Introduction  People with tracheostomies exhibit a higher risk of colonization of the lower respiratory tract, acute tracheitis and pneumonia. Despite this, the culture of tracheal secretions is not a routine in most hospitals, and sometimes empiric therapy is based on personal experience, which is not an ideal situation. Objective  To recognize the pathogens present in the tracheal secretions collected from people up to 18 years old with tracheostomies. Methods  Prospective evaluation of patients under the age of 18 of a tertiary care hospital. A standardized questionnaire was completed, and tracheal secretion aspirates were sent for microbiological cultures and antibiograms. Results  Twenty patients under 18 years of age were evaluated, 65% of whom were male. The microbiological culture was positive in 90% of the patients, and the most common microorganisms found were Pseudomonas aeruginosa (55.5%) and Staphylococcus aureus (27.7%). Discussion  Tracheostomized children and adolescents have respiratory tracts colonized by pathogens, the most common of which is Pseudomonas aeruginosa . These patients must undergo tracheal secretion cultures, whether they present symptoms or not, to determine if there is a correlation between the colonization and the infections. This finding could guide the adequate treatment, avoiding the inappropriate use of antibiotics and indicating the better therapy in cases of laryngeal reconstruction. Conclusion  In this sample, the culture of tracheal secretions was mainly positive, and the most common agent was P. aeruginosa . We suggest the routine access to Brazilian children and adolescents tracheal secretion cultures, which could help to make a profile of these children and guide the use of antibiotics.

External dacryocystorhinostomy (DCR) is the gold standard surgical technique for the treatment of primary acquired nasolacrimal duct obstruction (PANDO). However, new techniques such as endoscopic DCR and transcanalicular dacryocystorhinostomy (T-DCR) are being studied in an attempt to reduce surgical time, avoid external scarring and preserve the lacrimal pump while achieving the same efficacy. The purpose of this study was to compare the efficacy between conventional T-DCR and modified transcanalicular dacryocystorhinostomy (MT-DCR) in patients with PANDO. MT-DCR is performed to remove nasal mucosa prior to laser osteotomy. This is a comparative, prospective, interventionist and randomized study. Patients with PANDO were selected to undergo MT-DCR or T-DCR by blocked randomization. PANDO was diagnosed based on clinical presentation, dye disappearance test and dacryocystography. All of the procedures were performed by the same surgery team members. Anatomical success outcome was defined as positive lacrimal syringing and functional success outcome was defined as the absence or improvement of epiphora. A total of 44 surgical procedures were performed (22 MT-DCR and 22 T-DCR). In the case of MT-DCR, the anatomical and functional success rates after 12 months were 90 and 86%, respectively. After T-DCR, these rates were 77 and 72%, respectively (p = 0.162). MT-DCR and T-DCR are both safe and fast procedures with low morbidity and well-tolerated.

BackgroundDetermining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan.MethodsA retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed.ResultsMean follow-up duration was 27.8 months (interquartile range = 25.5–30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37–29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7–21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03–1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09–4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12–0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18–0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities (p < 0.001).ConclusionAge, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.

Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

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Purpose: To compare the accuracy and positive predictive values of the air bubble test (ABT) and endoscopic Jones I test for assessment of anatomical and functional success after diode laser transcanalicular dacryocystorhinostomy (T-DCR). Methods: This cross-sectional study included 60 eyes of 56 patients who underwent T-DCR by a single surgical team from January 2016 to December 2018. All the 56 patients (60 eyes) underwent lacrimal syringing, endoscopic Jones I test, and ABT. Anatomical success was considered as a free passage of fluid with no reflux on the irrigation test. Functional success was defined as the resolution or improvement of epiphora (Munk score of 0 or 1). The results of irrigation test, endoscopic Jones I test, and ABT were used to calculate the accuracy and positive predictive values (PPVs) of ABT and endoscopic Jones I test for assessment of anatomical and functional success (Munk score of 0 or 1) after T-DCR. A value of p < 0.05 was considered statistically significant. All statistical evaluations were performed using SPSS software. Results: There were 60 T-DCR procedures in 56 patients (82.1% women; 46 patients) with a mean age of 56.4 years (standard deviation: 15.7; range from 29 to 92). The mean follow up was 8.1 months. Overall anatomical and functional success rates were 83.3% (50/60) and 73.3% (44/60), respectively. The PPV of endoscopic Jones I test in anatomical success and functional success was 100% and 88%, respectively. The accuracy of this test in anatomical and functional success was 100% and 81.25%, respectively. The PPV of ABT in anatomical success and functional success was 100% and 90.4%, respectively. The accuracy of this test in anatomical and functional success was 92% and 80.65%, respectively. Conclusions: In conclusion, both endoscopic Jones I test and ABT showed PPV of 100% to detect anatomical success after T-DCR; the endoscopic Jones I test and ABT had 88% and 90.4% of PPV on evaluation of functional success, respectively. Both tests showed good accuracy in the assessment of anatomical and functional success after T-DCR. These outcomes may indicate that ABT could substitute Jones I test on postoperative DCR assessment.

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