Hoarseness and gastroesophageal reflux in children.
Gumpert L. Kalach N. Dupont C. Contencin P.
Department of Oto-rhino-laryngology, Hopital Saint Vincent de Paul, Faculte Cochin Paris, France.
The importance of a hoarse voice or voice change in children has not been stressed in the literature in the same way as it has been in adults. We present 21 children who had been suffering from chronic hoarseness for more than three months and had on fibre-optic laryngoscopy findings suggestive of gastroesophageal reflux. None of them had complained of gastroesophageal symptoms. Twenty-four hour pH monitoring revealed that 13 (62 per cent) of these children had gastroesophageal reflux, seven (33 per cent) having gastroesophageal reflux more than three times the upper limit of normal. The pH graphs highlighted frequent refluxes, ranging from 0.4 to 37.4 refluxes per hour (median of 7.3 refluxes/hour). The majority of these refluxes occurred when the child was awake as opposed to asleep, with a median of 14.8 refluxes/hour and 0.9 refluxes/hour respectively (p = 0.0009). The refluxes were classically of short duration. This study suggests that gastroesophageal reflux plays a direct role in the pathogenesis of chronic laryngitis and hoarseness in children.
An unusual complication of chemotherapy: an abscess in the pterygopalatine fossa.
Lale AM. Jani PJ. Ellis PD.
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK.
Abscesses of the pterygopalatine fossa are extremely rare. The cases reported in the literature are all secondary to dental or periodontal disease. We present a case of an abscess in this site which was a complication of chemotherapy and was the result of haematogenous spread.
Adenocarcinoma of the larynx--a distant metastasis from a rectal primary.
Hilger AW. Prichard AJ. Jones T.
Department of Otolaryngology/Head and Neck Surgery, Eye, Ear and Throat Hospital, Royal Shrewsbury Hospital, UK.
Laryngeal metastases from remote primary tumours are uncommon. They derive mostly from melanomas or renal cell carcinomas. The generally rare laryngeal adenocarcinomas can only be classified as metastatic tumours in the presence of a distant primary of the same histology. Only five cases of a laryngeal secondary originating from adenocarcinoma of the large bowel have been reported in the world literature. A further case is presented which to our knowledge is the first to arise from the rectum, a site which suggests haematogenous tumour spread. This paper emphasizes the need for the search of synchronous metastatic disease and discusses the therapeutic options on the grounds of current management of singular colorectal secondaries.