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Având în vedere rata crescută a morbidităţii şi mortalităţii tra­heotomiei la copil, se consideră o intervenţie chirurgicală di­fi­cilă. În lucrare se prezintă managementul şi dificultăţile tehnice ale traheotomiei pediatrice.

Material şi metodă. În Clinica ORL Ti­mi­şoa­ra, în perioadaau fost efectuate 18 traheotomii la co­pii cu vârsta cuprinsă între 1 și 15 ani.

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Indicaţiile traheotomiilor au fost pentru obstrucţie de căi aeriene superioare, ventilaţie asistată sau toaletă pulmonară. Au fost utilizate diferite tipuri de canule tra­he­ale.

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Alegerea canulelor trebuie să ţină cont de indicaţia tra­heo­to­miei. Canula ideală trebuie să fie din silicon, laryngeal papillomatosis ct de curăţat şi dis­po­nibilă în diferite dimensiuni. Toate traheotomiile au fost efectuate pe incizie cervicală inferioară orizontală. S-a utilizat anes­te­zia generală cu sondă de intubaţie orotraheală, regiunea cer­vi­cală fiind în hiperextensie. Complicaţiile intraoperatorii au fost minime: uşoa­re hemoragii şi probleme cu canulele traheale.

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Complicaţiile post­ope­ratorii s-au manifestat ca: decanulare accidentală, emfizem sub­cutanat, dificultăţi de alimentaţie, infecţie. Tra­heo­to­mia este considerată o intervenţie cu risc vital, neavând con­traindicaţii absolute. Este o intervenţie dificilă din cauza par­ti­cu­larităţilor anatomice la aceste vârste. Traheotomia ar trebui efec­tuată în situaţii controlate cu intubaţie orotraheală pe laryngeal papillomatosis ct sau bron­hoscop.

Cuvinte-cheie: traheotomie, copil, canulă, complicaţii Eustachian tube causes Adriana Neagoş MD, PhD, University of Medicine and Pharmacy Târgu-Mureş, Otorhinolringology Department, Târgu-Mureş, Romania Eustachian laryngeal papillomatosis ct is an important source of middle ear pathogenesis and has been linked to causing middle ear and mastoid aeration pathology.

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It can appear alone or in association with other factors as sinusitis and epipharingeal tumours. Otitis media with effusion is the most frequent pathology that appears after Eustachian tube disfunction.

The tympanic membrane retraction is one of objective symptomathology. Many causes of Eustachian tube function and dysfunction are described in the literature including cleft palate, surfactants, tympanic membrane athelectasis, and long term middle ear ventilation. The epidemiological studies illustrated that poor Eustachian tube function plays a major role in laryngeal papillomatosis ct pathogenesis of otits media, so it is very important to have a good function of the tube before and after a surgical procedures.

Evaluation of hearing results demonstrates that preoperative and postoperative tubal function is important for a good surgical outcome in case of laryngeal papillomatosis ct otitis media and cholesteatoma. In children the Eustachian tube dysfunction evaluated by impedance audiometer is important laryngeal papillomatosis ct document neutralization of positive and negative middle ear pressures.

This can be the explanation that Eustachian tube is an essential part of the pressure regulating system of the middle ear. The physiologic function of the tube is to equalize the pressure from the middle ear with the atmosphere.

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The Eustachian tube closing failure and the induction of negative middle ear pressure are important factors in the development of chronic ear disease. Pediatric Resident doctor First described indeafness caused by congenital cyto­me­ga­lo­virus infection - a major problem of public health - is today the most frequent cause of sensorineural deafness in children.

The pre­valence of congenital cytomegalovirus infection is between 0.

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Diagnosis of congenital cytomegalovirus in­fection is possible if the virus is isolated during the first 3 weeks of life or if the serum IgM antibodies are found at birth or shortly af­ter birth.

Deafness caused by cy­to­megalovirus infection can be progressive or with late onset at pre­schoolers or in the first years of schoolrequiring more frequent audio­logy monitoring at birth, at 3, 6, 9, 12, 18, 24, 30, and 36 months and annually until school age in order to detect and to treat deaf­ness. Pathophysiology of deafness caused by laryngeal papillomatosis ct infec­tion is not completely understood impaired endolymphatic struc­tures, cytopathic effect of the virus, host immune response to the inner ear structures.

Hearing loss can be unilateral frequency of kHz or bilateral, and varies from medium to severe.

Laryngeal papillomatosis in neonates

Hearing im­pair­ment has an impact on social and cognitive development of the child and his family, acquisition of speech being often delayed. The risk of permanent sequelae in case of symptomatic infection is higher in children from mothers suffering of primary infection, but disabilities were observed also in children from mothers with non-primary infections.

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In children with asymptomatic congenital cy­to­megalovirus infection, increased virulence in the first month of life is associated with sensorineural deafness. Balance problems invol­ving acoustic nerve should be taken in consideration in children with sensorineural deafness. The relation between high viral charge in infants and deafness probability suggests the role of antiviral the­rapy in decreasing the incidence and the severity of deafness caused by cytomegalovirus.

Oral Laryngeal papillomatosis ct represents today an al­ter­native to Ganciclovir, priory used intravenous. Valganciclovir has adverse ef­fects neutropeniathus the decision to initiate the anti­viral therapy is difficult to make.

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Cochlear implant is efficient in case of se­vere deafness in children with congenital cytomegalovirus infec­tion, but the evolution depends on associated psycho-neurological ma­nifestations. Keywords: infection, cytomegalovirus, deafness, child Difficulties in the diagnosis of hearing loss in children Raluca Enache ENT Sarafoleanu Medical Clinic, Bucharest, Romania Hearing represents an important social and cognitive function, the hear­ing loss being an important health problem worldwide.

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Hy­po­a­cusis is a common pathology found in both adults and children. Given these implications, the diagnosis of hearing loss in children must be done correctly and ra­pidly. The assessment of the auditory function is indicated in patients with subjective complaints and in those laryngeal papillomatosis ct belong to groups supposed to be at risk for a hearing loss.

Paediatric population is part of the se­cond group, children being unable to report deafness occurrence.

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Keywords: hypoacusis, audiometric evaluation, children Evaluarea beneficiului auditiv la pacienţii cu implant cohlear Mădălina Georgescu1,2, Magda Cernea2,3 1. Surditatea bilaterală in­sta­lată în primii doi ani de viață determină instalarea unui al doilea han­dicap senzorial - mutitatea, asociere care impietează laryngeal papillomatosis ct asupra dez­voltării ulterioare a copilului pe multiple planuri: educațional, social și economic.

Soluția terapeutică adecvată pentru pacienții surzi este re­pre­zentată de implantul cohlear, dispozitiv medical semiimplantabil, care per­mite stimularea directă a nervului auditiv și, în consecință, audiția. Eva­luarea beneficiului auditiv al implantului cohlear nu trebuie să se li­mi­teze la evaluarea pacienților implantați prin audiogramă tonală, ci, obli­gatoriu, prin audiogramă vocală, singura în măsură să redea nivelul abilitării auditive în toată complexitatea sa.