Hospital Practice

ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20

Pediatric Otolaryngologic Crises Werner D. Chasin To cite this article: Werner D. Chasin (1977) Pediatric Otolaryngologic Crises, Hospital Practice, 12:3, 89-102, DOI: 10.1080/21548331.1977.11707097 To link to this article: http://dx.doi.org/10.1080/21548331.1977.11707097

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Date: 08 August 2017, At: 05:50

Pediatric Otolaryngologic Crises WERNER D. CHASIN

Downloaded by [Australian Catholic University] at 05:50 08 August 2017

Tufts-New England Medical Cent er

In the second article on pediatric otolaryngology, speed of diagnosis is stressed as vital to prevent permanent aftereffects such as deafness or facial paralysis. Aggressive education of parents in preventing emergencies is recommended.

Some otolaryngologic emergencies in children reflect sudden and unforeseen events; others surface suddenly after a period of insidious development. Either way, effective treatment is possible in most cases, provided the first physician who sees the patient recognizes the urgency of the situation and takes appropriate action. To do so, he must anticipate the emergency potential in a variety of disorders. Accordingly, this second article on pediatric otolaryngology will be directed to emergencies that arise with some frequency in the age group concerned. As in last month's article, I would emphasize at the outset the importance of accurate clinical diagnosis. It is absolutely imperative when a true emergency exists. Let us start with the newborn infant in immediate trouble because of choanal atresia. If unilateral, this congenital anomaly interferes little with feeding and breathing, but unfortunately it is more likely to be bilateral, presenting as a life-threatening emergency shortly after birth. Many cases appear lost to the records, partly because of diagnostic error and delay; even so, bilateral choana} atresia is recognized as one of the important causes of preventable infant death. The generally accepted etiology is failure of resorption of the plate that remains at the junction of the nasal passage and the nasopharyngeal space. As a result, a bony (sometimes membranous) partition remains to separate the nose from the nasopharynx. This atretic plate is of variable thickness. It prevents the newborn infant from breathing through the nose, and the infant rapidly becomes cyanotic and dyspneic; the struggle to breathe is manifested by chest retractions and flaring of the nasal alae. Transient relief is obtained only when the infant cries, be-

cause this forces his mouth open. Newborn babies, it must be remembered, are obligatory nose-breathers, lacking the neurologic maturity to coordinate swallowing and mouth-breathing. Thus the victim of bilateral choana! atresia is in desperate straits, since he is unable to overcome nasal obstruction by voluntarily opening his mouth.

Choanal atresia must be considered in any newborn manifesting respiratory obstruction. A simple test attempting passage of a soft nasal catheter through each nostril into the nasopharynx - can be used to establish a tentative diagnosis or to exclude the possibility. Care must be taken in passing the catheter lest it become caught in the turbinates or against the nasopharyngeal vault and give a false impression of choana! atresia. The diagnosis can be verified by requesting the radiologist to perform a choanogram that demonstrates posterior nasal obstruction. For this study, contrast material is instilled into the nose with the patient lying supine; a lateral x-ray of the head is then obtained to see whether contrast material trickles into the nasopharynx as it would in a normal infant. The immediate priority in treatment is to open an airway. Ingenious approaches have included use of a plastic oropharyngeal tube taped inside the mouth to effect mouth-breathing, or an ordinary rubber nipple, the opening of which has been enlarged suffi-

Dr. Chasin is Professor and Chairman of Otolaryngology, Tufts University School of Medicine, and Otolaryngologist-in-Chief, Tufts-New England Medical Center Hospital, Boston.

Hospital Practice March 1977

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Pediatric otolaryngologic crises.

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