all three of these cases were culture-positive for SMG with anaerobes. In addition, one deteriorating case showed gas gangrene regardless of repeated surgical debridement and intravenous antibiotic therapy; hyperbaric oxygen therapy improved this patient's condition. CONCLUSION: It is important to recognize SMG as a pathogen in head and neck infection. In addition, the care should be taken with infectious diseases caused by SMG with anaerobes as the patient's clinical course can deteriorate rapidly.

Adolescent↗
PubMed1996

Synergistic necrotizing cellulitis resulting from peri-tonsillar abscess.

This case demonstrates the rare but potentially fatal condition of synergistic necrotizing cellulitis of the head and neck. Although similar to necrotizing fasciitis, this is more extreme as it also destroys muscle. Peri-tonsillar abscess is a recognized cause, but has not previously been described in this country, however it is a condition commonly referred to otolaryngologists and awareness of the complication of synergistic necrotizing cellulitis is necessary to allow early recognition and prompt treatment. This should be by broad-spectrum intravenous antibiotics with extensive surgical debridement and drainage procedures repeated as necessary. Although this case had a successful outcome, many patients do not survive, particularly if treatment is delayed or inadequate.

Cellulitis↗
PubMed2005

Tonsillectomy using the thermal welding system.

OBJECTIVE: To evaluate and introduce a new method of tonsillectomy using the Thermal Welding System (TWS). METHOD: The TWS is a new surgical instrument which uses direct heat and pressure to seal and divide tissues. Fifty consecutive patients underwent tonsillectomy with the use of the TWS. Inclusion criteria were chronic tonsillitis, peritonsilar abscess history and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy or any other procedure together with tonsillectomy and patients with bleeding disorders were excluded. Intraoperative bleeding, operative time, complication rates and return to normal diet were evaluated. RESULTS: There was no measurable bleeding during surgery in any case. No postoperative hemorrhage or other complication occurred. Mean operative time was 23 min. Mean time for return to normal diet was 8.7 days. CONCLUSIONS: The TWS was found quite effective and safe, providing sufficient hemostasis and minimal intraoperative blood loss.

Adolescent↗
PubMed2004

[Pancarditis as cause of death after abscess tonsillectomy].

Paratonsillar abscesses are preferably treated by abscess tonsillectomy as operative therapy. The casuistry of a patient aged 17 who was tonsillectomized for a paratonsillar abscess and died after 12 days prompted a discussion on the scope of preoperative diagnostics. The clinical examination and anamnesis of the young man prior to the operation did not give evidence of any concomitant diseases. It was only through extensive microscopic investigations of the myocardium after autopsy that inflammatory infiltrates of the epicardium, endocardium and myocardium in the vicinity of portions of the conduction system were detected. The relevance of autopsy to the quality assurance in clinical activities is emphasized. Legal questions of possible negligent homicide as a result of the failure to take diagnostic and therapeutic measures are raised.

Adolescent↗
PubMed1981

Peritonsillitis. Evaluation of current therapy.

The records of 84 patients with peritonsillitis were reviewed. Only 19% (16) of the patients had a history of two or more notable episodes of pharyngitis. Six patients underwent an immediate tonsillectomy. The remainder of the patients was treated initially with drainage and parenteral antibiotics. Twenty-one patients underwent an interval tonsillectomy, and 57 patients had no further therapy. Of those patients who received no further therapy, 72% (41) of the patients had either one or no subsequent episodes of sore throat symptoms. Only one patient had recurrent peritonsillitis. Peritonsillitis may not necessarily be an indication for an interval tonsillectomy, and it can reasonably be managed by drainage and antibiotic therapy.

Adolescent↗
PubMed1981

An organic and functional staging classification. A measurement of disability in otolaryngology.

The quantitative measurement of organic and functional problems is assessed by a staging classification that is a measurement of the severity of a patient's condition. The method separates a medical problem or disease into three stages. Stage 1 indicates disease with no complications or a problem of minimal severity. Stage 2 is disease with local complications or a problem of moderate severity. Stage 3 denotes disease with systemic complications or a problem of a serious nature. Eight examples in otorhinolaryngology are given to demonstrate the feasibility of developing scales that quantify organic and functional disability. The scale will be useful in evaluating diagnostic efficiency of physicians as well as to measure prognosis, therapeutic effectiveness, and medical care costs.

Acute Disease↗
PubMedDate not supplied

What a difference a day makes: a decision analysis of adult streptococcal pharyngitis.

With the availability of group A beta-hemolytic streptococcal (GABHS) antigen detection tests, the management of adult pharyngitis is being reassessed. A decision analytic model was developed which considered four strategies: immediate treatment, no treatment, performing a rapid antigen test, or obtaining a bacterial culture. Patient outcomes were expressed in "well" days, which were reduced by the "sick" days associated with adverse reactions to treatment or complications of GABHS infection. When immediate test results are available, testing is the optimal strategy for probabilities of GABHS between 1 and 49 per cent. This range includes almost all patients, using probability estimates based on clinical criteria. The absolute benefit of testing was 0.1 days. The major advantage of a rapid test is the avoidance of penicillin reactions. Variations in the symptomatic benefits of treatment had minimal effects on the analysis. The analysis supports the use of an antigen test for adult patients with pharyngitis.

Acute Disease↗
PubMed2005

Harmonic scalpel tonsillectomy: a prospective study.

The harmonic scalpel has been in use for tonsillectomy for the last 5-6 years in western Europe and North America. Although some studies have found this technique to be superior to other conventional methods, its use is still not very popular. In this single-blinded prospective study, the intraoperative events and postoperative morbidity after the use of harmonic scalpel in tonsillectomy (HST) was evaluated in 180 cases in two hospitals and compared with conventional steel tonsillectomy (CST) and hemostasis secured by bipolar diathermy or ligatures in 100 cases. Both bipolar diathermy and ligatures were used to control the intraoperative bleeding in all cases of CST and some cases (n =9) of HST. The study was done in two hospitals. Patients were randomized irrespectively of their age, sex, past history or indication for surgery. The total number of patients operated on was 180 for HST and 100 for CST. The surgical duration, intraoperative blood loss and postoperative pain were compared between the patients who only had tonsillectomy done in either group (n =120 in HST and n = 70 in CST). The mean operative time in the HST group was not longer than the CST group, but the intraoperative blood loss was significantly less in the HST group. Postoperative pain was present in all patients in the HST group, but to a lesser extent than in the CST group. There was no major postoperative hemorrhage in the HST group that required surgical attention. HST has the advantage over CST when secondary hemorrhage after tonsillectomy is considered. Thus, following the results of the National Prospective Tonsillectomy Audit (NPTA), it may be safe to say that HST is superior to most other conventional methods in reducing secondary hemorrhage. The use of disposable blades in CST certainly reduces the risk of the transmission of Cruetzfield-Jacob disease (CJD).

Adolescent↗
PubMed2004

Acquired upper airway obstruction.

Acquired upper airway obstruction is a common cause of respiratory emergencies in children. Most pathologic processes that result in upper airway compromise are a consequence of infection, trauma or aspiration. Today, many of the infectious causes of upper airway obstruction have lost their threat as a result of the progress made in preventing and treating these infections. Prompt recognition and appropriate management of the child presenting with upper airway obstruction remains critical, because certain causes can progress rapidly from a mild to a potentially life-threatening disease state. A correct diagnosis can often be made by history and physical examination, but additional studies may be useful in selected cases. The child's clinical appearance is the most reliable indicator of severity, and measurable signs are of less value. If respiratory failure is imminent, airway protection and endoscopy for definitive diagnosis may have priority over any other therapeutic or diagnostic procedure.

Airway Obstruction↗