Objectives Physicians have long had concerns about the potential harmful effects of pediatric septoplasties on the nasoseptal growth process because septal cartilage is important for the growth and development of the face. Methods In this review article, pediatric septoplasty and its indications are discussed, together with a literature survey. In addition, overviews of development of the nasal skeleton from neonate to adult, nasal growth, and cartilaginous septum are presented. Important issues and comments on pediatric septoplasties are provided. Results During septoplasty procedures, elevation of the mucoperichondrium unilaterally or bilaterally does not negatively affect growth of the face. Stabilization of the septum may be easier when mucosal elevation is performed unilaterally. The nasal floor mucosa should not be elevated so to avoid damage to the incisive nerves. Corrections and limited excisions may be done from the cartilaginous septum. Separation of the septal cartilage from the perpendicular plate, especially at the dorsal part, should not be performed because this area is important for the length and height of the nasal septum and nasal dorsum. Incisions or excisions should not be performed through the growing and supporting zones, especially at the sphenoethmoid dorsal zone. Conclusion Ifthere are severe breathing problems related to the septal deviation, septoplasty should be performed. In the majority of cases, septal surgery may be conducted in 6-year-old children. However, if necessary, septal surgery may be performed in younger children and even at birth.

Effervescence is defined as the evolution of gas bubbles from a liquid as a result of a chemical reaction. For medicinal use, effervescent tablets have specific characteristics that allow rapid adsorption of the intended drug. In this manner, a medication can be absorbed easily and effectively if it dissolves easily in water and is present at a sufficient dose. Common acids utilized for effervescent reactions are citric, malic, tartaric, adipic and fumaric acids. Citric acid is most commonly used for this application, which also adds a citrus-like taste to the products. Tartaric, adipic and fumaric acids are usually used in small amounts, due to their low water solubility. Effervescent tablets are used to simplify the handling of doses, provide optimal compatibility, promote superior and rapid absorption, increase a patient's liquid intake and circumvent the difficulty of swallowing large pills. This review defines effervescent tablets in terms of the technology and describes the advantages and disadvantages.

Background Aeroallergen immunotherapy (AIT) should be considered for patients who exhibit symptoms of allergic rhinitis (AR), rhinoconjunctivitis, and/or asthma after natural exposure to allergens and who also demonstrate specific immunoglobulin E antibodies against relevant allergens. Methods In this paper, clinical efficacy of immunotherapy in allergic rhinitis is reviewed. Result Subcutaneous allergen immunotherapy (SCIT) is effective for seasonal and perennial AR. Sustained effectiveness requires several years of treatment. SCIT may prevent the development of allergic asthma in children with AR. Sublingual allergen immunotherapy (SLIT) is currently considered an alternative treatment to the subcutaneous route. The use of SLIT has been included in international guidelines for the treatment of AR with or without conjunctivitis. Conclusion Patients treated with SCIT are at risk of both local and systemic adverse reactions; however, in most cases, symptoms are readily reversible if they are recognized early and treated promptly. The safety profile of SLIT is good; therefore, SLIT can be self-administered by patients in their homes. In this article, we reviewed the efficacy and safety of allergen immunotherapy.

Effervescence is defined as the evolution of gas bubbles from a liquid as a result of a chemical reaction. For medicinal use, effervescent tablets have specific characteristics that allow rapid adsorption of the intended drug. In this manner, a medication can be absorbed easily and effectively if it dissolves easily in water and is present at a sufficient dose. Common acids utilized for effervescent reactions are citric, malic, tartaric, adipic and fumaric acids. Citric acid is most commonly used for this application, which also adds a citrus-like taste to the products. Tartaric, adipic and fumaric acids are usually used in small amounts, due to their low water solubility. Effervescent tablets are used to simplify the handling of doses, provide optimal compatibility, promote superior and rapid absorption, increase a patient’s liquid intake and circumvent the difficulty of swallowing large pills. This review defines effervescent tablets in terms of the technology and describes the advantages and disadvantages.

INTRODUCTION:The correlations between the levels of cytokines, apnea, and obesity are not well understood. The aim of this study was to investigate the relationship between sleep apnea, body mass index (BMI) and plasma levels of leptin, ghrelin, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α).MATERIALS AND METHODS:Levels of leptin, ghrelin, IL-6, and TNF-α were compared in 20 obese (BMI > 30 kg/m²) and 6 non-obese patients (BMI < 27 kg/m²) with Obstructive Sleep Apnea Syndrome (OSAS), and in 13 obese and 11 non-obese control subjects without OSAS. All patients were investigated with Polysomnography (PSG) and ENT examination with flexible endoscopy and Müller's maneuver. Twelve patients were treated with continuous positive airway pressure (CPAP) and 14 with surgery. Fasting leptin, ghrelin and cytokine levels were measured at baseline, 2 days and 6 months after initiation of CPAP treatment, and 6 months after surgery.RESULTS:Leptin, ghrelin and cytokine levels did not change significantly from baseline after 2 days of CPAP. After 6 months of CPAP or surgery, leptin, IL-6, and TNF-α levels were decreased in all OSAS patients. No difference in ghrelin levels was observed.DISCUSSION:Elevated leptin levels are not determined by obesity alone, since they decreased with Apnea Hypopnea Index reduction. Higher pro-inflammatory cytokine basal levels observed in patients with OSAS were not correlated with BMI.

SUMMAry obstructive sleep apnoea syndrome (oSAS) is a disorder that leads to metabolic abnormalities and increased cardiovascular risk. The aim of this study was to identify early laboratory markers of cardiovascular disease through analysis of oxidative stress in normal subjects and patients with oSAS. A prospective study was designed to compare outcomes of oxidative stress laboratory tests in 20 adult patients with oSAS and a control group of 20 normal subjects. laboratory techniques for detecting and quantifying free radical damage must be targeted to assess the pro-oxidant component and the antioxidant in order to obtain an overall picture of oxidative balance. no statistical differences in age, sex distribution, or BMi were found between the two groups (p>0.05). There were significant differences in the apnoea/hypopnoea index (Ahi) between oSAS patients and the control group (p<0.05). Statistically significant differences in isoprostane, advanced oxidation protein products (A oPP) and non-protein bound iron (nPBi) levels were found between the study and control groups. no significant difference in the levels of thiol biomarkers was found between the two groups. The main finding of the present study was increased production of oxidative stress biomarkers in oSAS patients. The major difference between thiols and other oxidative stress biomarkers is that thiols are antioxidants, while the others are expressions of oxidative damage. The findings of the present study indicate that biomarkers of oxidative stress in oSAS may be used as a marker of upper airway obstructive episodes due to mechanical trauma, as well as a marker of hypoxaemia causing local oropharyngeal inflammation.

Objectives: Foreign body aspiration is a serious and preventable cause of morbidity and mortality in childhood. Considering that the type of foreign bodies varies depending on diet and custom of each population, the aim of the current paper is to present foreign body aspiration cases treated in three Argentinian pediatric hospitals and to emphasize the need for preventive strategies and necessity of increasing community and healthcare professionals’ knowledge about this problem.

A growing amount of scientific evidence suggests that herbal medicine may be helpful as an adjuvant treatment in rhinosinusitis. Herein, we systematically review and determine the role, efficacy and safety of phytotherapy in the treatment of acute and chronic rhinosinusitis and establish the qualities of herbal drugs as demonstrated by in vitro and in vivo experiments. Eligible studies published in English or German from January 1990 until June 2014 were identified via electronic database searches. Keywords were: sinusitis, phytotherapy, phytomedicine and herbal drugs. Additional studies were obtained through the references of selected articles. Twenty-two articles met inclusion criteria. Overall, the publications indicated that herbal medicines can have mucolytic, antiviral, antimicrobial, anti-inflammatory and secretolytic effects in experimental animals. Phytotherapy has also been found to be efficacious in reducing the symptoms of acute and chronic rhinosinusitis in children and the adult population in vivo, demonstrating a high level of tolerability and safety. Herbal products developed using phytoneering techniques have shown improvements in performance compared with previous formulations. The current literature suggests that phytotherapy is an effective and safe form of ancillary treatment for rhinosinusitis. In particular, herbal drugs made with the technique of phytoneering have proven effective in acute rhinosinusitis. Evidenze scientifiche, sempre più presenti in letterature, suggeriscono che la fitoterapia è utile come trattamento adiuvante della rinosinusite. Lo scopo principale del nostro lavoro è esaminare sistematicamente e determinare il ruolo, l'efficacia e la sicurezza della fitoterapia nel trattamento della rinosinusite acuta e cronica e stabilire le qualità farmacologiche dei fitofarmaci in vitro e in vivo. Sono stati identificati attraverso ricerche nelle banche dati elettroniche studi pubblicati in inglese o in tedesco da l gennaio 1990 al giugno 2014. Le parole chiave usate erano: sinusite, fitoterapia, fitomedicina e farmaci a base di erbe. Ulteriori studi sono stati ottenuti attraverso i riferimenti negli articoli selezionati. Ventidue articoli hanno incontrato i criteri di inclusione. Nel complesso, gli articoli analizzati indicano che i farmaci a base di erbe possono avere effetti mucolitici, antimicrobici, antivirali, proprietà anti-infiammatorie e secretolitiche in animali da esperimento. La fitoterapia risulta efficace nel ridurre i sintomi di rinosinusite acuta e cronica nei bambini e nella popolazione adulta in vivo, dimostrando un elevato livello di tollerabilità e sicurezza. Prodotti a base di erbe sviluppati con tecniche di "fitoingegneria" hanno mostrato miglioramenti in termini di prestazioni rispetto alle formulazioni precedenti. La letteratura corrente suggerisce che la fitoterapia è una forma efficace e sicura per il trattamento ancillare nella rinosinusite. In particolare i fitofarmaci realizzati con la tecnica di "fitoingegneria" si sono dimostrati efficaci nella rinosinusite acuta.

OBJECTIVES:The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children.METHODS:The study included 100 atopic children (52 boys, 48 girls) aged 5-9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed.RESULTS:The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 to Parietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference (P <0.01). Mean eosinophil cationic protein (ECP) values in the middle ear effusions of children who had undergone myringotomy were 251 ± 175.2 μg/L, and mean ECP blood values were 25.5 ± 16.3 μg/L, with significant differences (P < 0.001).CONCLUSION:There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms.

Background: Chronic rhinosinusitis (CRS) may be more frequent in patients with particular types of septal deformities. The aim of this article was to investigate the incidence of particular types of septal deformities in adult CRS patients and healthy volunteers in various countries to determine whether some of them are more frequent in those groups.Methods: This international multicentric study involved 505 subjects from five countries: Croatia, Romania, Italy, Russia, and Turkey. The types of septal deformities were observed and grouped according to the Mladina classification. Subjects were examined by means of native anterior rhinoscopy, anterior rhinoscopy after decongestion, and fiber endoscopy with topical anesthesia. CRS patients have been diagnostically proved by computed tomography scanning of the paranasal sinuses.Results: Considering the CRS patients, the prevalence of so-called vertical deformities (types 2, 3, and 4) was seen. Among them, type 3 deformity was found most frequently in Turkey, Croatia, Italy, and Romania.Conclusion: Type 3 deformity has been found frequently in CRS patients in all five of the countries. Russian subjects exhibited a high frequency of type 4 deformity. Because this type consists of types 2 and 3, the later, again, has been proven to be prevalent in CRS patients also in this group of patients.

A potential consequence of exposure to noise is a temporary reduction in auditory sensitivity known as temporary threshold shift (TTS), which mainly depends on the intensity and duration of exposure to the noise. Recovery time is related to the amount of initial hearing loss, and the most recovery takes place during the first 15 min following exposure. This study evaluated the efficacy in otoprotection against noise-induced hearing loss of an orally administrated food supplement containing coenzyme Q 10 -Ter. This water-soluble formulation of coenzyme Q 10 shows better bioavailability than the native form and has been found to have a protective effect on outer hair cells after exposure to noise in animal models. Thirty volunteers were enrolled, and the right ear of each subject was exposed to a narrow-band noise centered at 3 kHz for 10 min at the intensity of 90 dB HL. In the 30 subjects enrolled, TTS was evaluated after 2, 15, and 30 min and the recovery time was recorded in each subject. The longest recovery time was 45 min. Among the 18 subjects who underwent a second test after treatment with Q-Ter, the mean recovery time was 31.43 min. The results of the present study show that 30 days' treatment with Q-Ter can aid faster recovery after exposure to noise (P < 0.0001). The reduction in the recovery time following treatment can be explained by Q-Ter-mediated improvement of the outer hair cells' response to oxidative stress.

The correlation between middle ear pathology and nasal allergy has been debated for almost 30 years. This study aimed to evaluate the relationship between otitis media with effusion (OME) and persistent allergic rhinitis symptoms versus intermittent rhinitis in children.The study included 100 atopic children (52 boys, 48 girls) aged 5-9 years with otological symptoms who were patients of the University of Siena Hospital, Italy. Ear, nose and throat evaluations, tympanometry, skin prick tests (SPTs), mucociliary transport time (MCTt) and Eustachian tube function tests were performed.The SPTs revealed 50 children sensitised to Dermatophagoides pteronyssinus, 34 to grass pollen and 16 to Parietaria. Of all patients, mild symptoms were intermittent in 19 children and persistent in 18; moderate/severe symptoms were intermittent in 22 and persistent in 41. Tubal dysfunction was present in 25 children, whereas middle ear effusion was present in 45 children undergoing myringotomy. The MCTt was slower in the persistent group (21 ± 2 mins) versus the intermittent group (16 ± 2 mins) with a significant difference (P <0.01). Mean eosinophil cationic protein (ECP) values in the middle ear effusions of children who had undergone myringotomy were 251 ± 175.2 μg/L, and mean ECP blood values were 25.5 ± 16.3 μg/L, with significant differences (P < 0.001).There was a significant association between OME, delayed MCTt, ECP values in middle ear effusion and persistent symptoms of allergic rhinitis. These results suggest a direct involvement of the middle ear mucosa as a target organ in persistent forms.

AIM:The main aim of this study was to assess the presence of behavioural disturbances in child with OSAS before and after adenotonsillectomy (AT).BACKGROUND:In children adenotonsillar hypertrophy is associated with increased probability of OSAS. Children with OSAS present neurobehavioral disorders like attention deficit and hyperactivity, learning disabilities and daily attitudes due to excessive sleepiness.MATERIALS AND METHODS:195 consecutive young patients suffering from OSAS and recurrent throat infections (control group) underwent AT. All underwent clinical evaluation, polysomnography, Behaviour Assessment System for Children questionnaire (BASC-2), for parents evaluation of behavioural disturbances and nasal functionality tests (before and 6 months after surgery).RESULTS:Snoring and nocturnal apnoea were no more present in almost all. In OSAS group before AT 12 children were normal, 4 children were borderline and 2 were clinically significant at the BASC-2. After AT 16 children were normal, 2 children were borderline and none was clinically significant according to the same questionnaire. In the control group 9 children were normal and 1 was borderline both before and after AT.CONCLUSION:Adenoids/tonsils hypertrophy and nasal hypoventilation are frequent causes of snoring and OSAS. AT improves significantly both snoring/apnoeas and OSAS children's behavioural disturbances. Polysomnography cannot be carried out routinely due to the lack of specialised centres and because of its excessive cost. Nasal functionality tests can be useful for the differential diagnosis between sleep apnoea syndrome and other noises.

Nasal obstruction is a primary symptom of common upper respiratory tract disorders. In clinical practice nasal saline solutions are recommended for the cleansing of nasal cavities and relieving nasal symptoms.