Thieme: Ear, Nose, and Throat Diseases
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Retropharyngeal Cellulitis in a 5-Week-Old Infant
Retropharyngeal Cellulitis in a 5-Week-Old Infant Florence T. Bourgeois, MD*, and Michael W. Shannon, MD, MPH‡ ABSTRACT. An infant who presents with acute, unex- abnormalities. An abdominal radiograph was also unremarkable. plained crying requires a thorough examination to iden- Initial laboratory studies revealed a leukocyte count of 3900/mm3 tify the source of distress. We report the case of a 5-week- (12% band forms, 28% segmented neutrophils, 4% monocytes, 49% old infant who had sudden irritability and was found to lymphocytes, 1% eosinophils), a hematocrit of 37%, and a platelet count of 299 000/mm3. Urinalysis was negative. have retropharyngeal cellulitis caused by group B The infant continued to be extremely irritable and refused all Streptococcus. Pediatrics 2002;109(3). URL: http://www. feeds. He could be comforted intermittently, but any repositioning pediatrics.org/cgi/content/full/109/3/e51; group B Strepto- distressed him. Because of the sudden onset of the child’s symp- coccus, retropharyngeal cellulitis, infant, irritability. toms and his unwillingness to be moved, the question of acute injury was raised and a skeletal survey was performed. While obtaining the radiographs, it was noted that the child would calm ABBREVIATION. GBS, group B streptococcal. down when his neck was positioned in hyperextension. Lateral cervical spine films showed prominence of the prevertebral soft tissues, and a fluoroscopic assessment of the airway demonstrated rying is an infant’s principle form of commu- retropharyngeal soft tissue swelling, which persisted with the nication. Usually an infant’s source of distress neck in both flexed and extended positions. The remainder of the can be identified easily, and the child can be skeletal survey was negative. -
Care Process Models Streptococcal Pharyngitis
Care Process Model MONTH MARCH 20152019 DEVELOPMENTDIAGNOSIS AND AND MANAGEMENT DESIGN OF OF CareStreptococcal Process Models Pharyngitis 20192015 Update This care process model (CPM) was developed by Intermountain Healthcare’s Antibiotic Stewardship team, Medical Speciality Clinical Program,Community-Based Care, and Intermountain Pediatrics. Based on expert opinion and the Infectious Disease Society of America (IDSA) Clinical Practice Guidelines, it provides best-practice recommendations for diagnosis and management of group A streptococcal pharyngitis (strep) including the appropriate use of antibiotics. WHAT’S INSIDE? KEY POINTS ALGORITHM 1: DIAGNOSIS AND TREATMENT OF PEDIATRIC • Accurate diagnosis and appropriate treatment can prevent serious STREPTOCOCCAL PHARYNGITIS complications . When strep is present, appropriate antibiotics can prevent AGES 3 – 18 . 2 SHU acute rheumatic fever, peritonsillar abscess, and other invasive infections. ALGORITHM 2: DIAGNOSIS Treatment also decreases spread of infection and improves clinical AND TREATMENT OF ADULT symptoms and signs for the patient. STREPTOCOCCAL PHARYNGITIS . 4 • Differentiating between a patient with an active strep infection PHARYNGEAL CARRIERS . 6 and a patient who is a strep carrier with an active viral pharyngitis RESOURCES AND REFERENCES . 7 is challenging . Treating patients for active strep infection when they are only carriers can result in overuse of antibiotics. Approximately 20% of asymptomatic school-aged children may be strep carriers, and a throat culture during a viral illness may yield positive results, but not require antibiotic treatment. SHU Prescribing repeat antibiotics will not help these patients and can MEASUREMENT & GOALS contribute to antibiotic resistance. • Ensure appropriate use of throat • For adult patients, routine overnight cultures after a negative rapid culture for adult patients who meet high risk criteria strep test are unnecessary in usual circumstances because the risk for acute rheumatic fever is exceptionally low. -
Nasal Airflow Measured by Rhinomanometry Correlates with Feno in Children with Asthma
RESEARCH ARTICLE Nasal Airflow Measured by Rhinomanometry Correlates with FeNO in Children with Asthma I-Chen Chen1☯, Yu-Tsai Lin2☯, Jong-Hau Hsu1,3, Yi-Ching Liu1, Jiunn-Ren Wu1,3, Zen- Kong Dai1,3* 1 Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, 2 Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, 3 Department of Pediatrics, School of Medicine, College of Medicine, a11111 Kaohsiung Medical University, Kaohsiung, Taiwan ☯ These authors contributed equally to this work. * [email protected] Abstract OPEN ACCESS Citation: Chen I-C, Lin Y-T, Hsu J-H, Liu Y-C, Wu Background J-R, Dai Z-K (2016) Nasal Airflow Measured by Rhinitis and asthma share similar immunopathological features. Rhinomanometry is an Rhinomanometry Correlates with FeNO in Children with Asthma. PLoS ONE 11(10): e0165440. important test used to assess nasal function and spirometry is an important tool used in doi:10.1371/journal.pone.0165440 asthmatic children. The degree to which the readouts of these tests are correlated has yet Editor: Stelios Loukides, National and Kapodistrian to be established. We sought to clarify the relationship between rhinomanometry measure- University of Athens, GREECE ments, fractional exhaled nitric oxide (FeNO), and spirometric measurements in asthmatic Received: September 3, 2016 children. Accepted: October 11, 2016 Methods Published: October 28, 2016 Patients' inclusion criteria: age between 5 and 18 years, history of asthma with nasal symp- Copyright: © 2016 Chen et al. This is an open toms, and no anatomical deformities. All participants underwent rhinomanometric evalua- access article distributed under the terms of the Creative Commons Attribution License, which tions and pulmonary function and FeNO tests. -
Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy
Medical Coverage Policy Effective Date ............................................. 7/10/2021 Next Review Date ....................................... 3/15/2022 Coverage Policy Number .................................. 0554 Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy Table of Contents Related Coverage Resources Overview .............................................................. 1 Balloon Sinus Ostial Dilation for Chronic Sinusitis and Coverage Policy ................................................... 2 Eustachian Tube Dilation General Background ............................................ 3 Drug-Eluting Devices for Use Following Endoscopic Medicare Coverage Determinations .................. 10 Sinus Surgery Coding/Billing Information .................................. 10 Rhinoplasty, Vestibular Stenosis Repair and Septoplasty References ........................................................ 28 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence -
Retropharyngeal Abscess Complicated
RETROPHARYNGEAL ABSCESS COMPLICATED Ortega Coronel María Fernanda, Dr. Calvopiña José Dr. Mena Glennª ª Departamento de Radiología e Imagen del Hospital Eugenio Espejo Quito Ecuador _________________________________ Revista de la Federación Ecuatoriana de Sociedades de Radiología, Ecuador 2011 N° 4, Pag, 9 -11. ABSTRACT It is a concise review of retropharyngeal abscess, we report a case of long and torpid evolution with multiple subtreatments that masked the symptoms for a long time, increasing the risk of provoking severe morbidity and complications. the cervical spine, presence of air or INTRODUCTION foreign body in soft tissue. CT is useful for Retropharyngeal abscess is defined by the diagnosis of early-stage infections while infection between the posterior pharyngeal allows differentiation between cellulitis wall and the prevertebral fascia, it is an and abscess, is also useful in defining the uncommon condition, most common in vascular structures and their relationship children by extension of oropharyngeal to the infectious process defines exactly infections 1, in adults is caused by trauma like that space or spaces are involve. 7 MRI after ingestion of foreing bodies that has a higher resolution than CT and is able damage the esophagus or the trachea, to evaluate the retropharyngeal space with tracheal intubation and less frequently a series of sequences, including diffusion. untimely tooth infections.2 Many studies But this test is not used routinely for the have shown that most of these abscesses diagnosis of this condition, -
Medical Policy Directory of Documents Policy Number: 411
Medical Policy Directory of Documents Policy Number: 411 Q: How do I comment on the documents? A: You can email us at [email protected]. Q: How do I find out which documents have changed? A: New and updated documents are posted to the system every week. To find out what has changed see the Provider Focus newsletter. Drugs ∙ Treatments ∙ Devices and Equipment ∙ Surgeries ∙ Other Drugs Medical Technology Assessment Investigational (Non-Covered) Services List 400 Ampyra™ (dalfampridine) 246 Antihyperlipidemics: A Prescription Drug Therapy Guideline 013 ↳Prior Authorization/ Formulary Exception Form 434 Anti-Parkinsonism Drugs 054 Antisense Oligonucleotide Medications 027 Asthma and Chronic Obstructive Pulmonary Disease Medication Management 011 ↳Prior Authorization/ Formulary Exception Form 434 Benign Prostatic Hyperplasia (BPH) 040 Bisphosphonate, Oral 058 Botulinum Toxin Injections 006 B-Type Natriuretic Peptide 031 Anti-Migraine Policy 021 CNS Stimulants and Psychotherapeutic Agents 019 Compound Exclusion List for Pharmacy Medical Policy 579, Compounded Medications 705 Compound Inclusion List for Pharmacy Medical Policy 579, Compounded Medications 704 Compounded Medications 579 Cox II Inhibitor Drugs 002 Diabetes Step Therapy 041 Dificid (fidaxomicin) 700 Drug Management and Prior Authorization 251 ↳Prior Authorization/ Formulary Exception Form 434 Drugs for Cystic Fibrosis 408 Entresto Step Therapy 063 Erythropoietin, Recombinant Human; Epoetin Alpha (Epogen and Procrit); Darbepoetin Alpha 262 (Aranesp) Esketamine Nasal Spray (Spravato) -
Clinical Dilemma on Retropharyngeal Cellulitis and Croup Retrofaringeal
Case Report/ Olgu Sunumu Ege Journal of Medicine /Ege Tıp Dergisi 48(1):49-52,2009. Clinical dilemma on retropharyngeal cellulitis and croup Retrofaringeal yumu şak doku enfeksiyonları ile krup arasındaki klinik ikilem Saz E U Erdemir G Ozen S Aydo ğdu S Department of Pediatrics Division of Emergency Medicine Ege University School of Medicine, Bornova ,Izmir-Turkey Summary We report a case of retropharyngeal cellulitis which exactly mimics the croup symptoms. The case reported was an 19-month-old male. He was brought to the emergency department with a chief complaint of stridor and his mother denied any fever, trauma, upper respiratory or gastrointestinal complaints. He was alert, drooling, and became agitated when approached. He was intermittently stridulous, especially when placed supine, although he was not hoarse at rest. His neck was not hyperextended in the “sniffing” position . He had moderate substernal, intercostal, and supraclavicular retractions an nasal flaring. Đn addition, mild expiratory wheezing was appreciated upon auscultation. Examination of the neck revealed some anterior and posterior lymphadenopathy. Both lateral neck radiograph and computed axial tomograpy revealed that the present case has retropharyngeal widening and possible abscess. Based on these findings direct larygoscopy and aspiration was performed and diagnosed as cellulitis. Since the symptoms have improved with intravenous metronidazol and ceftriaxone he was discharged from the hospital. Key Words: Retropharyngeal cellulitis, children Özet Bu olgu, laringotrakeit klinik belirtilerini birebir taklit edip yanılsamalara neden olan retrofaringeal yumu şak doku enfeksiyonlarının ciddiyetini vurgulamak amacıyla sunulmu ştur. Olgu acil servise stridor ve hırıltılı solunum yakınmaları ile getirildi. Fizik bakısında alt, üst interkostal retraksiyonları saptanan ve burun kanadı solunumu olması nedeni ile ilk planda krup sendromu olarak dü şünülen bir olguydu. -
And Post-Pyriform Plasty Nasal Airflow
Braz J Otorhinolaryngol. 2018;84(3):351---359 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Evaluation of pre- and post-pyriform plasty nasal airflowଝ ∗ Oscimar Benedito Sofia , Ney P. Castro Neto, Fernando S. Katsutani, Edson I. Mitre, José E. Dolci Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil Received 29 November 2016; accepted 28 March 2017 Available online 6 May 2017 KEYWORDS Abstract Introduction: Nasal obstruction; Nasal obstruction is a frequent complaint in otorhinolaryngology outpatient clin- Rhinomanometry; ics, and nasal valve incompetence is the cause in most cases. Scientific publications describing Acoustic rhinometry surgical techniques on the upper and lower lateral cartilages to improve the nasal valve are also quite frequent. Relatively few authors currently describe surgical procedures in the piri- form aperture for nasal valve augmentation. We describe the surgical technique called pyriform plasty and evaluate its effectiveness subjectively through the NOSE questionnaire and objec- tively through the rhinomanometry evaluation. Objective: To compare pre- and post-pyriform plasty nasal airflow variations using rhinomanom- etry and the NOSE questionnaire. Methods: Eight patients submitted to pyriform surgery were studied. These patients were screened in the otorhinolaryngology outpatient clinic among those who complained of nasal obstruction, and who had a positive response to Cottle maneuver. They answered the NOSE questionnaire and were submitted to preoperative rhinomanometry. After 90 days, they were reassessed through the NOSE questionnaire and the postoperative rhinomanometry. The results of these two parameters were compared pre- and postoperatively. Results: Regarding the subjective measure, the NOSE questionnaire, seven patients reported improvement, of which two reported marked improvement, and one patient reported an unchanged obstructive condition. -
The Potential of Computational Fluid Dynamics Simulations of Airflow in the Nasal Cavity
Berger et al., J Neurobiol Physiol 2021; Journal of Neurobiology and Physiology 3(1):10-15. Short Communication The potential of computational fluid dynamics simulations of airflow in the nasal cavity Berger M1,2, Pillei M1,3, Freysinger W2* 1Department of Environmental, Process Abstract & Energy Engineering, MCI – The Entrepreneurial School, Austria Computational Fluid Dynamics (CFD) is a well-established and accepted tool for simulation and prediction of complex physical phenomena e.g., in combustion, aerodynamics or blood circulation. 2University Hospital of Recently CFD has entered the medical field due to the readily available high computational power of Otorhinolaryngology, Medical current graphics processing units, GPUs. Efficient numerical codes, commercial or open source, are University Innsbruck, Austria available now. Thus, a wide range of medical themes is available for CFD almost in real-time in the 3Department of Fluid Mechanics, medical environment now. Friedrich-Alexander University The available methods are on the point of reaching a usability status ready for everyday clinical use Erlangen-Nuremberg, Germany as a potential medical decision support system, provided adherence to the appropriate patient data *Author for correspondence: protection rules and proper certification as a medical device. Email: wolfgang.freysinger@i-med. ac.at This contribution outlines the current range of activities in our clinic in the field of Lattice-Boltzmann CFD based on CT and / or MR imagery and flashlights the following three areas: simulating the effect Received date: November 05, 2020 of nasal stents on breathing, predicting clinical Rhinomanometry and Rhinometry, and the numerical Accepted date: February 23, 2021 estimation of resection volumes for surgery to improve nasal breathing. -
Alteraes Na Mucosa Nasal Provocadas Pela Presso Atmosfrica, Oxignio E
ALTERAÇÕES NA MUCOSA NASAL PROVOCADAS PELA PRESSÃO ATMOSFÉRICA, OXIGÉNIO E OUTROS FACTORES PAULO SÉRGIO ALVES VERA-CRUZ PINTO Dissertação de doutoramento em Ciências Médicas 2009 PAULO SÉRGIO ALVES VERA-CRUZ PINTO ALTERAÇÕES NA MUCOSA NASAL PROVOCADAS PELA PRESSÃO ATMOSFÉRICA, OXIGÉNIO E OUTROS FACTORES Dissertação de candidatura ao grau de Doutor em Ciências Médicas, submetida ao Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto. Orientador – Professor Doutor Carlos Zagalo, professor do Instituto de Ciências da Saúde Egas Moniz. Co-Orientador – Professor Doutor Artur Águas, professor catedrático do Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto. Porto 2009 2 À Carla, ao Gonçalo e ao Bernardo 3 4 “Try and leave this world a little better than you found it and when your turn come to die, you can die happy in feeling that at any rate you have not wasted your time but have done your best.” Lord Robert Baden-Powell's Last Message to Scouts, 1941 5 6 ÍNDICE Preceitos legais ...................................................................................................................9 Agradecimentos.................................................................................................................10 INTRODUÇÃO...................................................................................................................12 1- Anatomia das Fossas Nasais no Humano ................................................................12 2 - Anatomia das Fossas Nasais no Rato .....................................................................14 -
Partitioning of Inhaled Ventilation Between the Nasal and Oral Routes During Sleep in Normal Subjects
J Appl Physiol 94: 883–890, 2003. First published November 1, 2002; 10.1152/japplphysiol.00658.2002. Partitioning of inhaled ventilation between the nasal and oral routes during sleep in normal subjects MICHAEL F. FITZPATRICK, HELEN S. DRIVER, NEELA CHATHA, NHA VODUC, AND ALISON M. GIRARD Department of Medicine, Queen’s University, Kingston, Ontario, Canada K7L 3N6 Submitted 18 July 2002; accepted in final form 28 October 2002 Fitzpatrick, Michael F., Helen S. Driver, Neela the snore vibration, which can originate from the soft Chatha, Nha Voduc, and Alison M. Girard. Partitioning palate or from the tongue base (30), may vary during of inhaled ventilation between the nasal and oral routes the night (10). In patients with obstructive sleep apnea during sleep in normal subjects. J Appl Physiol 94: 883–890, (OSA), one study demonstrated a change in the pri- 2003. First published November 1, 2002; 10.1152/jappl- mary site of upper airway obstruction with sleep stage, physiol.00658.2002.—The oral and nasal contributions to from the velopharyngeal level in non-REM sleep to the inhaled ventilation were simultaneously quantified during sleep in 10 healthy subjects (5 men, 5 women) aged 43 Ϯ 5 yr, hypopharyngeal level during REM sleep (4). Ϫ1 Ϫ1 The advent of the nasal cannula pressure transducer with normal nasal resistance (mean 2.0 Ϯ 0.3 cmH2O⅐l ⅐s ) by use of a divided oral and nasal mask. Minute ventilation as the preferred device for airflow measurement during awake (5.9 Ϯ 0.3 l/min) was higher than that during sleep sleep, because of its higher sensitivity for detection of (5.2 Ϯ 0.3 l/min; P Ͻ 0.0001), but there was no significant airflow limitation (27), is also predicated on the as- difference in minute ventilation between different sleep sumption that airflow during sleep is primarily via the stages (P ϭ 0.44): stage 2 5.3 Ϯ 0.3, slow-wave 5.2 Ϯ 0.2, and nasal route, regardless of sleep stage. -
Evolution of the Nasal Structure in the Lower Tetrapods
AM. ZOOLOCIST, 7:397-413 (1967). Evolution of the Nasal Structure in the Lower Tetrapods THOMAS S. PARSONS Department of Zoology, University of Toronto, Toronto, Ontario, Canada SYNOPSIS. The gross structure of the nasal cavities and the distribution of the various types of epithelium lining them are described briefly; each living order of amphibians and reptiles possesses a characteristic and distinctive pattern. In most groups there are two sensory areas, one lined by olfactory epithelium with nerve libers leading to the main olfactory bulb and the other by vomeronasal epithelium Downloaded from https://academic.oup.com/icb/article/7/3/397/244929 by guest on 04 October 2021 with fibers to the accessory bulb. All amniotes except turtles have the vomeronasal epithelium in a ventromedial outpocketing of the nose, the Jacobson's organ, and have one or more conchae projecting into the nasal cavity from the lateral wall. Although urodeles and turtles possess the simplest nasal structure, it is not possible to show that they are primitive or to define a basic pattern for either amphibians or reptiles; all the living orders are specialized and the nasal anatomy of extinct orders is unknown. Thus it is impossible, at present, to give a convincing picture of the course of nasal evolution in the lower tetrapods. Despite the rather optimistic title of this (1948, squamates), Stebbins (1948, squa- paper, I shall, unfortunately, be able to do mates), Bellairs and Boyd (1950, squa- iittle more than make a few guesses about mates), and Parsons (1959a, reptiles). Most the evolution of the nose. I can and will of the following descriptions are based on mention briefly the major features of the these works, although others, specifically nasal anatomy of the living orders of cited in various places, were also used.